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
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2 comments:
Two things I have learned in recovery from mental illness and addiction:
1) You must admit there is a problem.
2) You must take personal responsibility to solve the problem.
I have seen no one willing at the Division to do this!! There is lots of blaming of others but know personal accountability on behalf of any one at the level of the Division, the Dept., or the Govenor's office.
While, I think it is a shame that some private providers have milked the system but I think we are missing the focus. It is private businesses job to make money!! That's what they do. Can they truly be blamed for doing what they do best? Even non-profits must make money in order to survive and therefore must provide those services on which this is possible.
The problem is that privatizing services is not the best way to ensure that everyone will receive needed services, expecially those individuals who lack the ability to pay and those services which are not in someone profitable---these being the people most needed served and the services most needed.
Until someone in leadership is willing to first admit that reform is not working in its current form and take some personal responsibility for making changes. Nothing will change.
Our Division is in need of recovery!! The first step is admiting that there is a problem.
i'm ann
"It's not the providers fault the system is like it is it's the state and county, the new system with lme and no letters of support for new business opportunities leave consumers forced deal with business they don't want to and accept poor services from agencies because this is all that's available ! This is suppose to be a Free Enteprise system yet more and more it appears it's anything but. Anyone who was getting paid $ 65.00 and hr. to take Johnny to Walmart would be stupid not to take Johnny to Walmart. I think we all know the providers didn't set these rate of pay or the system which allowed this to happen in the first place. Much needed services have been done away with because the state sent letters to the LME'S saying not to issue letters of support and back around Nov. not to give out any more Endorsements. So for any providers who lost or was denied any one of these now you know why. Where has all the MONEY for gone? The services are NOT being offered that out tax dollars where suppose to be paying for. To make this worse is the current system dosen't even provide for any new or better services to be offered !!
I wonder how many needy people are sitting home with no substance abuse services, no dayprograms to attend etc. it's a proven fact these services KEEP people out of hospitals and jails and off the street, but these services are not even being offered or approved by LME'S because the state stopped the letters of support requried to open NEW BUSINESS! We MUST ALL SPEAK OUT AND DEMAND THIS STOP NOW.
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