Sunday, March 2, 2008

News & Observer on MH "reform": One week of articles, editorials, letters & Q comments

News & Observer investigative series on “Mental Disorder: The Failure of Mental Health Reform.”
http://www.newsobserver.com/news/health_science/mental_health/

Sunday, 3/2/08: "Patients die from neglect, restraint"

Patients die from poor care; families don't hear full story http://www.newsobserver.com/2771/story/976809.html

(also, links to documents on the Janella Wilson & Delores Franklin deaths can be found on this page)

"Law requires notice of deaths, but not all comply: Reports missing on 165 patients" http://www.newsobserver.com/2771/story/976645.html

Sunday Q section: "What do we do now?" http://www.newsobserver.com/2771/story/976757.html

DHHS Secretary Dempsey Benton http://www.newsobserver.com/news/q/story/976751.html

NCPA President Harold Carmel, MD http://www.newsobserver.com/news/q/story/976753.html

Disability Rights NC Exec. Director Vicki Smith http://www.newsobserver.com/news/q/story/976726.html

NC Med Soc. Immed. Past President Darlyne Menscer, MD http://www.newsobserver.com/news/q/story/976698.html

Joe Morrissey PhD (UNC), Marvin Swartz, MD (Duke) http://www.newsobserver.com/news/q/story/976719.html

Chief District Court Judge Joe Buckner (Orange/Chatham) http://www.newsobserver.com/news/q/story/976723.html

http://www.newsobserver.com/2771/story/975426.html

"Employees of mental hospitals disciplined for abuse, neglect" http://www.newsobserver.com/2771/story/975424.html

"Crowded hospitals turn patients away: Outpatient care falls short of need" http://www.newsobserver.com/2771/story/975419.html

"Video cameras can deter abuse, advocates say" http://www.newsobserver.com/2771/story/975417.html

CLICK ON "EXPLORE ABUSE DATA" HERE: http://www.newsobserver.com/1181/story/958236.html

LETTERS:

http://www.newsobserver.com/opinion/letters/story/975236.html http://www.newsobserver.com/opinion/letters/story/975246.html http://www.newsobserver.com/opinion/letters/story/975239.html

http://www.newsobserver.com/opinion/letters/story/975240.html

http://www.newsobserver.com/opinion/letters/story/975237.html

http://www.newsobserver.com/opinion/letters/story/975241.html

http://www.newsobserver.com/opinion/letters/story/975238.html

Friday Editorial (2/29/08): Repairing 'reform' 'http://www.newsobserver.com/print/friday/opinion/story/973317.html

Thursday (2/28/08) : "With reforms, serious therapy fades"

http://www.newsobserver.com/front/story/971029.html

You can view spending, by county, here: http://www.newsobserver.com/1181/story/958236.html

Wednesday editorials (2/27/08):

"Mental errors. . . the system is in shambles": http://www.newsobserver.com/opinion/editorials/story/968292.html

"Blame to go around": http://www.newsobserver.com/opinion/editorials/story/968291.html

Tuesday (2/26/08): "The door opens and companies rush in"
Main story:
http://www.newsobserver.com/front/story/965714.html

Community support can help if done right:
http://www.newsobserver.com/2771/story/965581.html

State clamps down on claims:
http://www.newsobserver.com/2771/story/965568.html

Day 1 (Sunday, 2/24/08): "Reform wastes millions, fails mentally ill"
Main article:
http://www.newsobserver.com/2771/story/962049.html

Video: http://www.newsobserver.com/1181/story/958236.html

Saturday, March 1, 2008

Fixing NC's Mental Health System: Public Comment Remarks to the Legislative Oversight Committee (LOC)

Submitted by: Debra G. Dihoff, MA, Executive Director, NAMI NC

The News & Observer has condensed the miseries of the last seven years of reform into a succinct five part series. The good thing is we can now admit what isn’t working and we can begin to do something about it. The assumption that complete privatization in the complicated health care arena would make things better and cheaper has been proven false.

Let’s seize the moment to move forward. I challenge you to adopt a goal- let’s be in the top ten states in the nation in mental health services, not 43rd in the nation in per capita spending.

How do we do this?

1.Leadership – We have an opportunity right now for new leadership to get a team, establish a goal, and get everyone moving in the same direction. Leadership must be clear on who does what.

2.Restore the public safety net- it’s time to fix what isn’t working. Put the service coordination, case management, linkage function back into the public sector. Data shows that discharges from our state hospitals have rising numbers of people going to shelters- there is no one to link them back to the community; we haven’t said whose job it is to do that, nor have we planned for a way to get paid. Let LMEs run community based walk in crisis facilities/clinics. Like Dr. McLellan said to you in October, require that providers also serve the non Medicaid people, and that they not be allowed to pick and choose.

3.Incentive the right treatments– Fund start up for the things we know work like ACTT teams, Multisystemic therapy (MST), intensive in home, psychoeducational programs that involve families in treatment, Supported Employment. Make rates that actually pay for the service. Give bonuses to providers who achieve outcomes like reduction of hospital days through receiving the right service mix in the first place. Realign hospital dollars to the local people to purchase care locally, which incentives the building of a local response system. Fund peer support services, using the Deficit Reduction Act provision, which gives jobs to people living with mental illness, who are effective, and at a cost less than half that of the community support rate.

4.Simplify getting the money out and get more money out NC still ranks 43rd per capita, we need more money in the right places. Since we’re in crisis mode, we need to cut through the red tape and get it out there quickly and easily. We need one IT system, one billing/authorization protocol. Let’s not spend 6 of l0 dollars on documentation rather than service delivery. We need to fund community inflationary needs. The legislature takes care of the psychiatric hospitals, and does excellent planning for their capital needs. Yet communities have enormous needs as well – where are those lists? Let’s provide ongoing inflationary increases where the system most needs stabilization- in the community

The people in North Carolina who are living with a mental illness are counting on their elected representatives to make the fixes that are necessary in statute when the session resumes May l3, 2008

Welcome to the new DMH co-directors

Yesterday, Secretary Benton announced his appointment of Mike Lancaster, MD and Leza Wainwright as co-directors of DMH. http://www.ncdhhs.gov/pressrel/2008/2008-2-29-new-management-mhddsas.htm

It would have been very hard for the Secretary to find someone from outside DMH to take the job (or jobs), in the last year of a gubernatorial administration. And, given the Secretary's efforts overall, which we must view positively, we want to support him even when he makes difficult decisions. At a time when many would desire new leadership for DMH, the new co-directors are closely identified with the failures of mental health "reform."

I think it is reasonable to point out that, in view of their record, the new co-directors have a certain burden of proof to meet. They have an opportunity here. They may signal that they view this as a new situation, with a new boss committed to change; that they are learning the lessons so forcefully publicized by the N&O this past week; and that like the Secretary they will include outsiders with different views in their decision-making. I think we would all welcome that.

Easley & the mentally ill: Easley Administration 2/27 response to criticism in Charlotte Observer

Easley and the mentally ill

Editorials implying governor didn't act are `flat wrong,' a top aide says

From Dan Gerlach, Gov. Mike Easley's senior policy adviser for fiscal affairs:

While editorials in your newspaper (Feb. 26, "Playing with lives") and others have been busy engaging in finger pointing to blame the current problems in our state's mental health system, rest assured that Gov. Mike Easley and his administration have been working to make sure it gets fixed.

It is clear that the rapid change in the mental health system led to problems, no doubt. But to insinuate that nothing has been done, or that these problems were ignored, is flat wrong. Regardless of what has happened in the past, we want to remain focused on solving problems for those in need of services. Consider the following:

• In 2006, Gov. Easley recommended, and the General Assembly supported, almost $100 million in additional funding to support the mental health system, including the replacement of lost federal funds for the developmentally disabled.

• This year, the governor ordered additional resources be made available to keep a state presence at Dix Hospital in conjunction with Wake County.

• Last year, the state Department of Health and Human Services and the administration recognized that some mental health community service providers were exploiting the system, inflating charges and wasting tax dollars. I informed the reporter in an interview that the governor demanded that the department take immediate action to audit the finances and practices of providers, adjust rates in cooperation with responsible providers, open fraud investigations, and toughen criteria for would-be providers and to screen inappropriate service requests. These changes started in early 2007, as soon as it became apparent that community support was open to abuse.

• In May 2007, Gov. Easley designated Dempsey Benton to be the state Secretary of Health and Human Services and specifically directed him to produce a set of proposals that will bring effectiveness and accountability to the state's mental health system. Secretary Benton has taken numerous steps to strengthen hospital oversight, involve independent experts and advocates, and increase accountability. The secretary's hard work has been uniformly welcomed.

Gov. Easley and Secretary Benton will soon recommend further initiatives to improve our mental health services for the General Assembly's consideration in May. More needs to be done.

Your editorial implies a lack of compassion and action for the mentally ill. This is false, as the above illustrations show.

Dan Barkin, N&O 3/1: Series touches a nerve

Our stories this week on the problems of the state's mental-health system tapped into an intense public policy debate that has been going on since the state decide to "reform" the system earlier this decade.

That's my conclusion after looking at the forum at share.triangle.com/mentaldisorder.

You get the feeling from reading the remarkably detailed posts that we stepped into a vast hall full of people who have been arguing vociferously about the mental-health system: State and local government employees, mental-health providers, families, academics. It is a debate that doesn't typically get as much attention, say, as school reassignment. And if you aren't steeped in the details of the system, you may need a glossary to keep up.

What has struck me about the forum is the length and the thought that has gone into the posts, which had drawn more than 5,900 views from people who clicked on them as of Friday afternoon. One of the headlines on a post was the poignant "I can't take it anymore," written by the mother of an ADHD and bipolar son. On my desk, I have a stack of the posts, printed out. Some of the comments run for several pages. Here are some of the points that have been made.

* There's too much red tape in the system. Forms and more forms. One provider says one form has changed five times, and each time it changes, 400 employees need to be trained in how to fill it out.

* State mental hospitals are unsafe places to work, according to front-line employees. As the state has come under increasing pressure to reduce the incidence of patient injuries, some workers say that their safety is a secondary concern.

* The state hasn't provided enough training for service providers.

* North Carolina should look at states that do a good job of providing mental health services and copy their practices.

* As bad as things might be for the mentally ill in urban areas, those in rural areas have a harder time getting access to services.

Some of the most useful insights in fixing the system come from parents, siblings and children of the mentally ill, because they live with the challenges of caring for a loved one.

A number of the most compelling posts in the forum come from moms and dads detailing how the system has let their children down, how their kids bounced in and out of short stays in institutions and, in one case, wound up on the streets. One woman worries that her daughter, who has attempted suicide, will not live to see 30.

These are painful -- but incredibly informative -- to read. One suggestion that was made: Anyone in a senior policymaking position (like a governor, lawmaker, Cabinet secretary) should get involved with a family trying to get services for a suicidal spouse, or an anorexic child, or a schizophrenic sibling. See firsthand what that experience is like, and then design a system that would make sense for these cases.

It is traditional in a column such as this to say something like, "This forum would make useful reading for candidates running in this year's election." And it would.

I am realistic enough to know, however, that seldom do candidates see much political upside in vowing to provide better services to the mentally ill. Typically, you'll see candidates promising to fill more prisons.

Now, no one who knows me would ever say that I am soft on crime. But I was impressed by one point made in the forum: It is wiser to provide good mental- health services early on so we can avoid having to keep building costly correctional facilities for the many prisoners who are mentally ill.

That strikes me as something a smart politician could run on.

dan.barkin@newsobserver.com or (919) 829-4562

NCMentalHealthVote