Bev Perdue on mental health

From her website - 4/18/08 - http://bevperdue.com/release_details.asp?id=1070

We need to get serious about the goal of quality health care for all North Carolinians – and that must include mental health care.

Thousands of our fellow citizens struggle everyday with mental health concerns. North Carolinians who face mental illness, developmental disabilities, and substance abuse issues as well as their families deserve our staunch support in dealing with their challenges.

My background in health care tells me that it makes no sense to separate mental from physical health care. The best research confirms that many patients have mixed mental and physical health issues. Thus I am proud that my plan for expanding health care coverage to all children and more low-wage working parents has been praised by such leading advocates as Adam Searing of the North Carolina Health Access Coalition for containing "the most significant changes in health care access in North Carolina in, quite literally, decades." To read more, go to bevperdue.com/healthcare.

Specifically in the mental health arena, my priorities include the following:

1) Extend Community Care model to mental health

North Carolina's Medicaid program has recently moved to the forefront in emphasizing the importance of a "medical home" for the primary care of adults and children. Our Community Care of North Carolina has developed a very cost-effective and quality-driven model of statewide case management through health care community networks. As Governor, I will extend this kind of collaboration and community network to the delivery of mental health services. Every person served by the mental health system should have the benefit of strong and effective case management to maximize treatment and service plans. In my view, the concept of a medical home should play a major role in helping to revitalize our badly tattered mental health system, for Medicaid recipients and others served by the system as well.

As North Carolina's next Governor, I also want to establish the national model for an integrated approach to behavioral and primary health services for patients with mental health, development disability, and substance abuse problems. One of my top goals will be to break down the barriers to the coordination of mental and physical health care.

2) Establish a “safety net” for those in need

We must also develop a basic safety-net which those in need of mental health services will have available to them. These core elements will provide a strong foundation for a true community-based system of care. Today there are just too many opportunities for people in need to fall between the cracks.

The quality and degree of care cannot be dictated by zip code. That is why I will take such immediate steps as expansion of the Office of Rural Health's loan forgiveness initiative to place more mental health professionals in the rural parts of North Carolina where they are desperately needed. This kind of state incentive can make a huge difference in the choices young students and professionals make when they are considering careers in mental health. As chair of our state's Health and Wellness Trust Fund, I have already developed an innovative loan assistance initiative to help our rural hospitals modernize and provide more up-to-date services across the board. Modernizing hospitals as well as attracting new health care providers will represent significant boosts to economic development in our small towns and surrounding rural areas, while at the same time enhancing the level of care for some of our most vulnerable citizens.

I know that we cannot neglect the need for strong in-patient services. To the extent possible, these services should also be community-based, close to home, family, and other resources. But the state cannot walk away from its obligations. If needed services are absent in a local area due to a lack of private providers, we must work to put them into place through public facilities.

3) Overhaul system to focus on outcomes

The state's overall approach to planning and implementation in mental health care must also be overhauled. We need a fundamental shift to a focus on outcomes – setting high program and service standards and then clearly stating what results we can and should expect while setting up the conditions most likely to achieve the best possible outcome for each person.

One way we can foster the highest quality services is to actively promote the best practices in the field. My vision is for the state to develop centers of excellence within our colleges and universities to advance evidence-based models and continue to build capacity for high-quality services across the state. Through these evidence-based models we can point the way to more effective and efficient services. We can also better support the ongoing training and development of our professionals who work in the fields of mental illness, developmental disabilities, and substance abuse services.

I know that changing mental health care in North Carolina is something far more easily said than done. Yet we cannot stop until we have a system that achieves access to high-quality mental health, developmental disability, and substance abuse services for all North Carolinians. We certainly need better funding. Our low standing in the National Alliance on Mental Illness' rankings of expenditures per capita is inexcusable. But funding is only one piece of this puzzle. We must work on many fronts to achieve the changes and improvements we need.

Many people, both professionals and volunteer advocates all across this state, are working their hardest every day to improve our system. The scale, complexity, and rapidity of change that they have endured over the past few years have been daunting but they are committed and determined. Our state needs the benefit of multiple perspectives as we work through the serious issues now facing our system. We will need to adopt a disciplined approach to maximizing system improvements. And we must make sure that government officials and the mental health community listen to and learn from one another.

As North Carolina's next governor, I will be directly involved in meeting our mental health challenges. I understand that our efforts will need sound leadership, accountability, policies, and coordination throughout state government and the system of services for mental health, developmental disabilities, and substance abuse. We all know someone – a family member, a friend, a co-worker – who is dealing with the challenges of mental health concerns. These are deeply personal issues for all of us. And they are critical issues for building a better North Carolina as well. I pledge to be the leader our state needs to establish a system of high-quality services that yields the best possible outcomes for those it serves.

Pat McCrory on mental health, Dix

N&O letter 6/27/08 Keep Dix open http://www.newsobserver.com/print/friday/opinion/story/1122013.html

I agree wholeheartedly with your June 24 editorial on the need to keep Dorothea Dix hospital open. Earlier this month, I held a news conference in Raleigh calling on the General Assembly to keep Dix open for another year. On Monday, June 23, I wrote Gov. Mike Easley, Lt. Gov. Beverly Perdue, Sen. Marc Basnight and House Speaker Joe Hackney urging them to personally intercede in this matter.

With the problems surrounding mental health escalating, the current administration appears to be implementing changes without proper planning. As a result, hundreds of millions of dollars are being misspent, poor medical treatment is being given to mental health patient, and concerns are rising for the safety of patients and staff in state mental facilities.

It is unacceptable that a nurse was beaten at Dix last week due to inadequate supervision of patients. It would be grossly irresponsible to close the hospital without making the necessary preparations for handling patients in a secure environment.

Dix hospital must be kept open and properly staffed for another year. This will give the next governor a chance to evaluate its closing and recommend the best way to address the growing scandal in mental health programs.

Pat McCrory

Charlotte

http://www.newsobserver.com/print/friday/city_state/story/1122070.html
Under the Dome N&O 6/27/08 :

Dix hospital

Pat McCrory has called for Dorothea Dix hospital to remain open for another year.

In a letter sent this week to Gov. Mike Easley, Lt. Gov. Beverly Perdue and other top Democratic leaders, the Republican gubernatorial nominee urged them to keep the Raleigh mental hospital staffed until the next governor could implement mental health reforms.

"I believe that the present problems are not a result of the legislatively passed reforms to provide local care for mental health patients," he wrote. "The scandal is a result of poor planning and implementation of the reforms. The next governor should be given the opportunity to bring new leadership to this area."

In the letter, McCrory says that the recent beating of a nurse at Dix shows there are continuing problems with the state's mental health care system.

From the McCrory website: http://www.patmccrory.com/docs/articles/McCrory-Calls-on-Administration-to-Keep-Dorothea-Dix-Open.html

McCrory Calls on Administration to Keep Dorothea Dix Open
‘Next governor should be given opportunity to bring new leadership to mental health’

Charlotte, N.C. – Mayor Pat McCrory today [June 23, 2008] wrote to Gov. Mike Easley, Lt. Gov. Beverly Perdue, Senate President Pro Tem Marc Basnight and House Speaker Joe Hackney to urge them to keep Dorothea Dix Hospital open and adequately staffed for another year. McCrory argued this would give the state’s next governor the opportunity to implement necessary mental health reforms. Below is the text of his letter:

“With problems surrounding mental health reform escalating, the administration appears to be implementing changes without proper planning. As a result, hundreds of millions of dollars are being misspent, poor medical treatment is being given to mental health patients, and concerns are rising for the safety of patients and staff in state mental facilities.

“It was reported on June 21 that a patient beat a nurse in the forensics unit of Dorothea Dix Hospital. It is unacceptable to inadequately supervise patients who are among the most violent being treated at Dix. Closing Dix without adequately preparing for handling forensics patients in a secure hospital environment is dangerous for patients, health care workers, and the public.

“I’m writing to ask you to keep Dorothea Dix hospital open and properly staffed for another year. This will give the next governor a chance to evaluate its closing and recommend the best way to address the growing scandal in mental health programs.

“During a June 2 news conference in front of the Legislative Building, I called on the legislature to keep Dix open for another year. I am now calling on you to personally intercede on behalf of the patients, staff, and the public. I understand that a version of the budget has passed the House and the Senate and is now before a joint conference committee to reconcile the two versions. However, inaction during this session could result in tying the hands of the next governor.

“This past week the Wake County Chapter of the National Alliance on Mental Illness, the N.C. Sheriff Alliance, the N.C. Public Service Workers Union, and a Dix psychologist wrote the legislature requesting Dix be kept open for another year. On Friday, hospital workers again marched on the office of the Secretary of Health and Human Services seeking a delay in the closure.

“I believe that the present problems are not a result of the legislatively passed reforms to provide local care for mental health patients. The scandal is a result of poor planning and implementation of the reforms. The next governor should be given the opportunity to bring new leadership to this area.”

From McCrory Website: "Policy Statement: Health Care"

http://www.patmccrory.com/docs/issues/Policy-Statement-Health-Care.html

Reform failed reform.
The current mess of our mental health system can be traced back to the “reform” measures backed by Governor Easley in 2001. Unfortunately, these “reforms” have wasted millions of taxpayer dollars, decreased community care, and left our mental health system without accountability. We need to establish citizen councils to review contracts and certify nonprofits; stop closing hospitals and reducing the state’s number of beds available to mental health patients; work with providers and Local Management Entities (LME’s) to meet the needs of local communities for short term care; provide new leadership to help citizens with developmental disabilities, substance abuse, and mental illness to lead productive lives in local communities; and establish clear priorities that will re-introduce accountability, allow interagency coordination, and bring care to those who need it.

Gubernatorial nominees weigh in on new state hospital

From the N&O, June 2:

Pat McCrory, the Republican candidate for governor, called on the state to keep Dix and Umstead open for a year to give the next governor a chance to bring in new leadership. "The hasty move to a new facility without adequate staffing and with design flaws only makes a bad situation worse," he said.

Lt. Gov. Beverly Perdue, Democratic candidate for governor, said the new hospital isn't ready to open, but she said she did not agree on imposing a deadline of a year.

"I don't believe one patient should be moved to Central Regional until we have adequate staffing and the safety issues are resolved," she said.

McCrory criticized the Department of Health and Human Services for not publicizing the results of work groups Benton appointed and said the work group report on the new hospital should be made public.