Notes from WUNC-TV's Governor Candidate Healthcare Forum

WUNC-TV hosted a forum for gubernatorial candidates on Thursday, Feb 7. that focused on health care. I watched the forum on-line (http://www.unctv.org/gubernatorial/health.html) this weekend and I thought I’d summarize what the candidates said. Almost every candidate, Republican and Democratic, recognized that the mental health care system in North Carolina is a mess, which was great to see. For the most part, they touched on the important problems - lack of a safety net, lack of leadership, a wasteful bureaucracy, the need for more funding, the need for local hospitals to provide psychiatric beds, the need to give more control to local providers, and the costs being shifted to police and sheriff departments, courts and prisons. To varying degrees they offered plans to fix the system. Of course, two minutes in a debate does limit a candidate’s ability to provide details, and the devil is in the details. I hope that each candidate will continue to tell us how they will fix the system. But recognizing the problem is the first big step (I’m sounding like a psychiatrist!), and we have to glad that the candidates for governor have done that.

The question was: “The Department of Health and Human Services secretary wants to completely overhaul our state's mental health system, how should the state’s mental health system be structured?”

Beverly Perdue said that the MH system was in a “real challenging state”, that there were challenges in finding community care and institutional placement. She proposed using the Community Care model for Medicaid recipients in the mental health system, so that there would be a mental health clinical home – with a “cadre” of mental health care providers that will provide excellent care.

Richard Moore said that the mental health system is an illustration about “why people get so upset with government”, and that “no one wants to defend what has happened”. He stated it was a system that was “not serving anyone as well as it could” and is “wasting millions and millions of dollars”. He stressed that accountability and strong management was critical for improving the system.

Pat McCrory said that mental health was a “difficult issue” and noted that the recent addition of mental health coverage to medical insurance runs the risk of making insurance too expensive and driving more people to Medicaid. He stated that future mandates should be stopped. Noting “good trends” in the mental health system in Mecklenberg County, he stressed transferring control to the local level as opposed to the centralized bureaucracy.

Bob Orr pointed out that while the mental health system in Charlotte may be working, it was not working in the rest of the state and called it “an absolute disaster.” He noted the recent announcement that the major provider of psychiatric care in Orange-Person-Chatam counties was closing, and that there was no safety net. He stated that this closure was due to poor reimbursement. He also noted that the state was losing community psychiatrists and other care providers because of the chaos in the system. He stressed that a safety net should be provided offering quality care, and that money should be put back into the Mental Health Trust Fund. He also noted that the system should be ready to provide care to returning veterans.

Fred Smith said the mental health system was “in crisis”, that there had been a rush to implement mental health reform and that many “poor decisions” had been made. He noted that there is inconsistent care across the state and “in some cases, no care”. He offered a new strategic plan that gave clear responsibility to local providers and called on local hospitals to provide crisis services.

Bill Graham said that the mental health care system was a “disaster” and was “broken”. He noted that the failure of the mental health care system has caused people to end up in the courts, and has created a burden on the police. It also creates problems in families as well. He called for reimbursements to be restored to local providers and asked the Division of Mental health to stop “changing the rules every other week” so that providers could function.