Mental health overhaul worries many - Greensboro News-Record

Sunday, July 16, 2006

By Nate DeGraff
Staff Writer

GREENSBORO - Gavin Hoover, a big, bespectacled middle schooler, should have been home playing video games or teasing his sister. Instead, he was back in the hospital.

Gavin has bipolar disorder, a condition that causes dangerous mood swings. Last fall, he became so angry and prone to outbursts that his mother had to check him into the hospital. He needed 24/7 attention; she needed help.

Then, in a stroke of good fortune, Nichole Pulliam found the Guilford Center, the county's mental health agency. A caseworker started arranging her son's appointments with the schools and a therapist, relieving her of those weighty responsibilities.

"She hooked us up with everything that we've got now," Pulliam said. "She did it all. I mean, none of it's anything that I went after myself. ... She was an amazing, amazing lady."

But that happy relationship ended this spring because North Carolina is changing the way it cares for mentally ill people. The idea is to treat people in their communities, surrounded by family and friends, rather than at large state institutions.

As a result, the Guilford Center is slashing jobs and shuffling families off to outside groups. Pulliam was told that she'd have to find somebody else to help Gavin.

Once again, Mom is doing more.

Like many of the 16,000 people who receive mental health care through the Guilford Center or the groups it contracts with, Gavin faces an uncertain future. Under the state's multiyear play for mental health reform, the agency is cutting a hefty chunk of its programs, eventually leaving sick people and their families to fend for themselves in the labyrinthine world of private mental health care.

Gone will be the Guilford Center's case management programs for mentally ill adults and children, along with special services for people with crippling developmental disabilities. Private groups are supposed to provide the services.

"Some of these families, they literally live and die on these services," said John Ansbro, executive director of Arc of Greensboro, a group that helps people with mental retardation and expects to add 20 to 30 families to already full case rolls.

"This is going to be a disaster waiting to happen," he said.

Mental health advocates got good news last week when state officials put an extra $95 million for mental health care in the new budget. But advocates worry that the money might not be enough and that local nonprofits already full of patients won't be able to handle the extra workload. Advocates say that could overburden police, emergency rooms, homeless shelters and jails with mentally ill people.

"You take someone that doesn't have enough sense to come out of the rain and you tell them to go to this agency or another one, what do you think are the chances of them going?" Guilford County Sheriff BJ Barnes asked.

"Some of these folks are going to end up in our jail," he said.

"It is a devastating cycle," the Mental Health Association in Greensboro wrote in a statement released this year. "When you cut mental health services, problems erupt elsewhere."

Much of the fallout will occur over the next several months, when the Guilford Center continues cutting 135 jobs from its payroll. Fewer than 180 positions will remain.

Many of the affected employees are caseworkers, the sorts of people who navigate the technical, acronym-filled world of mental health so parents don't have to. As county employees, they've been able to take advantage of the state's pension system, and their salaries are generally higher than what people make in the private sector.

Ansbro says someone making $40,000 at the Guilford Center would earn only about $35,000 with his group, and the retirement benefits aren't nearly as good.

Some employees who were working in the Guilford Center's child unit, which was shut down last month, are headed to the county's Department of Social Services. Others are going to ValueOptions, the Virginia company that the state has charged with doling out Medicaid payments to the private groups, taking over those responsibilities from public agencies such as the Guilford Center. Many others haven't found jobs yet, said Paul Evans, the agency's provider services director.

So in the end, fewer people could be caring for mentally ill young people in Guilford County.
Finding help
Most of the time, Gavin is a lot like other 13-year-olds. He plays basketball and baseball. He's a worldbeater at his football video game. He joshes around with his 6-year-old sister, Emileigh.

But Gavin is different. At age 3, doctors diagnosed an attention deficit hyperactivity disorder. The bipolar diagnosis was added later.

Gavin is what doctors call an "ultra-rapid cycler," meaning that his moods can swing from good to bad several times in the same day. And with an IQ below 70, he has mild mental retardation. Throw in the ups and downs that accompany adolescence, and his mom has her hands full.

When Gavin's up, he's laughing and giggling a lot. But then he starts losing sleep. He gets agitated. When that happens, his mother says, it starts getting ugly.

When Gavin's down, he's way down. It's hard to get him out of bed.

According to people who know him, Gavin wasn't getting the care he needed for most of his life. Because he was mentally disabled as well as bipolar, his mother said, some medical centers refused to treat him. And when he was hospitalized last fall, his mom felt that the psychiatrist who had been seeing him was overbooked and didn't have enough time for Gavin, who was in the middle of a manic episode that wouldn't go away.

But at Brenner Children's Hospital in Winston-Salem, the family caught a break. A social worker recognized that the family needed help and called the Guilford Center.

Enter caseworker Leola Avery. She stepped into a tough situation.

"(Gavin) seemed to lash out for no reason at all," Avery recalled. "He would threaten you. He was harmful to himself, as well as to other people."

Avery looked after all aspects of Gavin's mental health care. She dealt with his special learning plan at school. She set up psychiatric appointments. She made sure his medications were lined up. And when Mom needed time off, as parents of mentally ill children often do, Avery would arrange for someone else to look after Gavin.

Things got better. For the first time, Pulliam didn't have to set up everything for her son. The stay-at-home mom even thought about going back to work so her husband, Gavin's stepfather, wouldn't have to shoulder the family's financial burden by himself.

And Gavin was improving, too. With Avery's help, Gavin was seeing the right people, getting the right medications.

His mom said: "When his meds are right and he's stabilized, he's just as normal as you and I."

Marveling at all this was Gavin's godmother, Shanon Armfield, who had watched for years as Pulliam and Gavin kept struggling to find Gavin the right care.

"They're the first place that really did him any good," Armfield said of the Guilford Center.

By spring, Avery said, Gavin had "more better days than bad days."
Moving on
But the experience was short-lived.

Earlier this year, when cuts at the Guilford Center were starting to unfold, Pulliam got word that Avery wasn't going to be watching over Gavin anymore.

The family still uses the psychiatrist and other services that Avery found for them, but Pulliam worries about what will happen when Gavin becomes manic again. And she worries about wading through the inch-and-a-half-thick list of mental health groups to find the right people who can help her son.

And she has abandoned plans to get a job anytime soon.

Now, Gavin has a therapist, Monica Williams, who does some of the things that Avery used to do, but it's not the same as a professional case manager immersed in the system.

"They made friends," Pulliam said. "They know people everywhere. They can do recommendations. And now ... it's like an interview process. You just have to try so many until you find one that you know will fit."

Pulliam and her son have lost something else, too: comfort.

"It feels like the minute you finally get something that you can rely on," Pulliam said, "it's gone."
Contact Nate DeGraff at 373-7024 or ndegraff@news-record.com
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