Times-News wins seven journalism awards

February 25. 2006 6:54AM

DURHAM -- The Times-News won seven awards at the North Carolina Press Association on Thursday, including a first-place award for investigative reporting on mental-health reform and a first for Susan Hanley Lane's "Life in the Middle" columns.

The Times-News competed among daily newspapers with a circulation between 15,000 and 34,999.

"We were grateful that the NCPA recognized the reporting staff's work in our most important role, that of a watchdog," said executive editor Bill Moss. "We were pleased to see awards for the way we display news, and for what we hope are readable, entertaining and provocative opinion pages."

The newspaper's investigative reporting on mental-health reform exposed many flaws in a 2001 state law and led to a state registry of crisis-care beds. Judges said the series was "a thorough, important and well-written report that cut through bureaucratic barriers.

"Most importantly," they added, "the report triggered legislative change that promises to bring better care for the mentally ill." Read more!

Hospital seeking add-on

February 23. 2006 9:07AM

Scott Parrott
Times-News Staff Writer
scott.parrott@hendersonvillenews.com

COLUMBUS -- One recent weekend, a mentally ill patient inside the St. Luke's Hospital emergency room cornered and threatened a nurse.

A sheriff's deputy, who happened to be in the ER, defused the situation. But the confrontation sparked fear among the nurses, who say they see more and more patients who are delirious, suicidal and belligerent since the state launched a massive restructuring of the mental health system in 2001.

Hospital leaders say St. Luke's lacks the proper ER space to handle standard mental health cases, let alone the infrequent instances in which patients turn violent.

So the hospital wants to spend $600,000 for renovations and additions to the ER, a project that would provide space specifically for mental health patients. Now it's looking for the cash.

The ER houses a few seats, in a high-traffic hallway shared by patients suffering physical ailments and those struggling against mental illness. Privacy is limited. Patients first meet nurses behind an adjacent cubicle. Nurses crank the volume on the overhead television so other patients cannot hear the conversation.

"I think the main thing is the confidentiality," said Becky Brodar, a registered nurse in the hospital's geriatric psychiatry unit. "It's a big issue. And the security of the area, not only for the staff, but most importantly for the patient. The patient needs a secure, safe area they will feel comfortable in. That's my main concern."

The project

Under the proposed project, a proper waiting room would be added and the ER would receive a 23-hour bed for mental health patients. A "safe room" would be built for mental health patients, a space lacking sharp instruments and scary-looking medical equipment. The ER would also get an area where nurses could consult incoming patients in privacy.

Hospital officials say more people turn to the ER for mental health needs because they know of no other place to go. Mental health advocates say many patients and families who sought help through the state's complex new system found only confusion, so they turn to the place they know they will find help. Twenty-two mental health patients sought help through the St. Luke's ER last year, double the number from the previous year.

Under the current plan, the St. Luke's Hospital Foundation would raise $200,000. The hospital secured another $200,000 from the Duke Endowment, but that check comes with a stipulation -- Polk County must pitch in another $200,000.

On Monday, hospital CEO Cameron Highsmith pitched the project to the Board of Commissioners, trying to get the money before the deadline for the Duke Endowment commitment comes in March.

The pitch drew mixed response from county leaders and some mental health advocates, who supported the project but not through the route of funding Highsmith suggested -- using cash from a $433,000 mental health reserve fund. The money dates back to the demise of the Rutherford Polk Mental Health Authority, which dissolved when the state launched mental health reform in 2001.

The tab

The tab

One of the principles of the state's mental health reform is to move patients out of state institutions and reduce the dependence on state hospitals like Broughton in Morganton, while pushing communities to expand local care for the mentally ill. State leaders hoped the change would reduce the stigma attached to mental illness and allow patients to stay near family and friends. With fewer patients in state-run institutions, more money could be contributed to mental health care on the local level.

But local government leaders say towns and counties are being stuck with the tab.

Dr. Gordon Schneider, a member of the Polk County Mental Health Advisory Board, told county commissioners they should hang onto the $433,000 in case the county finds itself covering more of the tab for mental health care.

"What we're saying is for y'all to wait and hold the money," Schneider told county leaders. "I have a feeling that if things continue to go the way they are ... y'all are going to have to pick up more.

"It's not saying that we don't agree the hospital needs the money," Schneider added. "They do need to do the renovations, and I truly support that. But I do not think it is wise to use this money."

County leaders agreed. The Board of Commissioners unanimously voted to write the Duke Endowment for a deadline extension. The county leaders also voted to consider other routes to help cover the cost of the hospital project, rather than tapping into the mental health money.

"Unfortunately, we don't know what the future of mental health is," County Manager Michael Talbert said. "It is evolving, and we want to reserve this money for future capital needs and/or programmatic needs that we may have for Polk County." Read more!

Latest bad news for N.C.’s mental health system puts onus on legislators for action - Asheville Citizen-Times

published February 26, 2006 6:00 am

For those suffering from mental illness, for their families and for the local units set up to oversee state mental health services, the latest news from Raleigh must feel like the ultimate betrayal.

It now appears that the very premise on which the state’s mental health reform was based, the plan to use money saved by closing state hospital beds to establish community services, is being overturned. The impact on a mental health delivery system already reeling from poor state management and inadequate funding will be disastrous with corresponding ramifications for other local institutions, from hospitals to law enforcement.

State Budget Director David McCoy has recommended that the money instead be diverted to pay debt service, $4 million this year and $8.9 million next year, on a new hospital under construction in Butner, which is located near Raleigh. The state plans to close Dorothea Dix Hospital in Raleigh and John Umstead Hospital in Butner, which have 631 beds between them, and consolidate services at the new hospital, which will have 432 beds.

McCoy wrote a letter to N.C. Department of Health and Human Services Secretary Carmen Hooker Odom informing her that the Division of Mental Health, Developmental Disabilities and Substance Abuse Services is not authorized to transfer money from “downsizing funds” to the local management entities, called LMEs, which are responsible for building and managing a network of local mental health service providers.

“We can’t build a network of services if we don’t have the money to do it,” Anne Doucette, director of provider and community network development at Western Highlands Network, told an AC-T reporter. “It just can’t be done without money. People are going to wind up in crisis, in jails and emergency rooms, and that’s a lot more expensive.”

It will be especially more expensive for local governments, as local agencies and law enforcement are forced to deal with mentally ill patients without the resources or training they need to provide care.

One primary objective of mental health reform was to establish local treatment facilities to help mentally ill patients in crisis and keep them out of large mental hospitals located far from their families. Tom McDevitt, director of Smoky Mountain Center, the LME for the seven westernmost counties, said the Balsam Center, a unit built by his LME to stabilize patients in crisis, diverts 40 to 45 percent of those patients who would otherwise go to Broughton, a state hospital in Morganton.

“… If we don’t get what we expected from the downsizing, we’ll have to bear the cost of creating this alternative to hospitalization and it will have to come out of other services.”

Ultimately, the responsibility for fixing the state’s system for delivering mental health services, which was already suffering an appalling meltdown before this latest reversal, rests with state lawmakers who set the process of reform in motion.

Sen. Martin Nesbitt, D-Buncombe, co-chairs a Mental Health Legislative Oversight Committee that’s trying to figure out how to reform the reform. All the committee members agree, he said, that the system can’t take any more funding cuts.

There are some problems that don’t have to do with money, but the need for an influx of money to establish community-based services and to pay providers, among other things, is critical. It is demoralizing to learn that an expected source of community funding may now be diverted.

The fallout from failing to provide services for the mentally ill is huge for a community. It manifests itself in homelessness, in potentially fatal confrontations between law enforcement officers and mentally ill patients, in the inefficient use of hospital and law enforcement personnel, to name a few of the negative impacts.

But it also puts an intolerable strain on families. About one in four Americans has a diagnosable mental illness. That means few families escape being affected. Nesbitt said his committee will pressure the General Assembly to add more money to the mental health system. Lawmakers who can’t appreciate how critical it is to get this right don’t have any business serving in state government. Read more!

Children’s unit closes at Balsam recovery center - Waynesville Mountaineer

Children in crisis must travel to Asheville, Morganton for help
by PEGGY MANNING
Senior staff writer

Changes in the state’s Medicaid plan have eliminated facility-based crisis services for children suffering from substance abuse, experiencing severe depression or dealing with other mental health issues. That forced the closure of the recently opened Child Recovery Unit at the Balsam Center for Hope and Recovery.

The unit had provided crisis services for children since it opened in August 2005. It closed Jan. 31.

“Smoky Mountain Center was notified by the Division of Division of Mental Health, Developmental Disabilities and Substance Abuse Services that the final Medicaid plan eliminates facility-based crisis services for children. Because of this, our organization has no choice but to close the Child Recovery Unit,” said Tom McDevitt, chief executive officer of Smoky Mountain Center, which funds the Balsam Center for Hope and Recovery.

Since 80 percent of the children served in this unit were funded through Medicaid, Smoky Mountain Center is unable to continue operating the program, which kept 47 children experiencing a mental health or substance abuse crisis from having to go to state hospitals or private facilities outside of the western region, McDevitt explained.
Doug Trantham, service management director for Smoky Mountain Center, called the closure a “great disappointment.”

“We worked for two years to develop and implement this innovative program,” he said. “It was already making a difference for children and families in our region.”

Those children must now be taken to hospitals like Copestone in Asheville or Broughton in Morganton, where they had to go before the children’s unit at the Balsam Center opened.
“We would like to serve those children locally, but unfortunately that will not be possible now,” Trantham said. “This is definitely a setback.”

Another problem is that long-time Smoky Mountain Center child psychiatrist Don Buckner is the only child psychiatrist serving Western North Carolina. ”We are in the process of recruiting an additional child psychiatrist, but child psychiatrists are very hard to come by,” Trantham said.

Because of the shortage of child psychiatrists, not only in Haywood County but nationally, there is a heavy reliance on nurse practitioners.

“This is a health hazard in a region of the state with an extraordinarily high abuse and neglect rate affecting many aspects of a child’s life,” said Ed Seavey of Waynesville, a mental health advocate.

“With Dr. Buckner and the nurse practitioners working for Smoky Mountain Center, one might wonder about the process of diversification and success of reform in our area. Is it a cost-savings trend in the state for clients to have to rely on nurse practitioners in place of child psychiatrists or are rural areas lacking capacity so subject to this outcome?” Seavey said.

Seavey traveled to Greensboro last week to be briefed on the new service definitions that were approved Jan. 1, which were responsible for the closure of the Balsam Center children’s wing. “As typical, the state is not prepared to present the new definitions

Such delays have been common since the beginning of reform in 2001 (House Bill 381). Such delays have left clients without services such as case management and psychiatric care or treatment with little explanation. “The Department of Health and Human Services admits that reform was rushed. In fact, changes were so massive that at some point reform became transform,” Seavey said.

While the children’s program at the Balsam Center was the first of its kind in North Carolina, other communities were in the process of starting facility-based crisis services for children as an alternative to hospitalization. The Child Recovery Unit was staffed by a team of mental health professionals and peer support specialists that work with youth and their families to help resolve issues that have led to a crisis and to link them with community resources for ongoing support.

The program focused on creating respectful relationships and flexible services that empower families to build on their strengths and to develop new, healthier skills to deal with their difficulties. Services available at the Child Recovery Unit included psychiatric and substance abuse evaluations, detoxification, medication evaluation and monitoring, and individual, group and family therapy.

The unit served children and youth from ages 6 to 17 for up to 15 days. The unit had five beds, but the center had planned to enlarge the facility to nine or 12 beds. Adult services at the Balsam Center are not closing and may be expanded to meet growing needs, Trantham said.

Smoky Mountain Center is convening a task force of child-serving agencies and organizations to develop alternative strategies to meet the crisis needs of children and families, Trantham said.

The first meeting of this task force is set for Wednesday, March 15, at the area office in Sylva.

“During this meeting, we will review the goals that the Smoky Mountain Center hopes to accomplish, with feedback and input from the group, and to set the committee/subcommittee structure that will be necessary to develop a comprehensive plan for children’s crisis services,” Trantham said.

North Carolina’s new Medicaid plan for individuals with disabilities will take effect on March 21. The plan defines the services Medicaid will fund for adults and children needing mental health, developmental disability and substance abuse services.

“While the new Medicaid plan eliminates facility-based crisis services for children, it does create opportunities for intensive, home and community-based services that might fill the void created by the closure of the Child Recovery Unit,” Trantham said.

Peggy Manning can be reached at 452-0661, ext. 127, or at peggy@themountaineer.com. Read more!

Times-News wins seven journalism awards - Hendersonville

From Staff Reports

DURHAM -- The Times-News won seven awards at the North Carolina Press Association on Thursday, including a first-place award for investigative reporting on mental-health reform and a first for Susan Hanley Lane's "Life in the Middle" columns.
The Times-News competed among daily newspapers with a circulation between 15,000 and 34,999.

"We were grateful that the NCPA recognized the reporting staff's work in our most important role, that of a watchdog," said executive editor Bill Moss. "We were pleased to see awards for the way we display news, and for what we hope are readable, entertaining and provocative opinion pages."

The newspaper's investigative reporting on mental-health reform exposed many flaws in a 2001 state law and led to a state registry of crisis-care beds. Judges said the series was "a thorough, important and well-written report that cut through bureaucratic barriers.

"Most importantly," they added, "the report triggered legislative change that promises to bring better care for the mentally ill."

Other comments:

• First place -- Columns, Susan Hanley Lane. "Newspapers aren't known for telling love stories. Mrs. Lane surprises readers with a love story so heartbreaking, it takes their breath away. That it is her own story -- and that she had the courage to share it -- is nothing short of amazing."

• Second place -- General news reporting, Problems at Pardee Hospital, Joel Burgess and Jonathan Rich. "For Jonathan Rich and Joel Burgess, their story began as a simple restructuring and its related job cuts at the local hospital. What then unraveled amid Pardee Hospital's financial troubles was the saga of its CEO Bob Goodwin, whose abrupt resignation turned out to be a firing. A battle over the terms of his dismissal and the deep-seeded problems that surrounded it was carefully revealed in the daily coverage by Rich and Burgess."

• Second place -- News page and section design. "Good story selection, well-written headlines, photos (both local and wire) for Memorial Day were chosen well and the typography is elegant."

• Second place -- News enterprise reporting, Vanishing history, Jennie Jones Giles. "Absolutely comprehensive. Although not hard-hitting, these stories were the best reads of all contestants."

• Third place -- Serious columns, Stephen Black, On Borrowed Time. "A fine stream of cold, clear anger courses through Mr. Black ... His columns on the so-called runaway bride and Terri Schiavo have more bite than many produced by the big-name national columnists."

• Third place -- Editorials, Bill Moss. "These editorials minced and spared no words in making strong points against the flawed thinking of a cold-blooded killer (Eric Rudolph), the shallowness of new state mental-health legislation, and in chastising local elected officials for their juvenile behavior at public meetings. Written with passion, whether in agreement or not, the reader is not left wondering where the newspaper stands."


Read more!

Inevitable change - News & Observer/Carmen Hooker Odom's Reply

Ann Akland's Feb. 22 Point of View article "Costly trouble for mental health services" seemed to suggest that the state's mental health reform process occurred in a vacuum without regard to consumers. Reform didn't appear out of thin air; the General Assembly sought the input of consumers, professionals, advocates, providers and elected officials before it passed the 2001 legislation.
Change is inevitable if we are to have a sustainable public mental health system. The goals and principles of our reform, and the obligation to effectively manage financial resources, are consistent with the system transformation mandated by the federal government.The legislation required us to identify and focus our finite financial resources on target populations, those with the greatest need.
We are committed to ensuring person-centered care for people in the public mental health system. This is not solely a state responsibility. Some counties have risen to the task and invested the financial resources necessary to foster local providers. Mecklenburg County with a population (789,940) roughly equivalent to Wake County (744,024) has earmarked $42.2 million in county money this fiscal year for mental health services. It has more than 40,800 active community cases and sent only 347 consumers to a state psychiatric hospital for treatment in 2005. Wake County has budgeted $10 million, has an active community caseload of 11,400, and sent over 1,400 clients to a state hospital.
As Akland so appropriately says, it is time that all parties start working together to fully implement mental health reform.
Carmen Hooker Odom
Secretary, N.C. Department of Health and Human Services
Raleigh Read more!

Costly trouble for mental health services - News & Observer Point of View/Ann Akland, Wake NAMI

Point of View
Published: Feb 22, 2006 12:30 AM
Modified: Feb 22, 2006 07:51 AM

Ann Akland
Thanks to the way the mental health reform is being administered, the state Department of Health and Services has at last become a uniter and not a divider. Current chaos has united service providers, Local Management Entities, consumers and their families in an outcry against the agency's misguided approach and lack of leadership.

Many of us who will be affected by the changes have feared the potential loss of services for people with mental illness. But as the fog has lifted over how statewide mental health reform will be implemented, it is clear that consumers are not the only victims: service providers and program administrators are to be crippled as well. How is this possible?

As with the confusing federal drug coverage offered to senior citizens, the state's plan to transform the mental health system is complex. Granted, the goals are laudable: more effective services provided to the people who need them most, and provided in their own communities. But the way those goals are being translated into services is not laudable.

For the approximately 200,000 adult North Carolinians with severe mental illness, and for the approximately 75,000 children with serious emotional disturbances, the next 12 months may be extremely turbulent as the state radically reorganizes the delivery of mental health services in the following ways:

• Limiting services to only a fraction of those who now receive them.

• Changing the types of services consumers will receive.

• Changing the providers responsible for delivering the services.

The state is changing its entire service paradigm, shifting responsibility for service delivery away from government-funded Area Mental Health Programs (now called Local Management Entities, or LMEs) to private providers. At the same time, the Department of Health and Human Services is stripping authority from most LMEs to make decisions about which consumers are eligible for services.

Under threats of budget reductions, some LMEs have banded together, agreeing on one to serve as a "lead" agency and perform utilization review for all of them. For other LMEs, including those of Wake, Durham and Orange counties, authority has been shifted to a statewide contractor, ValueOptions. These counties are being told they may be allowed to do the review again in the future -- if they contract out all services provided internally.

These administrative changes will have harmful and wasteful results. Stripping authority from local LMEs to authorize services severely limits each LME's ability to ensure that consumers are getting adequate services. Under the state's reform, each consumer has been promised a "person-centered" plan with all the services he or she needs. A contract-provider is being entrusted to develop that plan and coordinate care. LMEs will no longer be in a position to determine which services are being used and where there are gaps. Contractors may be tempted to authorize the highest levels of service, those with the most lucrative rates of reimbursement. Limited funds may be exhausted without regard to priorities.

Contracting out services does not necessarily improve care or reduce cost. But it does remove the safety net of services delivered by the government.

The department claims that LMEs are not ready to take on the task of utilization review, yet the contractor, ValueOptions, which began work July 1, has not been able to keep up with the existing workload. Contractors serving consumers will be stymied without the authorization to provide services, and consumers, left without help, will suffer. And service providers with limited cash reserves may not be able to stay in business without timely authorization and payment for their services.

As a family member of a person with mental illness and as an advocate, I find myself advocating not only for the consumers whom this system was designed to serve but also for service providers and LMEs. Department of Health and Human Services officials, acknowledging that these problems are real, believe they must press forward -- even though many consumers will fall through the cracks, LMEs will be crippled and some contract agencies will go out of business. I have heard one official say "It will be like Medicare Part D. The state will tell providers, 'Just provide the services, and we'll straighten it out later.'"

But if we wait until some consumers are denied needed care, until our public mental health safety net has been dismantled and until only a few big mental health providers are solvent, it may be too late to pick up the pieces.

It is time for all those affected by the state's mental health reform plan to work together for the good of those struggling with mental illness and for the health of North Carolina.

(Ann Akland is president of the Wake County NAMI (the National Alliance on Mental Illness) affiliate.) Read more!

Mental health fight heads back to court - News & Observer

Mother won her case against the state but says services aren't available for her son

ANDREA WEIGL, Staff Writer
A Wake Superior Court judge might force state health officials to provide the crisis mental health services they are legally required to give to a 17-year-old boy.

The boy's mother, Kathy Reiter, 49, of Fletcher in Henderson County, on Wednesday asked the judge to make the state Department of Health and Human Services provide services to her son, Thomas. She has been waging a legal battle with the agency since 2003.

She won her case in September when Michael Moseley, the agency's mental health director, agreed that the services should be provided. Five months later, Kathy Reiter said the clinics offered by the state to help during a crisis will not accept her son.

Reiter said she had no other option but to take the state agency back to court. "They haven't done what they were ordered to do and what they agreed to do," Reiter said Wednesday.

Mark Van Sciver, a Health and Human Services spokesman, declined to comment about the pending litigation. A court hearing on Reiter's motion has yet to be scheduled.

The judge's ruling could have far-reaching effects for the tens of thousands of mentally ill children in North Carolina who receive community-based care. The state has been struggling to provide the full spectrum of services to the state's mentally ill since passing reforms in 2001 aimed at shifting services from state institutions to community care.

Kathy Reiter adopted Thomas at age 3 after an abusive early childhood in which he lived in and out of foster homes. He suffers from bipolar disorder, severe attention-deficit hyperactivity disorder, post-traumatic stress disorder, autism and reactive attachment disorder. Since age 8, he has been hospitalized 14 times.

And now, when the 6-foot, 220-pound teen gets angry or upset, the situation can escalate beyond what can be handled by his mother or the trained mental health worker who is in the home 40 hours per week.

The most recent crisis happened in January, Kathy Reiter said, when Thomas threw a Molotov cocktail at the case worker, who was not injured. Thomas then ran into the woods and was gone for hours. Kathy Reiter did not want to call the police, and she and the case worker were able to calm him when he came home.

It is at those times that Kathy Reiter wishes the state had 24-hour crisis intervention and stabilization services, as the law requires, and a mobile crisis response team to transport Thomas to a center if he has to be removed from the home.

In October, state officials told Kathy Reiter that two clinics would offer such services to her son. It turned out that one clinic wouldn't accept him because he has a history of aggressive behavior and the other wouldn't accept him because his IQ was below 70.

The state agency hopes to have the special teams, the mobile crisis response units, available across the state starting March 20, when the new mental health reforms go into effect, said Dr. Mike Lancaster, medical director of the state's Division of Mental Health, Developmental Disabilities and Substance Abuse Services. Some mobile crisis units already exist, and some are in development, he said.

Lancaster said the state agency will meet today to discuss providing $1 million to pay for 10 such units across the state.

Plus, Lancaster said, his agency has been trying to get community hospitals to offer more psychiatric services.

"That's been slow to evolve," he said.

Staff writer Andrea Weigl can be reached at 829-4848 or aweigl@newsobserver.com. Read more!

Mother forced to seek judicial help again to get services for her - Legal Aid of NC

(Raleigh, NC) - Today in Raleigh, Kathryn Reiter, who won a lawsuit in September on behalf of her severely mentally ill son, was forced to file yet another motion, compelling the North Carolina Department of Health and Human Services (NCDHHS) to do what it has been ordered to do.

Five months ago, Michael Moseley, Director of the Division of Mental Health for the NCDHHS, ordered his agency to make crisis services, which are necessary for safety during a severe mental episode, immediately available. For Kathryn Reiter and her son, the long months since winning their case have been full of frustration.

"The Department has tried to create the illusion, on paper, that they are providing the services to which my son is entitled, but those services just do not exist. It's a charade," says Mrs. Reiter.

Mrs. Reiter had turned to the courts for help more than two years ago, because the Department had not contracted with any mental health providers in the Western North Carolina counties near her home to help her child, Thomas, in a crisis situation. When he was twelve years old, and the psychiatric inpatient unit at the local hospital refused to treat him, Thomas was handcuffed in the back of a police car for the entire four hour ride to a state-run mental hospital.

According to Mrs. Reiter's attorney Erwin Byrd, of Advocates for Children's Services, situations like these are not uncommon in the post-reform world of North Carolina mental healthcare. Two major goals of the mental health reform were to reduce long-term stays at costly institutions and to allow children to be treated in or near their homes. The promised mobile crisis units and local crisis facilities, however, have yet to materialize for most ofthe Medicaid-eligible children of this state. The absence of services thus calls into question the good faith of the entire reform effort.

"This motion is necessary because our client is entitled to these services by law," says Byrd "The services have been promised to him, and he should be able to rely on them, but, after all these years and court orders, the services are still not in place. The NC Department of Health and Human Services should not be allowed to evade its legal obligation to this child."

Advocates for Children's Services (ACS) is a statewide project of Legal Aid of North Carolina that provides free legal representation to at-risk children and children involved in the juvenile justice system because they have been denied Medicaid, Special Education, speedy permanent placement and/or the opportunity for a sound basic education. ACS currently has offices in Durham and Winston-Salem, NC.

Legal Aid of North Carolina (LANC) is a statewide, nonprofit law firm that provides free legal services in civil matters to eligible, low-income people in all 100 counties in North Carolina through 24, geographically located offices in North Carolina. LANC's clients typically have an annual income of 125% or less of the federally established poverty levels.


CONTACTS:
Lewis Pitts (Senior Managing Attorney, Advocates for Children's Services, Durham), 919-226-0052

Erwin Byrd (Staff Attorney, Advocates for Children's Services, Durham), 919-226-0052
Read more!

Overcoming Anxiety: Cognitive-behavior therapy helps Tobaccoville man regain his life - Winston-Salem Journal

W/S Journal
Tuesday, February 21, 2006

By Kim Underwood
JOURNAL REPORTER

Once upon a time, being at the mall made Jim McGee feel as if he were confronting a bear in the woods. "My hands were physically shaking," he said. "My heart felt as if it was going to pop out of my chest."

He felt dizzy and would quickly become so hot that he would break into a sweat.

Because going to the mall was so stressful, he pretty much stopped going. He estimates that, before he started working with a cognitive-behavioral therapist, he had gone perhaps three times in 10 years - and one of those times was because he was unwilling to tell someone who wanted to meet him there about his anxiety disorder.

Everything has changed, though, since the therapist helped him learn, among other things, how to change his perspective on stress. In the past couple of months, he has gone to a mall several times - and enjoyed himself while doing so.

"I'm amazed I'm feeling this good now," he said on a recent visit. "I never thought I would get over it."

"His confidence has definitely improved," said his wife, Marilyn McGee.

The McGees live in Tobaccoville. She is an elementary-school teacher, and he works at a group home in Mount Airy.

McGee, 40, is one of about 19 million Americans who suffer from an anxiety disorder. Anxiety disorders come in a number of flavors. Classifications - which can vary according to the organization doing the classifying - include obsessive-compulsive disorder, agoraphobia (loosely, fear of crowds), post-traumatic-stress syndrome, panic disorder and generalized anxiety.

In trying to understand what someone with an anxiety disorder is going through, it's important to know that the feelings and sensations are intense and real, said Andy Hagler, the executive director of the Mental Health Association of Forsyth County.

"They are not putting on," Hagler said. "It's not just a case of the jitters. It's very serious."

For half of his life, McGee has been suffering from a debilitating mix of generalized anxiety, panic disorder and agoraphobia, which is often associated with panic disorder.

In describing one attack, McGee said, "I felt like somebody had thrown gas on me. I was hot. I was shaky."

In describing another experience, he said, "It's like having a top inside your head."

Anxiety disorders are often complicated by depression, Hagler said. Anxiety is not depression, he said, but the effect that it can have on someone's life can be just as disruptive and can lead to depression.

"It's not uncommon for people to have both," Hagler said.

The good news about anxiety disorders is that, with treatment, significant improvement is possible. That's true, for instance, for 70 percent to 90 percent of people with panic disorder, according to statistics from the Anxiety Disorders Association of America.

But, when a person is in the grip of an anxiety disorder, he can lose hope. Over the years, McGee saw counselors, read books on the subject and took countless medications. But until recently, he feared that he might never come out the other side.

"You're existing; you're not living," he said.

McGee experienced his first anxiety attack in 1982 while he was still in high school. He describes himself as an active student. He played guard on the South Stokes High School basketball team and played guitar in a band.

"I was always a busy kid," he said. "I never learned to relax."

The first attack seemed to come out of nowhere. Sitting in geometry class one day, he suddenly became hot and dizzy. Of course, the teacher called on him.

"I had lost touch with the class, basically," he said. "The class laughed.... I went home and told my folks about it. They said it will probably pass."

He could understand them saying that. He, too, thought it would be a passing thing.

But, as time passed, the attacks came more frequently. He went off to High Point College (now University) to study business administration but eventually dropped out because of the attacks. He worked, often changing jobs after a couple of years in hopes that things would be better in a different situation. They weren't.

The jobs he held over the years include computer-services clerk, electrician's assistant, counter person at electrical-supply businesses. He went to work at the group home in January.

In some respects, he continued to function well. He served as an informal general contractor for the house he built, and he played guitar in a professional cover band.

He didn't do so well in other respects. He avoided such places as grocery stores, restaurants and malls, and had to ask someone else to buy his jeans and shirts because he couldn't bring himself to go into a clothing store. He dated rarely and didn't imagine himself ever getting married until he met his wife-to-be.

"He has such a big heart," Marilyn McGee said.

She played an active role in her husband finding hope. They married about a year ago, and last spring, at her suggestion, he went to an anxiety-disorder support group. He came home with materials that included information about William J. McCann, a clinical psychologist who has specialized in anxiety disorders for 20 years.

She encouraged her husband to see McCann, which he began doing this fall. McCann's approach includes cognitive-behavioral therapy - the marriage of cognitive therapy, which helps a person analyze underlying causes, and behavioral therapy, which helps a person become less sensitive to stressful situations. It is one of several treatments recommended by the Anxiety Disorders Association of America. Others include medication and relaxation techniques.

No one approach works for everyone, McCann said, and, often, a combination of approaches that may include medication works best.

With cognitive-behavior therapy, McCann said, one of the premises is that we don't actually respond to events themselves.

"We respond to our interpretation of the event," he said. "There are distortions that take place."

Someone with an anxiety disorder has developed a fear of certain physical sensations, he said. When they are under stress, certain sensations arise. The sensations are real, and a person with an anxiety disorder finds them disturbing.

"It's the same fear system as if somebody had a gun to your head," he said.

But it's not the sensations themselves that create the problem, McCann said, it's how the person interprets and responds to them. Other people - thrill-seekers in particular - might interpret the same sensations in a positive light.

"People do bungee jumping to get that rush," he said.

McCann helps the person shift perspective on those sensations. He also helps people to become more aware of the thoughts and situations that precipitate feelings of anxiety.

One reason that anxiety disorders can become so debilitating is that people start avoiding places and situations where they have had uncomfortable experiences, and, as the list - mall, social settings, grocery store - becomes longer, people are going fewer places.

As Hagler put it, "Your world starts getting smaller until the point where you don't go out and are isolated."

Stephen R. Rapp, a professor of psychiatry and behavioral science at Wake Forest University Baptist Medical Center, said that cognitive-behavioral therapy can be very effective for someone with panic attacks.

"It's also an excellent treatment for other anxiety disorders," Rapp said.

In our society, many people look to medication as a solution first, he said. "A simple solution to a problem is preferred."

Medications can certainly help, Rapp said, but people are usually left dealing with some level of symptoms. By "moving back up the causal stream," cognitive-behavioral therapy can help people understand some of the mechanisms of their patterns.

"You're working on things that are responsible for anxiety downstream," he said.

In addition to talking with McCann, McGee has been doing homework that includes practicing relaxation and breathing techniques, keeping a journal and shifting his perspective on potentially stressful situations.

"It's retraining your mind," McGee said. "If a negative thought comes into my mind, I laugh it off because it's not reality."

As for whether an anxiety disorder arises out of genes or the environment, McCann said, "it's virtually always both."

People with anxiety orders tend to be sensitive - often shy, he said. "They are nice folks."

Before working with McCann, McGee had tried various approaches to managing his anxiety.

Doctors prescribed medications. They helped with some of the symptoms but didn't control the overall problem and he didn't like some of the side effects, such as a fuzzy mind. So, after taking them for a while, he would stop.

He saw various therapists but, until he met McCann, never felt as if he received much help. He read countless books - some about anxiety, others about the power of positive thinking.

One thing that did help, McGee said was meeting Sharon Stafford, the owner of The Herb Merchant in King and a registered nurse. Her recommendations regarding exercise, nutrition, vitamins and herbs - along with her support as a person - led to a distinct improvement, he said.

Now - finally - he feels as if he is getting his life back.

"You've got to put in the effort," he said. "There's not going to be any success without effort."

Coming out the other side of an anxiety disorder doesn't mean that people no longer experience anxiety, McCann said. "Nervousness, anxiousness and fear are all normal parts of life."

It means that it no longer limits their choices.

Now that McGee has gotten some tools for dealing with his anxiety and is feeling better, he is eager to help others, perhaps by speaking to civic groups and working directly with others dealing with anxiety disorders.

He says he hopes that by speaking out about it, others might be willing to acknowledge publicly that they are dealing with similar problems. Before, he was ashamed.

"It's more accepted in today's society to say 'I'm an alcoholic' than to say, 'I have an emotional disorder.'"

Now, though, he understands that he has nothing to be embarrassed about.

And now he knows there is hope.

"I feel better now than I have felt since I was 16," he said.

• Kim Underwood can be reached at 727-7389 or at kunderwood@wsjournal.com Read more!

A Ward of North Carolina - New York Times

Welfare Agencies Seek Foster Children's Assets

By ERIK ECKHOLM
GREENSBORO, N.C. — In 2004, at the age of 14 and at his own desperate request, John G. became a ward of North Carolina.

His mother abandoned him for crack when he was 3, and his adoptive father died of cancer a year later. A succession of guardians beat him, made him sell drugs and refused to buy him toys.

When he finally arrived at a county-financed group residence, he was wearing outgrown clothes. On the plus side, he was receiving Social Security survivor benefits and he held title to a modest house, willed to him by the adoptive father 10 years earlier and an asset that might give him traction, or at least a place to live, when he "ages out" of foster care at 18.

Now, the fate of the house — and the insistence of Guilford County officials on taking all of John's Social Security benefits to help pay for his foster care — are at the center of a legal battle with potential repercussions around the country.

The dispute is the latest in a continuing struggle between children's advocates and money-starved welfare agencies. They are wrestling over the proper use of more than $100 million in Social Security benefits that the states are taking on behalf of foster children with disabilities or a dead or disabled natural parent.

Determined to extract as much federal aid for social programs as the law will permit, some state welfare agencies even hire private companies, working for contingency fees, to help them reap more federal money by identifying foster children who are eligible for Social Security benefits. The money is then routinely used to help offset the cost of foster care.

Advocates for children question the wholesale takeover of money, accusing agencies of repaying themselves for care they are obligated to provide and of failing to use the windfall to meet children's individual needs, whether extra tutoring or counseling or, as in John's case, something more unusual.

Guilford County officials refused to release any of John's money, even when they learned that his last guardian had stopped making the $221 monthly mortgage payments on his house and that he faced its imminent loss. A local court has ordered the county to make payments for now, but the county has appealed and said it might appeal to the United States Supreme Court if necessary.

For John, who as a foster child may not be fully identified, it was clear as he visited the house recently that it represented not just money but also a precious link to his troubled past and an unknown future.

"This is my childhood," John, now 15, said as he climbed through a broken window to explore the boarded-up structure for the first time since he fled it two years ago. On the floor of the bedroom, he found a brown teddy bear and clung to it, saying softly, "My mother gave this to me before she left."

John has no idea how he will support himself, but he wants to live in the house he inherited, a property valued at $80,000. "It will be a good place to be," he said.

John's court-appointed volunteer protector found out about the threat to his house and enlisted a Legal Aid lawyer to help him fight for it.

"For the state to pocket a child's money and allow his home to go into foreclosure just doesn't make sense," said his Legal Aid lawyer, Lewis Pitts. "No one can say it's in the best interests of the child."

The benefits that states routinely take include both Supplemental Security Income, or S.S.I., and other Social Security money for children whose parents have died or are disabled. The payments are often close to $600 a month, and usually end when children reach 18 or 21.

"The practice is not the result of deliberative policy discussions regarding how to best serve children in foster care," said Daniel L. Hatcher, a law professor at the University of Baltimore who is the author of an article on the subject that is to be published in The Cardozo Law Review. "It is simply an ad hoc reaction by underfunded state agencies."

"The Social Security benefits are treated as a funding stream," Mr. Hatcher said, rather than as an opportunity to provide any special services or to give children savings for the perilous months after they turn 18, when many fall into crime or homelessness.

A Supreme Court decision in 2003, overturning a decision by courts in Washington State, affirmed that states could legally use children's Social Security benefits to offset current "maintenance costs." But it did not address a deeper question: does that always serve the child's "best interests," as federal rules require, or the longer-term interests of the public for that matter?

In the case of John G., a Guilford County district court ruled last Dec. 29 that the state must pay up the mortgage and cover repairs so the house could be saved for the youth. Reviewing John's rough history and uncertain prospects, Judge Susan E. Bray declared that "any reasonable person would see the fiscal wisdom" of helping him keep the property.

The county has appealed to a higher state court, arguing that the state courts have no jurisdiction over the matter, that the county is legally entitled to use John's benefits to cover his care and that it has no responsibility to exhaust public resources so a child can own property.

"The federal regulations say that the funds are to be used for current needs and expenses," said Lynne Shifton, an assistant county attorney. "His house payments are not, in our opinion, to meet his current needs."

For now, the county must pay up the arrears on John's house and for needed repairs. A private group hopes to rent it as a transition home for foster children until John is able to move in.

State governments around the country stoutly defend their use of foster children's benefits.

Twenty-six states filed a supporting brief to the Supreme Court in the 2003 Washington case, noting that the practice had been approved by the Social Security Administration and arguing that barring it "could leave the states in a position of economic peril."

If states cannot devote money to current care, the brief added, children will ultimately suffer because the states will not help eligible children sign up for benefits.

Many advocates for children agree with that point: preserving an incentive to enroll more children is good for them because the benefits will continue if the child is adopted or returns to his birth family.

"If you tinker seriously with incentives of the child welfare agency, you can wind up doing a lot of harm," said Bruce Boyer, director of the child law clinic at Loyola University in Chicago.

Mr. Boyer led a lawsuit that stopped Illinois from using benefits to cover, in addition to direct care expenses, the overhead costs of foster agencies.

Mr. Boyer said state governments had an inherent conflict of interest, serving as creditors trying to recoup the cost of their programs and also as trustees of children's money. As a first step, he said, agencies should try harder to find relatives or volunteers to serve as official recipients of benefits.

A new law in California, passed with the support of advocates for children, requires counties to evaluate each foster child for Social Security eligibility. But it also demands new scrutiny of how benefits are used and modest savings to help aging-out children become independent.

"We are moving toward an individualized system, requiring counties to stop and think about the child at every stage of the process — in choosing a payee, determining how to spend the money, and accounting for how the funds are spent," said Angie Schwartz, a lawyer at the National Center for Youth Law in Oakland, Calif.

During John G.'s recent visit to his house, it became clear that the property may offer John more than shelter.

Its yard overgrown, its front plastered with a "condemned" poster because the utilities were cut off, the vacant house is an eyesore in a tidy cul-de-sac of similar homes, all built by Habitat for Humanity.

But neighbors poured forth with hugs and joy when John showed up unexpectedly and said that he hoped to move back.

"He's had it real tough, but he's a good kid," said a mother from across the street.

As he left to return to his foster home — he has recently moved from the group facility to a private home — John vowed that he would return to the house in a few weeks, to mow the lawn. Read more!

Durham Center hopes to provide utilization review/police on front lines of reform/anxiety disorder - Raleigh News & Observer

Raleigh News and Observer 
Published: Feb 21, 2006 12:30 AM
Modified: Feb 21, 2006 02:31 AM

Mental health agency could keep review power

ERIC FERRERI, Staff Writer

Durham County's public mental health agency is getting another chance to prove that it's qualified to manage the affairs of its clients.

The Durham Center has received word that it can submit a new application to the state's Department of Health and Human Services in hopes of retaining "utilization review" under a pending statewide reorganization of mental health services.

Utilization review, which the center has held for about three years, is essentially the ability to authorize and oversee health services for clients. The center was told recently that, under the coming restructuring, it would no longer have that power.
The center subsequently announced plans to sue the state over the issue. A state official said Monday that the decision to allow mental health agencies to reapply for the utilization review authority has nothing to do with the threat of a lawsuit.

"We don't react to things like that," said Mike Moseley, director of DHHS's division of mental health, developmental disability and substance abuse services. "The department has agreed to engage in a re-review. The results of that process will decide who ultimately is chosen."

Ellen Holliman, the center's director, said Monday she's pleased -- for the moment.
"We are thrilled that [the state] is allowing us to provide additional information, and we hope there's a positive outcome," Holliman said.

In recent weeks, the center's governing board and the Durham Board of Commissioners announced plans to sue, claiming in part that in trying to restructure the way mental health is administered in North Carolina, DHHS is unlawfully breaking a contract it holds with The Durham Center. The center is under contract with the state to provide and receive reimbursement for mental health services through the summer of 2007.

Another piece of the same lawsuit would allege that the proposed restructuring isn't legal because there is no state law allowing it.

For now, county officials say they're content to see what the state does with the new applications but haven't written off the possibility of following through with the lawsuit.

"Now, maybe there's going to be litigation and maybe there's not," said Chuck Kitchen, Durham County's attorney. "It's all in their hands."

The Durham Center is a "Local Management Entity," or "LME," one of a number of agencies across North Carolina charged with administering mental health services for larger regional clusters of agencies.

Under the restructuring, the state wants to further regionalize that task by reducing the number of LMEs providing utilization review. The overall restructuring is an attempt to save about $28 million annually.

Staff writer Eric Ferreri can be reached at 956-2415 or eric.ferreri@newsobserver.com.
Read more!

Jail Diversion in Asheville? - The Mountain Guardian

Several months ago, it came to my attention that Dr. Mumpower’s Asheville/Buncombe Drug Commission was looking into the feasibility of establishing a minimum-detention detox center to try to rehabilitate some of the local population that is burdening the local law enforcement and emergency service providers with recurring calls for help.

In preparing this article, I ran across a very colorful article about a Vietnam vet who suffered schizophrenia, took up crack cocaine, and held a whole NYC neighborhood in terror. Law enforcement could do nothing until somebody was maimed or killed, and mental health reform had downsized the system to where this man just didn’t fit.

I flashed back to conversations I used to have with folks at Deaverview. About a year ago, I was told all the old ladies were locking their doors and staying behind them because a certain crazy crack addict was back. He’d graze in the lawns, run around insufficiently clad, and occasionally pull a girl into his apartment. I stopped off in Deaverview to find out what had happened to this man.

I was told he got kicked out when he was arrested for raping a girl. He was not allowed to return to Deaverview, but he was back on the streets. He reportedly got off because he was crazy. I was reminded that he was not the only crack user who had terrorized Deaverview. Another guy, also fond of streaking, had once jumped out of a second-story window.

Fortunately, the Housing Authority of the City of Asheville has gotten really tough on its eviction policy. People can’t afford to do massive quantities of crack and pay rent, so Deaverview is currently free of such levels of excitement. But one resident shook her head and repeated, “Whenever they let someone loose from Broughton, they send him to Deaverview.”

Failed Public Policy

In the 1960s, America began shutting its mental institutions down. There were many reasons behind this. One was that the invention of new psychotropic drugs promised normal lives to many who formerly would not be able to function in society. Civil rights activists saw it as some form of discrimination to put the mentally ill together in institutions. There was also a large social impetus toward mainstreaming people with what were then called “handicaps.” Perhaps most significantly, states began cutting their funding for the care of the mentally ill. With a belief that community-based care would more adequately serve the population, group homes were advocated as replacements for the institutions.

But like most feel-good pipe dreams, this scheme wasn’t as clean in the execution as it was on the policy-making end. Left unsupervised, many mentally ill patients would refuse or forget to take their medication. NIMBY’s protested the establishment of group homes in their neighborhoods. Group homes hired untrained staff who, sometimes, were more interested in the money than the clients. In the end, the community-based mental health services just didn’t grow to meet the demand as readily as had been anticipated.

Though statisticians will argue, many people who would have been taken care of in institutions are now wandering the streets, staying in homeless shelters, and burdening hospitals and prisons for temporary relief. It has been argued that America’s prisons and jails are now the largest institutions servicing people with mental disorders.

Statistics

• In February of 2000, the number of US citizens behind bars passed the 2 million mark.
• That meant 1 in 138 Americans was in prison or in jail.
• The US leads the world in the percentage of its citizens incarcerated.
• Approximately 800,000 persons with serious mental disorders are admitted to US correctional facilities annually, comprising 16% of detainees.
• In 1955, state mental hospital populations peaked at 559,000; by 1999, this number had fallen below 80,000.
• The Los Angeles County Jail is reputed to be the largest de facto mental institution in the US, housing 3,300 persons classified as seriously mentally ill.
• In New York City, 11% of the prison population can be classified as having a serious mental illness.
• 72% of persons with mental disorders who are incarcerated are believed to suffer substance abuse problems.
• A person with a mental illness in North Carolina is three times more likely to be in prison than in a state psychiatric hospital.
• Numbers vary by locality, but police officers spend a lot of time waiting for patients in emergency rooms, transporting the mentally ill to institutions, or serving on suicide watch.

While numerous reports were consulted, there is little variation in statistics, indicating they are all drawing from the same pool of data.

Why Not Prisons?

It is undeniable that people with mental disorders cannot be institutionalized as they used to be. Some, poor and on the streets, opt for jail as a means of getting badly needed medication. Asheville’s Ten Year Plan to End Homelessness cited a lot of statistics about the strong correlation between dual diagnoses and the chronic homelessness. This has raised questions about the appropriateness of prisons (and hospitals) as revolving doors for the violently insane who sometimes just need nothing more than to get leveled off on their meds.

Just about every urban area sees a segment of its population cycle from shelters to hospitals to prison and back to the streets. This portion of the population usually suffers from mental illness which they try to self-medicate with street drugs.

These people often cannot hold down a job, and once they get a prison record, they often lose any Medicaid benefits they may have had. The mentally ill not only comprise a disproportionate share of the prison population. They are more expensive to keep in prison, due to needs for more attention and medication. They also tend to serve longer terms than typical inmates because they do not respond to rules, constraints and opportunities as they might were they seeking rewards. Often they are incarcerated for nuisance crimes, and they come out of the jail experience more traumatized than before.

Alternative Programs

Believing it is not a crime to have a mental illness and noting that prisons do nothing to remediate the suffering of people with emotional challenges, several communities have begun pursuing alternatives to incarceration for the mentally ill. The National Criminal Justice/Mental Health Consensus Report, the President’s New Freedom Commission on Mental Health, the Sentencing Project, and work by GAINS/TAPA seem to be the leading advocates of what has become known as jail diversion.

Prisons are full of inmates. Prisons are known as schools for crime where convicts learn more illegal tricks they can pull once discharged. States alter their sentencing laws because there aren’t enough prison beds for everybody that the cops can arrest. Taxpayers moan every time they’re asked to build another expensive prison. Citizens complain when violent persons are turned loose from prison. Prisoners complain they’re discharged penniless, homeless, and jobless with no other choice than a life of crime.  A break in the cycle is long past welcome; so many localities are experimenting with alternatives to incarcerating the mentally ill or persons with substance abuse problems.

One idea that has been around for awhile is boot camps. Persons facing a sentence are given a choice between going to jail or spending a time in the camp where they have to work and live according to a tight military-like schedule. Graduates of boot camps do show a lower recidivism rate than typical prisoners, but some people like to dismiss the difference as being attributable to the fact that only persons of stronger character will opt for the boot camps in the first place.

One small step communities can make would be simply to have a 24-7 rehab/detox center where police can drop persons off, no questions asked. On a Ride-A-Long with Asheville’s police department a couple years ago, a girl on crack, shivering from withdrawal in the dead of winter, consented to being admitted for rehab, but was turned back on the streets because all the local detox centers were full. Hillsborough County, Florida, has an eight-bed unit center just for police drop-offs. The state of Mississippi also has crisis intervention centers to help relieve the backlog at the institutions.

The state of Ohio is serious about getting a program that will work. Some communities have police drop-off shelters. Others have drug/alternative/mental health courts where persons can consent to work off their sentences through meetings with a case manager and upholding certain standards of sobriety. Buncombe County, NC has a small drug court already. Some communities in Ohio assign case workers to bridge the gaps in the system that many people with mental problems fall through. Helping the mentally ill learn to make choices to foster self-reliance and to responsibly stay on their medication is a practice encouraged when practical.

The star program, which almost every community looking into diversion programs cites as the model, is the Crime Intervention Team (CIT) in Memphis, Tennessee. This program simply trained police officers on a volunteer basis in techniques of crisis de-escalation. Persons from the mental health system volunteered their time to train the officers in dealing with the mentally ill. The costs were minimal, as there was no need to take officers off the street and no expenses were incurred by the police department. Advantages included immediate and appropriate responses to crisis, family members of the mentally ill requesting CIT officers as opposed to obstructing their visits, and fewer injuries from police restraint.

Unfortunately, it usually takes a tragic incident for a community to show an interest in jail diversion programs. Public pressure then demands attention.

Is Diversion for Real?

The current system of treating the mentally ill in penal institutions is riddled with problems, many of which have already been discussed. Yet some of the diversion plans read like monstrous bureaucracies aimed at coddling criminals. The outlines for coordinators, liaisons, wraparound services, systematic screening, evaluating, tracking, early identification, etc., were reminiscent of Asheville’s Plan to End Homelessness. Was jail diversion just another attempt of do-gooders to do what has never been done; namely, heal mental illness via paper-shuffling bureaucrats?

Various studies have been conducted to assess the effectiveness of diversion programs, but all of them lack long-term data. They also gauge success in terms of different parameters. Perhaps the most comprehensive was conducted on 1,000 divertees. It concluded only that persons engaging in diversion programs were more likely to be out in the community, as opposed to in a clinic or jail, in the first year after release than traditionally imprisoned inmates. The ratio of community days was 303:245. There were no statistically significant differences among other factors. It seemed the cost of providing health care for divertees equaled the cost of imprisonment for traditional inmates, and recidivism rates were equal.

Then other statistics denied that there was a trans-institutionalization from mental health care facilities to prisons since the 1960s. They also state that there is no correlation between mental disorder and violence, and no correlation between homelessness and mental illness. Anybody who has spent any time reading government reports is surely aware of the technique of gerrymandering boundary conditions to get the desired result.

Yet proponents of diversion argue that it:
• Improves the quality of life for people with mental illness.
• Prevents persons with mental illness from sinking deeper into the criminal justice system.
• Enhances public safety.
• Makes more efficient use of the criminal justice system.
• Improves officer and client safety by reducing the need for violent arrests.
• Reduces taxpayer expense.
• Increases public confidence in law enforcement and the justice system.

What Can Be Done Locally?

Statistics aside, it seems North Carolina could do more to appropriately address the needs of the mentally ill and substance abusers than send them to jail. Huge bureaucracies are not likely to generate any welfare, either. Still, drug users, the community, and emergency rescue programs might all benefit from simple changes like a police drop-off rehab center. CIT certification of police officers on a voluntary basis might introduce some efficiencies, too.

Richard Slipsky at the state’s district attorney office said Asheville could do this, but in order to involuntarily corral persons into the “liberty-depriving place,” whether for treatment or hospitalization, a statute would be required. There would have to be standardized policies and procedures for screening, but once these were in place, delays for judicial processes might not be necessary. Partnerships with local judges, district attorneys, attorneys, court staff, mental health providers, mental health advocates, law enforcement, city and county governments must be forged, and everybody must know about the process and its legality.

Slipsky surmised that getting Western Highlands on board would be the toughest part of realizing such a program. Currently, Western Highlands must approve all admissions of mental health patients in the state. This often requires a trip to Broughton before the person can be housed in a local facility. Prosecutors routinely allow persons arrested for intoxication to be sent to shelters to receive treatment while awaiting trial. Courts will uphold waivers of rights as constitutional as long as it is evident they were not coerced. It is very difficult to commit somebody involuntarily in North Carolina. A full judicial hearing with legal representation is required even for involuntary hospitalization.

Calls to Western Highlands are not always immediately returned, and some people have waited a week before receiving treatment. Treatment can also be held up while delays in Medicaid approval from Raleigh are processed. Sometimes people get arrested before they get a chance to go to Broughton. Henderson County Sheriff George Erwin says mental health in the state has been “deformed” not reformed.

Opinion

Asheville is not in need of a comprehensive, fuzzy-wuzzy, feel-good jail diversion program that coddles persons with mental illness from the cradle to the grave. The city (or region) could, however, improve upon the fragmentation in services available for rehab. A police drop-off for intoxicated people seems like a step in the right direction. Training a voluntary CIT seems a small investment for potentially high returns. Two things are for certain: (1) The current revolving door arrests of persons with mental disorders isn’t helping them or the community, and (2) Government mazes of bureaucracy and micromanagement don’t help either. Read more!

We are unfairly burdening law enforcement with our failure to support mental health programs - Asheville Citizen-Times

published February 20, 2006 6:00 am

Over the last few decades there has occurred a quiet phenomenon best described as job-shifting. Teachers don’t just teach anymore; they’re substitute nurses, parents and counselors.

Similarly, law enforcement personnel don’t just watch for speeders or investigate burglaries anymore. They now find themselves squarely on the front lines of mental health reform.

It can be a dangerous place, as witnessed by an incident in Watauga County last month, when Deputy Sheriff Wes Hawkins was shot by a man who had just finished what he thought was a conversation with God.

Fortunately, Hawkins was wearing a bulletproof vest, and has recovered. But the incident is illustrative of the potential dangers that can be faced by police officers in today’s world.

Diagnosable mental illness is a very common condition. The National Institutes of Mental Health estimates about one in four U.S. adults suffers from a diagnosable condition in a given year.

However, more and more responsibility for dealing with the mentally ill has been shifting to local authorities in recent years. Because of that, in large cities, nearly 7 percent of all police contacts are with the mentally ill, according to The Criminal Justice/Mental Health Consensus Project. An especially touchy contact is where police are called to serve involuntary commitment papers.

The Buncombe Sheriff’s Department has used its SWAT team to serve such papers a minimum of 20 times over the last three years. In 2004 Sgt. Jeff Hewitt was slain while attempting to serve involuntary commitment papers. Overall, involuntary commitments are on the rise in places like Henderson County, where the numbers went from 458 in 2004 to 524 in 2005.

While law enforcement personnel are well-trained, this isn’t supposed to be their primary task. But now, with a growing population and fewer resources devoted to mental health issues, it often falls to local authorities to be the first contact with a person dealing with a serious mental health issue. From there, other issues that ideally require special training — transporting and housing an acutely mentally ill individual — must be handled.

Essentially, we seem to be sliding toward a world where local police authorities and emergency rooms are the first, second and third options when it comes to mental health.

Henderson County Sheriff George Erwin would like to see this stop-gap solution dumped for a real solution, and we agree with him. Erwin, teaming with mental health advocates, service providers and law officers, has formed a task force. It now has a hotline to help deal with issues related to involuntary commitments; additionally, his department now has an on-call psychologist via Mountain Laurel Community Services. Erwin said, “Let’s be proactive. Quit throwing Band-Aids on the wound.”

He’s right. The justice system is part of the solution here. It shouldn’t be as large a part as it currently is. Read more!

Smoky Mountain Center chimes in about mental health

By Merritt N. Shaw, Staff writer


In January, when board of health members came together for their annual retreat to discuss community health issues, one of the main discussions focused on mental health.

Donna McClure-Allen, co-owner of Mental Health Professionals, a private mental health practitioner in Franklin, was a guest speaker. She spoke of the specific problems a small practice like hers faces and the overall effect that mental health reform has had on mental health services in our community and in general.

Smoky Mountain Center (SMC) the local management entity (LME) for the seven most western counties, also has its own dilemmas and challenges resulting from mental health care reform.

In an interview Wednesday, Thomas McDevitt, CEO for Smoky Mountain Center, and Shelly Lackey, community relations coordinator, gave a different perspective as a local management entity as compared to a provider.

McDevitt said that, with the newly approved service definition for Medicaid that will go into effect on March 20, private practitioners will eventually be driven out of business if they don't take steps to conform to the new “best practices” treatment program.

The reason he gives is the way private-practice providers give treatment in individual therapy. As of March 20, the new service definitions require a para-professional, a professional with a bachelor's degree and a professional with a master's degree to be involved in the assessment of a patient to accurately diagnose the patient and to give that person the best treatment possible. All providers will be required to have these three types of professionals on staff to provide this kind of treatment and diagnoses.

This kind of treatment has been proven to work, McDevitt says. In one case he mentioned, a patient who had been going to individual therapy for 13 years claimed to have gotten more out of the community treatment model in three months.

The idea behind teams of professionals is to better diagnose a patient's illness. Instead of the possibility of one person making an incorrect diagnose or doctors taking a patient on his caseload because they have room and need the business, a team of professionals will do the diagnosis.

The dilemma lies with the smaller practitioners who can not afford to keep such professionals on staff and can't afford the staffing for administrative and billing duties - not to mention the day-to-day operations required to run a business as well as practicing psychiatry. The new Medicaid plan also requires stringent regulations for accreditation, which take time and money to achieve.

At the board of health retreat, Allen touched on the subject of having to partner with Mountain Youth Resources to be able to offer this kind of service.


Smaller businesses will be forced to partner with bigger businesses or nonprofit organizations in order to be able to offer the kind of treatment required by the new service definitions.

Western North Carolina's mental health system historically had Smoky Mountain Center as the sole entity for mental health services. SMC had all of its services such as administrative services, electronic record keeping and billing, as well as access to providers, under one umbrella. Then, in 2003, the state started a health care reform, which required treatment services to privatize.

SMC was required to become a local management entity and had to draft a local business plan to show the state how they would successfully transition to become an LME only. The state's reasoning was that separating the functions would eliminate any conflict of interest. Smoky was no longer allowed to be a health care provider as well as an LME.

So, in order to help providers make a smooth transition without interrupting services to the consumer, SMC offered office space at a reasonable rate, billing services, access to electronic records and other things that were already set up in the building, such as a receptionist, lobby area, etc. The local business plan was to be projected until 2007.

SMC, in order to help providers get started and to cut expenses, offered office space for rent at a lower price than renting a full building. Along with that rental came the services such as telephone service, email, internet, electronic medical record storage, billing services for Medicaid, etc.

Only a certain percentage of providers who left SMC to become private practitioners took advantage of the service.

All the providers (doctors, nurse practitioners, and caseworkers) who were once employed by SMC were looking for new jobs or starting their own businesses. SMC went from 400 employee to approximately 150 employees. Some went on to other fields of work. McDevitt explained that some private practitioners don't like reform because they just can't adapt to the change.

He admits it is hard to adapt to the ever changing laws.

“It crushed us to have believed in the Child Recovery Unit and the time and effort we put into that program and they took it away so easily by not including the service definition in the mental health reform plan. We could be bitter about it, but we can't. We have to be positive and try to focus on making other programs better,” said McDevitt.

Both McDevitt and Lackey agreed that state and federal funding is the main problem with providing the mental health services that are needed.


At some point, they say, there will be a point of crisis because of the way mental health care is funded. No matter how many people there are who need services the state and Medicaid only funds a certain amount of dollars. Agencies and facilities such as Balsam center or Meridian will have to shut down because the funds are not enough to sustain operation. Government agencies that are not in the business of making a profit, but are just trying to keep their doors open and provide services to people who need them, will go under. Then there will be no services. That's when the crisis will hit. It will result in state hospitals being overrun with patients.

“Even if they built three new state hospitals it still wouldn't accommodate the capacity that would develop if places like the Balsam center shut down. Balsam center treats people so they don't have to go to the hospital. They are treated individually, incorporating the family to eventually help them incorporate back into society,” McDevitt said.

Mental health care reform has been a long hard road with ever changing rules and regulations, but Smoky Mountain Center has tried coming up with new and innovative ideas to meet the needs of the community. These were some of the goals of reform that SMC feels they have reached and done successfully:

€ Create access.

€ Improve choice for consumers (the area has 2.5 times the providers it had three years ago).

€ Establish and implement evidence-based practice, which is a guideline that SAMHSA (Substance Abuse & Mental Health Services Association) requires.


€ Downsizing of hospitals and moving the patient load to the community. “The new disposition in the community is to prevent hospitalization. The idea was to take money that was saved or not used for those hospital beds and use it for other programs, etc. - but we never got the money,” McDevitt said.

€ Emphasis on outcomes. “This is the most important aspect. We are achieving results by being able to substantiate the success of team-type treatment. The system is in such disarray it is not focusing on the outcome,” McDevitt said.

€ Separate management of services from provider of services. The state mandated this in order to avoid conflict of interest. Now, the only services Smoky Mountain Center provides are psychiatric services and adult crisis recovery at the Balsam Center. The reason they are still the providers for these services are because they are needed and due to the rural nature of the community, there isn't a provider, yet, to take over these services.

SMC also take on provider roles that cross over into the community such as prevention information, for example if there were a teen suicide, SMC would go into the schools to educate and provide prevention information for the classmates. Other services they provide are screening, triage and referral services and finally crisis and emergency management care.

“ Every person is entitled to these services whether they have insurance or not,” McDevitt said. Read more!

Mental health care for homeless is focus - Raleigh News & Observer

Published: Feb 15, 2006 12:30 AM
Modified: Feb 15, 2006 02:52 AM
The News & Observer

Anne Blythe, Staff Writer

As Triangle leaders work to end chronic homelessness within the next decade, they say there is a dire need for low-cost housing with associated mental health programs to better keep the mentally ill homeless from a quick return to the streets.
Craig Chancellor, president and chief executive officer of Triangle United Way, made that pitch Tuesday as he released results from the most recent count of people trying to survive without homes in Wake, Durham and Orange counties.

At least 1,711 people were living under bridges, in abandoned cars, in the woods, on the streets or at emergency shelters Jan. 25 when volunteers fanned across the Triangle to make the annual count.

Nearly a third of the homeless were children, counters said.

At a time when the state is involved with a massive overhaul of its mental health care system, many advocates for the homeless worry that future counts might get higher if more money is not set aside for housing for the mentally ill. Nearly 30 percent to 40 percent of homeless North Carolinians are mentally ill, according to the state Department of Health and Human Services.

"Mental illness does not cause homelessness," said Terry Allebaugh, chairman of the Council to End Homelessness in Durham. "Homelessness, especially chronic homelessness, makes those conditions causing mental illness worse."

In 2001, when the state began making changes to the mental health care system, the goal was to move toward treating the mentally ill in community-based programs instead of big state institutions.

Consolidation planned

The state plans to close two hospitals, Dorothea Dix and John Umstead, within the next two years and replace them with one hospital with slightly fewer beds.

Mental health advocates worry about the day the hospitals close, saying that most emergency shelters are not designed for the needs of the mentally ill.

Too often, some mental health advocates say, the state is recycling some of the mentally ill from state hospitals to emergency shelters and back again.

Mike Hennike, chief of state operating services for the state division of mental health, developmental disabilities and substance abuse, said Tuesday that it can be difficult to find anything but emergency shelter for patients who must be released from state hospitals within 72 hours.

Before release, Hennike said, social workers arrange appointments with mental health programs in the community where the patient is going.

For any patient who has been at a state mental hospital for 30 days or more, very specific housing plans are made, Hennike said.

Chancellor, the chief of Triangle United Way, said the state needs to provide more money for housing, too. Rent for a one-bedroom apartment in the Triangle is, on average, nearly $700 a month, he said. Monthly income for someone receiving disability pay is $564.

"We have to be about knowing where people's incomes really are," Chancellor said.

BY THE NUMBERS
WAKE COUNTY

Population: 719,520

Total homeless: 981 in 2006; 1,106 in 2005; 1,235 in 2004

2006 snapshot: 649 individuals, 332 in families. Of that total, 213 were children and 106 of the people were on the street.

DURHAM COUNTY

Population: 223,314

Total homeless: 493 in 2006; 535 in 2005; 578 in 2004

2006 snapshot: 378 individuals, 115 in families. Of that total, 64 were children, and 42 of the people were on the street.

ORANGE COUNTY

Population: 115,531

Total homeless: 237 in 2006; 230 in 2005; 179 in 2004

2006 snapshot: 154 individuals, 83 in families. Of that total, 51 were children, and 37 of the people were on the street.

Staff writer Anne Blythe can be reached at 932-8741 or ablythe@newsobserver.com. Read more!

Mental health chaos - Raleigh News & Observer

Raleigh N&O opinion page


Taken together, recent stories in The N&O of patients discharged from psychiatric hospitals to homeless shelters (Feb. 13), turf wars within state government over money for mental health services, (Feb. 11), a lawsuit against the state by a local mental health agency (Feb. 10) and the rejection by the federal government in December 2005 of important elements of the state's Medicaid plan tell at least part of the story of unbelievable chaos within the division of the state Department of Health and Human Services that is supposed to take care of people with mental illness, developmental disabilities and substance abuse.
Readers who have loved ones with disabilities either know or soon will realize that services for their loved ones are being dismantled, downgraded or in many cases eliminated. Readers who are not currently affected by these disabilities soon will be, as our streets, hospitals and jails begin to fill up with people who no longer have an effective safety net.

Shame, shame, shame.

Victoria Shea, Ph.D.
Chapel Hill Read more!

N.Y.U. Plans Mental Health Center for Children - New York Times

By RICHARD PÉREZ-PEÑA
New York Times


New York University plans to build what it says will be the nation's largest pediatric mental health center to treat thousands of children and train thousands of doctors, and Gov. George E. Pataki has pledged more than $65 million in state funds for the project, which will help address a pressing need.

The centerpiece will be a $110 million 120,000-square-foot Child Studies Center on First Avenue, between 25th and 26th Streets, to open in 2009, university officials said. It will be dedicated mostly to outpatient treatment and research, but will have a small number of inpatient beds. The project also includes the construction of a children's psychiatric hospital in Rockland County.

The project, will be formally announced today at a ceremony with Governor Pataki and Mayor Michael R. Bloomberg. The state will contribute $30 million toward the center in Manhattan, the entire $35 million cost of building the Rockland hospital, and an undetermined amount — also in the millions of dollars — on research staff members at the hospital. Including a $50 million endowment the university hopes to raise for the Child Studies Center, N.Y.U. put the price of the entire effort at $200 million.

New York has an acute shortage of mental health services for children, especially for those on Medicaid, the government health plan for the poor. Children on Medicaid routinely wait many months to see therapists, and some give up and go without care. Each year, more than 1,000 children who need psychiatric hospitalization are sent out of state because there is no place in New York for them.

The state has long resisted granting new licenses for mental health centers. Some centers, like the one N.Y.U. has now, were able get licenses to operate, but not to be Medicaid providers.

But people involved in mental health say that in the last few years the state has become somewhat more receptive to allowing new centers. This year Mr. Pataki added $62 million for pediatric mental health services to his proposed budget. In N.Y.U.'s case, the state plans not only to allow a new center — an enormous one, at that — but also to license it to accept Medicaid payment, to cover a large share of the cost.

The governor said in an interview that the emphasis on research was a big part of the project's appeal, that "as new treatments, new concepts arrive, we're going to make sure that New York" is a leader in developing them. "We're going to do the most advanced treatment in the world, but we're also going to find the nature of the problems."

Dr. Harold S. Koplewicz, the director of the Child Studies Center, said, "We've been talking to the governor about this for two years, and I think he has recognized that instead of building new jail cells and wondering why kids drop out of school, if we front-loaded this and built more treatment centers, trained more doctors, that would be better."

The current N.Y.U. center accepts about 2,000 new children each year for outpatient treatment, and Dr. Koplewicz said that in the new center the number "will at least triple, if not quadruple." In addition to expanding its work on depression, anxiety, attention deficit and hyperactivity disorder, and other common problems, he said, the center will focus on autism, eating disorders and the science of genetics and the brain.

The number of child psychiatrists the center trains each year will double to 16, Dr. Koplewicz said.

"But more important," he said, "because there are never going to be enough child psychiatrists, eventually, we're going to train thousands of pediatricians a year in identifying and treating depression, anxiety, A.D.H.D. and autism as a routine part of their practice."

Mr. Bloomberg said that the center held out "the promise of revolutionizing our understanding of these types of mental health problems," and that "it will bolster our city's position as a global leader in medical and bioscience research."

News of the project — and the state's involvement in it — surprised people who work in children's health. Phillip A. Saperia, executive director of the Coalition of Voluntary Mental Health Agencies, a trade group, said the project was the latest sign, and perhaps the most impressive, of a change in the state's approach to children's mental health. "This is a very big deal," he said.

Dr. Irwin Redlener, president of the Children's Health Fund, which operates several clinics, said, "This is fantastic news." He added, "Whatever Harold Koplewicz did to make this happen needs to be replicated, because the state has been so adamant about not licensing or paying for new facilities."

Jeremy Snyder, 14, who has A.D.H.D., said that like many young people, he found that before he started going to N.Y.U.'s center, "It was such a struggle to find places to go, especially anyplace that could address all of my needs under one roof." He said the center had helped him overcome behavioral and academic problems.

The state operates a psychiatric hospital complex in Orangeburg, in Rockland County, and N.Y.U. plans to replace the existing pediatric hospital there with the one it intends to build. The plan is to use N.Y.U. students and faculty as staff members and bolster the research done there. Read more!

County backing Durham Center - Durham Herald-Sun

Durham Herald-Sun

BY GREGORY PHILLIPS : The Herald-Sun
gphillips@heraldsun.com
Feb 14, 2006 : 12:18 am ET

DURHAM -- The Durham County Commissioners have thrown their weight behind The Durham Center's plan to sue the state over control of local mental health care.

The county board voted unanimously Monday night to become co-plaintiffs in the legal action The Durham Center plans to take over the loss of utilization review -- the power to match consumers with services and authorize payment for mental health care in Durham.

The state announced two weeks ago Durham would not be among the local management entities -- also known as LMEs -- conducting utilization review after July 1, as part of a $28 million cost-cutting initiative. In response, the center's board voted Thursday to demand documentation to support the decision and to file suit alleging the state's plan violates its own statutes and a contract the Durham Center has through June 30, 2007, to conduct the reviews.

After a 25-minute closed session Monday night, the commissioners signed on to the Durham Center's action.

Chairwoman Ellen Reckhow, who also serves on the center's board, said County Attorney Chuck Kitchen advised the commissioners that as the Durham Center's primary source of funding, it's important they participate in the action.

"I'm hopeful the state will reconsider," Reckhow said. "We have really worked hard over the past three years to reconstruct our mental health services."

The Durham Center has followed the state's reform plans requiring LMEs to privatize services and retain only management functions, Reckhow said.

"We feel we should be rewarded for doing all the right things," she said. "Instead we feel this could be a major setback."

County Attorney Chuck Kitchen said the documents requested under public records law haven't been provided yet. He said a letter outlining the county's intentions will be sent to the state within the next two days and that the suit will be filed if there's no response after 10 days.

"We're just asking the state to allow us to provide those functions through the contract," Reckhow said.

Loss of utilization review would cost The Durham Center over $1 million in funding and about 15 of its 55 employees, according to its director Ellen Holliman. The center had been promised increased state funding based on its efforts to reduce admissions at state mental hospitals. However, the latest word from the state is that savings from reduced admissions at Dorothea Dix and John Umstead hospitals will be used to reduce debt on the new facility under construction at Butner.

Holliman said that plan "goes against the very essence of mental health reform," to direct money to local communities so care can be provided there.

Holliman said it hasn't been proved that using a private vendor to conduct utilization review will save the state money. She said what it would do is make it harder for people with mental illness, developmental disabilities and substance abuse problems to get effective help.

"You can't effect positive, lasting change if you don't have a comprehensive approach," she said. Read more!

Relatives of defendant talk about troubled past - Winston-Salem Journal

Tuesday, February 14, 2006

By Titan Barksdale
JOURNAL REPORTER

A man whom a jury found guilty Friday of killing a cook at a Winston-Salem restaurant was neglected by his schizophrenic mother and has battled a behavioral disorder throughout his life, relatives testified yesterday.

The sentencing phase in the trial of Jeremy Dushane Murrell began yesterday in Forsyth Superior Court. A jury will decide whether Murrell should be sentenced to death in the killing of Lawrence Matthew Harding, who was 19. Harding was a cook at South by Southwest restaurant on South Marshall Street.

Murrell, 26, was charged with murder in 2003 after detectives found Harding's remains in the trunk of a car in Richmond. Jurors last week found him guilty of kidnapping Harding from the parking lot of the restaurant, robbing him and shooting him to death.

Three of Murrell's relatives testified yesterday that their family has a history of mental disorders and it is likely that Murrell has inherited a mental disorder. Last week, exam results showed that Murrell was fit to stand trial, but Murrell's attorney has said that the exam was limited to competency.

Defense attorney Kevin Mauney told the jury during his opening statement that Murrell has had a dysfunctional family life, is battling a condition that's a precursor to schizophrenia and has improved his relationship with family while in jail awaiting trial.

"Our evidence is that (Murrell) does not deserve to die," Mauney told jurors.

The testimony of Edward Murrell, Jeremy Murrell's father, took up much of the day. He testified that shortly after he married Jeremy Murrell's mother, she started to show signs of mental problems. She often threatened to kill him, he said, as well as Jeremy Murrell and Pebbles Farrar, Jeremy Murrell's sister. They all lived on a military base in Philadelphia, according to Edward Murrell's testimony.

Murrell, who was a technical sergeant in the Air Force, was reassigned to California, and the children soon followed with their mother. Their mother later battled in court for custody of the children, Murrell said.

As part of the custody proceedings, a judge in California ordered that Jeremy Murrell and the rest of his immediate family take psychological exams. But before they could take the exam, Murrell's mother kidnapped the children, Edward Murrell testified. A judge awarded Edward Murrell custody of the children.

That was one of at least two kidnappings by the mother and the first of several trips for Jeremy Murrell from California to the East Coast, according to testimony. While on the East Coast, Jeremy Murrell would usually live with his mother or other relatives.

Edward Murrell said he had two automobile accidents, which led to his own mental disorders. He allowed the children to live elsewhere while he recovered.

The arguments increased between Jeremy and Edward Murrell after the accidents. Edward Murrell testified that voices told him to kill Jeremy Murrell and commit suicide.

"Jeremy would blow up at me for no reason," Edward Murrell said. "He would sit in the room, stare at the wall and not talk to anyone. When we tried to talk to him, it was like he couldn't hear us."

During Prosecutor Jim O'Neill's cross-examination of Edward Murrell, he questioned whether Jeremy Murrell really has a mental disorder.

"If you knew Jeremy Murrell had been diagnosed with a mental disorder, you would tell the jury now, wouldn't you?" O'Neill asked.

"That's what I'm trying to tell the jury," Edward Murrell replied. "I knew he had (mental) problems, but they went undiagnosed."

The only witness O'Neill called was Judy Harding, Harding's stepmother. The defense, who also called Jeremy Murrell's aunt, plans to call four to five additional witnesses before it finishes it case, Mauney said.

• Titan Barksdale can be reached at 727-7369 or at tbarksdale@wsjournal.com Read more!

Robeson facing Medicaid cuts on disabled students’ services

By Venita Jenkins

Staff writer

LUMBERTON — Providing one-on-one services for children with disabilities could cost more than $3 million a year, Robeson County school officials learned Monday.

For the past 10 years, mental health workers have helped the students in the classroom. Medicaid has paid for the services; but beginning March 20, it will stop paying for students who don’t have at least two diagnosed disabilities.

About 187 students receive the service. School officials aren’t sure how many students will be affected by the move.

School systems are not required to replace the service, but they must provide support services so students can continue progressing.

The state’s Exceptional Children Division plans to ask for money to support students who might lose the aid.

Board member John Campbell said many parents depend on the one-on-one assistance.
“I want to know what we have done to prepare for this,” he said.

School officials did a cost analysis and have met with representatives from the county’s Department of Social Services and the local mental health agency to find less expensive alternatives, said Linda Emanuel. She is assistant superintendent of instructional services and federal programs.

Superintendent Colin Armstrong said school officials didn’t think the changes would happen until July 1, said.

“Unless one of the children is Gov. (Mike) Easley’s nephew, it’s going to happen on March 20,” Armstrong said.

The board voted to send a resolution to the state opposing the March 20 deadline. Read more!

Our View: Mentally ill, hapless and homeless isn’t an outcome to accept - Fayetteville Observer

Published Wednesday, February 15, 2006
The Fayetteville Observer

North Carolina cares enough about its residents’ problems that the General Assembly appropriated $602 million for mental health services in this fiscal year.

But the state cares so little that psychiatric patients are still released to the streets. It’s another story where good intentions don’t produce good outcomes.

Officially, these patients aren’t sent to the streets — they are released to homeless shelters. There, they get a cot and a blanket. What they don’t get is someone who reminds them of their mental health appointments and monitors their medications. Shelter workers aren’t trained to deal with illnesses like schizophrenia, bipolar disorder or chronic depression. But they have to learn.

In 2004, the state released 1,140 psychiatric patients to shelters, up from 763 in 2000. It’s anyone’s guess how many of them got their lives together — and how many ended up living in cardboard boxes under freeway overpasses.

State officials say the rising cost of housing is one reason released patients end up in shelters. The law requires the state’s four psychiatric institutions to release most patients who are in for evaluations. They must go someplace, and costs are a problem for mental health officials as they try to figure out where to send patients who can’t afford rent or mortgage payments.

Advocates for the mentally ill blame changes in mental health policies — federal and state — for homelessness among the mentally ill. The state is transferring most patient-treatment responsibilities to communities. But counties haven’t kept up with the state’s pace when it comes to these changes.

Mentally ill people with no place to go after an evaluation need more help than shelters offer, regardless of whether the state or counties send them there.

The private sector will be taking over some mental health services. But the state and local communities can’t forget patients once those contracts are signed. Problems of abuse and neglect in some group homes taught Cumberland and Mecklenburg counties why private caregivers need to be inspected.

The state Department of Health and Human Services has made the homeless issue a high priority, which is promising. The state can offer a list of reasons why community care is best in the long run.

But today, there are at least 1,140 reasons why the system isn’t working. Read more!

Officers on front lines of helping mentally ill: Henderson sheriff wants help from state in dealing with issue - Asheville Citizen-Times

by Angie Newsome, STAFF WRITER

published February 15, 2006 6:00 am

Wes Hawkins had set out to investigate a complaint of someone throwing rocks at a mobile home the day he was shot.

But the Watauga County sheriff’s deputy barely made it out of his patrol car before coming under fire from a man whose attorney later argued had been convinced he was following God’s orders.

After a three-hour standoff involving about 50 officers on Jan. 29, authorities charged Gary Powers, 56, with attempted murder and two counts of assault, a case that highlights a dangerous trend for law officers.

In an era of mental health reform, officers more often are finding themselves responding to and watching out for people with suspected or confirmed mental illnesses.

Examples from around the region include:

• The Buncombe County Sheriff’s Department in the last three years has used its special response team — often called the SWAT team — at least 20 times to serve involuntary commitment papers, Capt. Lee Farnsworth said. Thirty-four-year-old Sgt. Jeff Hewitt was shot to death in 2004 while trying to serve involuntary commitment papers on a man who later took his own life.

• In Henderson County, involuntary commitments rose to 524 in 2005 from 458 the year before, Sheriff George Erwin Jr. said.

• Watauga County officers served more than 200 involuntary commitments in 2005, said Sheriff Mark Shook, up from the year before.

In the Watauga shooting, an attorney for Powers said in court papers that Powers had “talked about having a conversation with a ‘large bearded man on my roof’ who was shooting a rocket launcher. This ‘large bearded man’ told him he was the Lord, and told him to kill Deputy (Wes) Hawkins.”

While some encounters can turn deadly, Shook said Tuesday Hawkins has recovered after being hit in the arm and chest. He was wearing a bulletproof vest.

“This fellow was just having a bad day and he saw the patrol car and apparently thought the officer was there for him,” Shook said. “He came out with his gun. It could have been a real bad situation.”

The shift in responsibility

Though as many as 50 million Americans have experienced some form of diagnosable mental illness, most will never have an encounter with police. The Criminal Justice/Mental Health Consensus Project says about 7 percent of all police contacts in large cities involve a person with a mental illness. The Council of State Governments coordinates the national project.

But when officers can help, they often are stymied by a system where there is more demand for help than places to get it.

The increase in calls for help, they say, likely stems from a combination of an increasing population and recent reforms in how the state cares for the mentally ill.

Henderson County’s Sheriff Erwin has asked for state help before and said Tuesday he plans to keep pushing to make state mental health professionals keep better track of where officers can take the mentally ill for help.

When someone is involuntarily committed, counties must transport the patient to and from the facility. Officers often spend hours with someone in the emergency room, waiting to find a bed in a treatment facility.

“A lot of the responsibility for the mentally ill has shifted to the local government,” Farnsworth said.

But most officers receive relatively little training on how to handle someone who may be psychotic, paranoid or suicidal.

“These aren’t always the most sympathetic people in the world. A lot of times people have a hard time believing they’re not acting this way on purpose,” said Ron Honberg, legal director for the National Alliance for Mental Illness, a support network for the mentally ill and their families. “A lot of times, the officers are just scared. They’re human beings, too.”

Looking for a model

Florence Rowe, a member of the board of directors of NAMI Western Carolina, said the group wants local law enforcement to take a look at the model offered by Memphis, Tenn.

Memphis was the first police department in the nation to offer specialized, in-depth training for officers to handle mental health crises. Memphis police Maj. Sam Cochran estimated as many as 500 communities have instituted programs modeled on it.

Prompted by a 1987 standoff ending in a mentally ill man’s death, the department created the Crisis Intervention Team. Its members learn how to approach and talk to someone in crisis to defuse a situation before it escalates.

“Quite often, a mentally ill person will appear to be threatening out of their confusion, and, as a result, the police are understandably concerned about their own safety and react,” said Rowe, who added jails are the largest treatment centers for the mentally ill.

Henderson County Detention Center’s nurse, Karen Styles, agreed. In 2005, the center housed 72 acutely mentally ill inmates — or those openly psychotic, for example, but who had not been in treatment. It housed 108 others who were on medication for mental illness.

“We have a real hard time getting anyone committed into a psychiatric unit,” she said. “Once an inmate is in jail, we’re told they’re safe here, that we provide a safe environment for proper treatment.”

Erwin said more should be done.

About six months ago, he formed a mental health task force of officers and local mental health service providers and advocates.

The committee formed a hotline for magistrates and others looking for help in involuntary commitments. The department also has an on-call psychologist available from Mountain Laurel Community Services. And they are looking to the Memphis program to create a model for Henderson County.

“We can have an impact in Western North Carolina,” he said. “If people only knew how much this impacts the criminal justice system, but the health care system, let’s be proactive. Quit throwing Band-Aids on the wound.”

The Associated Press and Gannett News Service contributed to this report. Read more!

Parents sue Guilford over daughter's fatal jump from ambulance - The Associated Press

THE ASSOCIATED PRESS
Tuesday, February 14, 2006

GREENSBORO

The parents of a woman who jumped from a moving ambulance and was fatally injured want Guilford County to pay for $2.3 million, saying medics failed to properly restrain their mentally ill daughter.

Alma Jean Collins, 28, was injured early Feb. 11, 2005, when she unbuckled her safety belt, opened the rear doors of the ambulance and jumped out as it drove 40 mph. She died six days later.

Archie and Jean Collins claim two emergency technicians erred by not properly restraining their daughter, who had bipolar disorder. They also say she was left unattended when one technician turned her back to give her colleague directions to a hospital.

The claim, which is not a lawsuit, offers to absolve the county for damages caused by "clear negligence" in exchange for a settlement. It proposes the county pay medical and funeral expenses, plus projected future earnings for Alma Collins, who had left her job on disability in February 2004.

The Collinses referred questions to their attorney, who declined to comment.

County Attorney Jonathan Maxwell could not be reached for comment Monday evening.

Read more!

A safety net: North Carolina is right to use state funds to provide critical services for the mentally disabled that Medicaid disavows - N&O

Who knew the government health insurance program for the poor has been paying for job coaches? North Carolinians are finding out about all manner of community services that Medicaid has provided for the mentally handicapped, now that federal administrators are pulling the plug.

They're also learning just how vital services like job coaching can be to the 5,000 disabled people who receive them. So it's heartening that the state Department of Health and Human Services promises to continue those services, with state money where necessary, when federal subsidies end in March.

To extend that commitment into the next budget year, the General Assembly will need to set aside about $30 million. It's early, but Governor Easley rightly assigns high priority to protecting the state's most vulnerable citizens. The public should expect his budget to reflect that priority and provide enough money for the transition to a patient-centered mental health system.

At a recent legislative hearing, Rose Reaves of Raleigh expressed the terrible fear of the changes that many disabled people feel. Her job coach, paid by Medicaid, provides the training and other support that Reaves, 39, needs to do her work at Papa John's Pizza. Understandably, she dreads losing her coach in a bureaucratic coverage gap.

Because of that job, this woman with cerebral palsy, who grew up in foster homes, is able to live independently and give back to her community. Not only does she vote in every election, Reaves does more than her share of volunteer work and advocates for others with disabilities. North Carolina leaders would do their state proud by shoring up the foundation of Reaves' independence.

In terms of state pride, lawmakers need to make up for lost time. One of the steps legislators have taken to solve budget problems has been to dip callously into a fund that was created to help patients while old state mental hospitals are being phased out.

In the wake of those decisions, North Carolina has seen shameful gaps in the care of its most vulnerable citizens. Patients have been discharged to homeless shelters in communities where private services have been slow to take root.

A revamped schedule of services that federal funds will cover has already started to ease that problem. Yet the state is bound to encounter unanticipated needs. It should approach them just like it has approached services for the mentally handicapped: Take care of people first.

The process must begin with Governor Easley submitting a budget that includes the $30 million needed for Rose Reaves and the others. And the governor ought to be relentlessly asking if there are other necessary services left uncovered. If the legislative leadership shares his priority on protecting vulnerable people, as it should, then North Carolina will be on its way toward the wisest and most compassionate budget in years. Read more!

Budget chief: Savings will go to new facility - Raleigh News & Observer

Lynn Bonner, Staff Writer

Money saved by moving patients out of two state psychiatric hospitals should be used to build a new hospital in Butner rather than to bolster programs in communities, Gov. Mike Easley's budget chief ordered.

The state Department of Health and Human Services has already transferred millions out of the hospitals to pay for patient placements in adult-care homes, day programs and other services. Budget officer David McCoy, in a Jan. 23 letter to department secretary Carmen Hooker Odom, said mental health administrators should stop transferring the money without his office's permission.

An important goal of the massive mental health overhaul the state started in 2001 was to treat the mentally ill in community programs or local hospitals instead of big state psychiatric institutions. The money saved at the state level was meant to pay for for beefed-up community services.

With a network of programs in communities, the state predicted it could close two state psychiatric hospitals, Dorothea Dix in Raleigh and John Umstead in Butner, and house fewer patients in a new $108 million hospital built on state land in Butner. Those plans have moved forward, but efforts to establish more services and treatment in communities have met snags.

Counties have complained, and state mental health administrators agree, that cities and towns do not have enough mental health programs and specialists to care for people close to their homes.

Hooker Odom said the department plans to ask for more money for community mental health programs in the next state budget to make up for the loss of hospital transfers.

"It is not a death blow to community services," she said.

But county mental health administrators were dispirited by the news that money from the hospital transfers would not be funneled to their programs.

"Outrageous," said Carol Duncan Clayton, executive director for the N.C. Council of Community Programs.

"Do we want to serve people in the community or not?" Clayton asked. "Before the hospital plan was ever written, they should have figured how they were going to pay off the debt."

In his letter, McCoy said that money saved from Dorothea Dix and Umstead in the next two years must go to paying for the new hospital. Debt payments are $4 million this year and $8.9 million next year.

Any extra money saved at the hospitals could probably go to community programs, Hooker Odom said.

State Rep. Verla Insko, a Chapel Hill Democrat helping run a legislative oversight committee on mental health services, said she had not heard about the decision to use hospitals savings to pay new debts.

Insko didn't object to using hospital savings for debt payments, saying the real trouble is that the state legislature has not devoted enough money to community mental health services.

"The department can only work with the money they have," she said. "We don't always give them an easy way to fulfill their mission." Read more!

A Strange System - Letter to the editor/News & Observer

Imagine my surprise when I recently discovered that Central Prison in Raleigh has its own 144-bed psychiatric in-patient hospital embedded within the prison hospital system. What a relief! Finally a solution to the mental health reform process.
Instead of Wake County spending so much energy, time and money in efforts to replace Dorothea Dix Hospital's acute-care beds for county residents by building a freestanding psychiatric hospital, I have a more cost-effective, quicker solution. Let's send all individuals who need acute psychiatric care to the prison hospital.

When looking at the incarcerated population, psychiatric illnesses are already overrepresented. Many individuals there probably should have been diverted to mental health care rather than the prisons. But why buck a trend? If we are already sending some of the mentally ill to prison, at least they get psychiatric in-patient care. Let's not discriminate! Everyone should have access to that care. Send them all to the prison.

Now all we have to do is raise more money for more prisons. This seems a much easier task.

Seth E. Tabb, M.D.
Child, Adolescent and Adult Psychiatrist
Cary Read more!

Mental health agency will take state to court: Durham Center says law violated - Raleigh News & Observer

Eric Ferreri, Staff Writer

Durham's public mental health agency plans to sue the state's Department of Health and Human Services, claiming that a pending statewide reorganization of mental health services violates the law.

The governing board of The Durham Center authorized the county Thursday to file two lawsuits on its behalf.

In one of the lawsuits, the Durham agency will claim that a DHHS effort to restructure and streamline the state's mental health agencies and practices is against the law because there is no law allowing it. In addition, the lawsuit will claim that the reorganization will unlawfully break a contract The Durham Center has to be reimbursed by the state for providing local mental health services through 2007.

A separate lawsuit will try to force the department to turn over scoring sheets and other documents that would explain why The Durham Center was not selected, under the reorganization, to conduct "utilization review." That is essentially the power to authorize and oversee health services for its clients.

Last week, The Durham Center's director, Ellen Holliman, learned in a phone call that her agency would not retain utilization review authority when the restructuring takes effect this year. The center has had the authority for three years.

On Thursday, The Durham Center governing board's chairman said the state agency and its secretary, Carmen Hooker Odom, are acting irresponsibly in attempting the restructuring, which aims to save $28 million a year.

"We feel like the secretary is on a rogue mission; she's just doing things she shouldn't be doing," said Doug Wright, the board chairman. "We think the actions she's taking are far above her authority, and we're sick of it."

Mark Van Sciver, a Health and Human Services spokesman, said late Thursday that he couldn't comment on the lawsuit because it hadn't been filed. A spokeswoman, Debbie Crane, said the agency plans to turn over as much of the documentation as it can today. Some of information The Durham Center requested, such as an official letter denying Durham the authority, doesn't exist because decisions haven't been finalized, Crane said.

Under the reorganization, The Durham Center had hoped to be one of several agencies to receive the utilization review authority. That would enable the center to review case work for a regional cluster of mental health agencies. Though it wasn't selected to conduct utilization review, The Durham Center was tapped to manage screening, triage and referral services at night and on weekends.

Earlier this week, the head of the state mental health division said that, though The Durham Center didn't score well enough on an evaluation to retain the review authority under the restructuring, he hopes the center will be able to grow into the role. Read more!

Durham Center jousts with state - Raleigh News & Observerr

Eric Ferreri, Staff Writer

Though Durham's mental health agency is losing its ability to authorize and manage health-care services, a state official said Wednesday he thinks the county department may eventually regain the proper certification.

A week ago, The Durham Center got word from the state Department of Health and Human Services that under a new administrative reorganization it would not be selected as one of a handful of sites across the state allowed to conduct "utilization review" -- essentially the power to authorize and oversee health services for its clients. The center has the authority now but stands to lose it in the restructuring, which is under way in an attempt to cut annual costs by $28 million.

The center's governing board, vexed by what it deemed an insufficient explanation, quickly fired off a letter to the state agency last week requesting more information. The board plans to discuss the issue at a meeting this afternoon.

On Wednesday, the head of the state agency's mental health division said The Durham Center simply hadn't scored as well on an evaluation as some others but still appears able to improve and receive the certification.

"What we were saying to Durham and some others is that you're not ready now, but you have the ability to build the capacity to perform the function," said Mike Moseley, division director for mental health, developmental disabilities and substance-abuse services.

Ellen Holliman, director of The Durham Center, said Wednesday that her agency has received no official information from the state other than one phone call last week and is still largely in the dark about what's expected of it.

"To be real honest, it's hard for us to know what they're requiring," Holliman said, "because according to what we know, we've met their criteria. What is it they want us to do?"

The Durham Center has been conducting utilization review for about three years and authorizes, on average, about 3,000 health services each month. The loss of certification could cost the agency $1 million in annual state funding, officials have said. It might also result in less personal care to clients and might increase the number of people in state hospitals, center officials have said, because they might not be advised to seek specialized care. Read more!

Michael Moore Takes On Health Care --- Seeks Input

Friends,

How would you like to be in my next movie? I know you've probably heard I'm making a documentary about the health care industry (but the HMOs don't know this, so don't tell them -- they think I'm making a romantic comedy).

If you've followed my work over the years, you know that I keep a pretty low profile while I'm making my movies. I don't give interviews, I don't go on TV and I don't defrost my refrigerator. I do keep my website updated on a daily basis (there's been something like 4,000,000 visitors just this week alone) and the rest of the time I'm... well, I can't tell you what I'm doing, but you can pretty much guess. It gets harder and harder sneaking into corporate headquarters, but I've found that just dying my hair black and wearing a skort really helps.

Back to my invitation to be in my movie. Have you ever found yourself getting ready to file for bankruptcy because you can't pay your kid's hospital bill, and then you say to yourself, "Boy, I sure would like to be in Michael Moore's health care movie!"?

Or, after being turned down for the third time by your HMO for an operation they should be paying for, do you ever think to yourself, "Now THIS travesty should be in that 'Sicko' movie!"?

Or maybe you've just been told that your father is going to have to just, well, die because he can't afford the drugs he needs to get better -- and it's then that you say, "Damn, what did I do with Michael Moore's home number?!"

OK, here's your chance. As you can imagine, we've got the goods on these crooks. All we need now is to put a few of you in the movie and let the world see what the greatest country ever in the history of the universe does to its own people, simply because they have the misfortune of getting sick. Because getting sick, unless you are rich, is a crime -- a crime for which you must pay, sometimes with your own life.

About four hundred years from now, historians will look back at us like we were some sort of barbarians, but for now we're just the laughing stock of the Western world.

So, if you'd like me to know what you've been through with your insurance company, or what it's been like to have no insurance at all, or how the hospitals and doctors wouldn't treat you (or if they did, how they sent you into poverty trying to pay their crazy bills) ...if you have been abused in any way by this sick, greedy, grubby system and it has caused you or your loved ones great sorrow and pain, let me know.

Send me a short, factual account of what has happened to you -- and what IS happening to you right now if you have been unable to get the health care you need. Send it to michael@michaelmoore.com. I will read every single one of them (even if I can't respond to or help everyone, I will be able to bring to light a few of your stories).

Thank you in advance for sharing them with me and trusting me to try and do something about a very corrupt system that simply has to go.

Oh, and if you happen to work for an HMO or a pharmaceutical company or a profit-making hospital and you have simply seen too much abuse of your fellow human beings and can't take it any longer -- and you would like the truth to be told -- please write me at michael@michaelmoore.com. I will protect your privacy and I will tell the world what you are unable to tell. I am looking for a few heroes with a conscience. I know you are out there.

Thank you, all of you, for your help and your continued support through the years. I promise you that with "Sicko" we will do our best to give you not only a great movie, but a chance to bring down this evil empire, once and for all.

In the meantime, stay well. I hear fruits and vegetables help.

Yours,
Michael Moore
michael@michaelmoore.com

Read more!

Nowhere to Go: State hospital moving patients into area's homeless shelters - Wintson-Salem Journal

By M. Paul Jackson
JOURNAL REPORTER

Sunday, February 5, 2006

Christopher Dobbins, 23, was released from John Umstead Hospital, a state psychiatric hospital in Butner, after a six-day stay in November. He was dropped off by Forsyth County deputies at the Samaritan Ministries homeless shelter in Winston-Salem carrying his clothes, his prescribed medication for clinical depression and schizophrenia, and little else.

"Most people want to fight you or want to steal your stuff," Dobbins said of his second stay at the shelter. "I can't deal with the loud arguments. I can't deal with these people yelling at me."

North Carolina treated and sent 1,140 mental-health patients such as Dobbins to homeless shelters in 2004, compared with 763 in 2000, according to state records.

Mental-health advocates accuse the state of having no consistent plan to care for thousands of homeless patients once they're discharged from a state hospital and leaving the responsibility to shelters that are ill-equipped to manage those patients.

Without such care, many patients are ending up back on the street, they say.

North Carolina health officials counter that state hospitals cannot keep patients after their mental evaluations are over and blame the rise in discharges on a lack of housing for low-income residents.

Still, critics say, the growing homeless numbers are another example of the cracks in North Carolina's mental-health care system. Without sufficient care, thousands of mentally ill homeless patients are simply being recycled in and out of the state's psychiatric hospitals, with few afforded off-ramps to stability.

"There's so much pressure to reduce bed use. Folks are being discharged in unstable conditions," said Marvin Swartz, the head of the psychiatry and behavioral sciences department at Duke University. "My concern is that we're putting too much attention on hospital-bed utilization and having these sorts of unintended consequences."

An investigation by the Winston-Salem Journal last year showed how the overhaul of the state's $2.3 billion mental-health system that began four years ago has failed to adequately provide services for the more than 358,000 North Carolina residents who have mental-health problems.

The series called "Breakdown: A Crisis in Mental-Health Care," detailed how the plan to shift care from public state hospitals to private community agencies relied largely on flawed assumptions about government payments for mental-health programs and the ability of smaller community agencies to provide care. The changes in the state's mental-health system were supposed to reduce reliance on its four mental hospitals. Instead, admissions to those hospitals have increased. In addition, private mental-health agencies have found it difficult to provide care for the state's neediest patients.

Mental-health advocates also say that the state has failed to deal with significant problems associated with the mentally ill, including finding them much-needed, 24-hour crisis care and housing designed for their specific needs.

"It's unfortunate that they would consider a homeless shelter to be an acceptable option" for mental-health patients, said Benjamin Staples, the executive director of the state branch of the National Alliance on Mental Illness in Raleigh. "I think it's just passing the buck."

Reduced role for the state

North Carolina started to overhaul its mental-health system in 2001, hoping to reduce the state's role in caring for patients who, many said, could be better cared for in their own communities.

As a result, the state has closed 441 of its state psychiatric beds since 2001. State and local mental-health officials have also worked harder to shorten the time that patients spend in state hospitals.

The state operates four mental hospitals - Umstead, Broughton Hospital in Morganton, Dorothea Dix Hospital in Raleigh and Cherry Hospital in Goldsboro.

According to figures from the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services, the hospitals have had to release more and more patients to homeless shelters.

The figures include duplicate discharges, meaning that patients who were repeatedly discharged are counted more than once.

State housing advocates said that the increase stems partly from a housing shortage for lower-wage North Carolinians.

A patchy job market, coupled with inadequate federal money for subsidized housing, has left more residents unable to afford homes, said Chris Estes, the executive director of the N.C. Housing Coalition, an advocacy group in Raleigh.

"With people in a high-risk area, any kind of economic crisis kind of throws them back into a shelter," he said.

At the Bethesda Center for the Homeless, the rising number of mental-health patients has put a strain on its ability to house residents effectively, said Stephanie Sanders-Pratt, the center's supportive-services director.

The center, on Patterson Avenue, houses about 150 homeless men and women at any one time and takes in about five psychiatric patients a month, Sanders-Pratt said. The center has one manager to oversee residents during the day and usually three at night, she said.

Even so, those managers are not trained in counseling psychiatric patients, and there are no staff members to dispense residents' medications or remind them when to take their drugs, she said. Patients who are in crisis are simply picked up by the police.

"We have monitors who don't have the experience in mental health, so there's no communication that 'this is a mental-health diagnosis,'" she said. "This is what we deal with on a daily basis. It's been difficult."

For residents with mental-health problems, shelter life can also be difficult.

Keeps to himself

Dobbins, a quiet, shy man, came to Winston-Salem from Southern Pines last fall. He had originally moved here to be with a former girlfriend, and family problems prevent him from moving back home, he said.

Because of his illness, Dobbins prefers to keep to himself. He spends much of his time reading crime fiction and Harry Potter novels in the central branch of the Forsyth County Public Library. He said he hopes to attend Forsyth Technical College Community College as a nursing student next semester.

Most of Dobbins' days are unstructured. He interacts with few people and tends to split his time quietly between Samaritan Ministries and the Bethesda Center up the street. He said he has occasionally gotten into fights at Samaritan Ministries, mainly because of his mental illness.

"They know when you're trying to isolate yourself, and then they pick on you worse," he said. "This is the stuff I deal with every day in the shelter."

Hospital social workers typically try to find housing for patients who stay longer than 60 days for treatment, but they cannot arrange housing for shorter-stay patients, who are more numerous, said Michael Hennike, the chief of state-operated services for the N.C. Department of Health and Human Services.

The state's system of alerting agencies and homeless shelters about their discharges is inconsistent.

Hospital social workers are supposed to alert the region's local-management entity - the public agency that oversees mental-health services in a particular area - when the hospital is discharging a homeless patient.

But with fewer state hospital beds, many patients stay in the hospital for only a few days, and social workers cannot always notify public agencies of every discharge, Hennike said.

"The shorter the stay and the higher the volume, the more complicated getting all these things done becomes," he said. "I would suspect there are occasions when this happens, but that's not standard operating procedure."

Officials at CenterPoint Human Services, the local public agency that oversees mental-health care, said that the agency does not always receive advance notice from Umstead social workers.

Patients discharged to homeless shelters typically have their medical information - including their diagnosis, their prescribed medication and any scheduled appointments with a mental-health agency - sent to CenterPoint, said Burch Johnson, CenterPoint's care coordinator

But, Johnson said, he does not always receive patients' information, which can make it difficult for him to coordinate their care with a mental-health agency.

The lack of advance notice means that shelters typically have to arrange mental-health services for their residents.

Priscilla Cooke, the case manager for the Salvation Army shelter on Trade Street, said she will often call outreach workers from local agencies who can arrange to have a resident seen by a mental-health agency.

The shelter houses more than 50 people, primarily women and families. Cooke said that none of the shelter monitors are trained in how to deal with patients in crisis.

Success story in Durham

Some homeless shelters have been able to successfully manage their influx of new residents. The Durham Rescue Mission in Durham has an employee who is responsible for dispensing medication to the mission's mentally ill residents daily, said Ernie Mills, the mission's executive director.

Few other shelters have an employee to oversee residents' medication.

The 24-hour mission in Durham, with a $2 million budget, has about 20 employees and houses 170 people. Mills said that the mission takes in about four state psychiatric patients a month.

Local shelters, in contrast, do not have Durham's budget. The Salvation Army's local shelter budget is about $1.1 million annually, higher than both the Bethesda Center and Samaritan Ministries' annual budgets.

Mills acknowledged that the Durham rescue mission is different from other shelters, but he said that providing more services for mental-health residents is key.

"Most shelters are not treatment centers; they're just Band-Aids," he said. "We want to be more holistic in our approach. It takes a whole lot more staff, but we feel like the end result is worth it."

Advocates for the homeless and mentally ill said that more emphasis needs to be placed on finding affordable housing for such people.

The N.C. Department of Health and Human Services began a 10-year plan to end homelessness early last year, as part of a national plan.

The plan, which is still being drawn up, includes changing discharge-planning procedures in state mental hospitals, creating new shelter beds in communities without shelters and persuading legislators to spend money on community services.

"The discharge solution is a housing solution," said Michael Moseley, the director of the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services. "Folks with mental illness need housing," he said. Without it, he said, "people just recycle."

Moseley said that mentally ill and homeless people need more care, jobs and a stable environment to get them back on their feet. "It's going to take a holistic response to really get at it," he said.

Providing more housing for the homeless will cost money. Winston-Salem and Forsyth County officials unveiled a plan last month to spend about $8 million annually to build nearly 600 housing units for the homeless by 2015.

State housing officials estimate that it will cost more than $300 million to build or renovate more than 3,500 housing units for homeless North Carolinians by 2009 - an expense that some homeless advocates worry will not be approved by legislators.

"We've got sort of this survival-of-the-fittest mentality that's going on," said Obie Johnson, a homeless-outreach coordinator for Step One Substance Abuse Services in Winston-Salem. "We just don't have enough rungs on the ladder for people to be climbing onto, but we prefer not to talk about that."

For mental-health patients such as Christopher Dobbins, life remains up in the air.

Dobbins checks in twice a month at Daymark Recovery Services, a local mental-health agency, and he's still staying at Samaritan Ministries. The shelter allows residents to stay for only 90 days, but it gave him an extension this month.

He said that Daymark officials are trying to find him a place in a group home, but he did not know how long that could take.

"It's hard living in a homeless shelter," he said. "If you have a mental illness, you're not used to coping with this everyday life."

• M. Paul Jackson can be reached at 727-7473 or at mjackson@wsjournal.com Read more!

House OKs Cuts to Medicaid, President Expected to Sign Measure Soon - NAMI.org

House OKS Cuts to Medicaid, President Expected to Sign Measure Soon

The House gave final approval to a $39 billion package of budget cuts on February 1, 2006 that will result in major changes in Medicaid, including reductions aimed at beneficiaries across all eligibility categories and new flexibility for states that could result in higher cost sharing for recipients with mental illnesses and other disabilities. The vote was 216-214.

The legislation -- known as the budget reconciliation bill (S 1932) -- now moves on to the White House where President Bush is expected to sign it into law. This marks the end of a six-month struggle to stave off changes to Medicaid that are likely to result in renewed state efforts to shift cost sharing onto beneficiaries for services such as prescription drug benefits, case management, and early intervention services for children.

NAMI is extremely grateful to advocates across the country that worked to oppose this legislation. The struggle now shifts to the state level as governors, state legislators, and state Medicaid directors weigh changes that could have a profound impact on the way the program serves the most vulnerable beneficiaries, including mandatory beneficiaries eligible for SSI.

What Happens Next?

Once the measure is signed into law, new guidance will be provided to state Medicaid agencies by the federal Centers for Medicare and Medicaid Services (CMS) outlining new discretion to make changes in their programs -- largely without having to seek waivers from the federal government for protections that currently exist in federal law.

NAMI is most concerned about the potential for states to be able to:

Impose higher cost sharing on Medicaid recipients with mental illness for "non-preferred" drugs and "non-emergency services in emergency rooms,"
Require Medicaid recipients to pay higher premiums to participate in Medicaid,
Realign optional services to limit access to targeted case management that is integral to programs such as assertive community treatment, and
Create alternative benefit packages that do not include all of the services traditionally required under Medicaid.
NAMI will be working with state affiliates across the country to carefully monitor the activities of states seeking to use their new authority to ensure that any changes do not adversely impact children and adults living with mental illness. NAMI will also be working with state and local NAMI affiliates to advocate vigorously against such changes.
Read more!

Judge rips state on care for mentally ill children - Boston Globe

Judge rips state on care for mentally ill children
Ruling requires more home-based aid for the poor
By Scott Allen, Globe Staff | January 27, 2006

Massachusetts has illegally forced thousands of mentally ill children ''to endure unnecessary confinement in residential facilities" because the state did not provide adequate care for them at home, a federal judge ruled yesterday, handing a major legal victory to advocates for low-income children who rely on the state-run Medicaid program for their healthcare.

The long-awaited decision by US District Judge Michael A. Ponsor found in favor of the families of eight low-income children who sued the state in 2001 over the unavailability of mental health services such as counseling, crisis intervention, and coordination of care. The ruling applies to about 15,000 low-income children statewide with serious mental health problems. Most are not currently institutionalized, but are not getting proper care while at home.

Ponsor ruled that the state does a ''woefully inadequate" job of monitoring low-income children to be sure their mental health needs are met, violating federal Medicaid law.

Ponsor gave the Romney administration and the plaintiffs until Feb. 23 to negotiate a plan to drastically expand home-based services, and he made it clear that the reforms need not cost more money. He called it ''one of the painful ironies" of the case, known as Rosie D. v. Romney, that the state wastes vast amounts of money on institutionalizing children who could have received better, cheaper care by getting counseling or other care while living at home.

''This is a stunning victory for children with serious emotional disturbances in Massachusetts and throughout the country," said Steven Schwartz, executive director of the Center for Public Representation, the nonprofit, advocacy-oriented law firm that filed the lawsuit. Since Ponsor is a federal judge, Schwartz said, his decision would set a precedent for other federal lawsuits seeking to force states to provide various services to Medicaid recipients.

Officials in the Romney administration said they were analyzing the 98-page decision, and they ponted out that Timothy Murphy, the health and human services secretary, was in Washington, D.C., yesterday. After consulting with him, ''we will decide if we are going to appeal," said Dick Powers, Murphy's spokesman.

In the past, the Romney administration has argued that the state is already improving the mental health system, having recently started small, community-based programs in Cambridge, Worcester, and other locations. The assistant attorney general representing the state argued unsuccessfully that Ponsor should consider improvements the state made after September 2004, when the judge stopped accepting new evidence.

The decision by Ponsor, whose court is in Springfield, follows a similar ruling last year that Massachusetts is not providing enough dental care for low-income children who rely on MassHealth, the state Medicaid program. The federal law that governs Medicaid requires states to ''provide all reasonably necessary medical care regardless of ability to pay," which has inspired lawsuits on behalf of the poor all over the country. Schwartz said the Rosie D. decision is the first time a federal judge has weighed in on the need for home-based mental health services.

Ponsor's ruling climaxes a long-running battle over so-called ''stuck kids" who remain longer than medically required in hospital psychiatric wards, group homes, or specialized foster care because of the very limited availability of home-based care for them. All of the children named in the suit suffer from ''serious emotional disturbances" such as bipolar disorder, autism, or post-traumatic stress disorder, and their care providers struggled to find long-term help for them at home. In the worst cases, they were needlessly placed in a psychiatric ward, the judge wrote.

In his ruling, Ponsor wrote that Roselin D., the 16-year-old girl for whom the case was named, suffered ''poorly coordinated services" for her multiple psychiatric problems, including bipolar disorder, resulting in a three-month stay in a hospital when she was 6. Now a defiant adolescent living at home, she is on the brink of being institutionalized again while her care providers argue about what is best for her, he added.

Ponsor made it clear that the state was not solely at fault for Rosie's plight: the girl suffered extreme physical and sexual abuse that left her in the care of a foster mother. But, he wrote, ''Roselin's treatment history presents a familiar picture of inadequate home supports and arbitrary limitations on services" outside a hospital because of a shortage of services.

The other children named in the suit had similarly complex lives and problems, such as a 12-year-old Brockton boy whose mother had to choose between limited care at home for his bipolar disorder or treating him as an emergency case and putting him in a hospital.

Romney administration officials estimate that 75 to 125 children are currently ''in private psychiatric hospitals when they should be in a less restrictive setting. But James C. Burling of the law firm WilmerHale, who also represented the children, said the real count of such children should include hundreds who are living in group homes or other institutions when they should be getting intensive mental health services at their homes.

Burling said that an analyst for the plaintiffs estimated that the state spends $70 million a year on unnecessary institutionalization of mentally disturbed children through MassHealth. ''The places where the kids are going . . . are the most expensive and least effective in the whole state," Burling said.

Ponsor agreed that the Romney administration had taken steps to improve services for low-income children by September 2004, setting up centralized programs that coordinate the different kinds of mental health and medical care the children require, while also supporting the children's guardians and helping during crises. However, he said, these efforts reached only a ''minuscule" portion of the 15,000 Medicaid-eligible children who could benefit from them.

In the end, Ponsor said, the case was not even close, praising the plaintiffs for providing ''prodigious" evidence that the state broke Medicaid law. A detailed analysis of 35 mentally ill children served by the Medicaid program showed that ''the vast majority of this group needed, but was not receiving," a wide range of at-home mental health services.

Under Ponsor's decision, the two sides must meet within two weeks to discuss a proposed remedy and let him know by Feb. 17 what, if anything, they have come up with.

Then, he ordered them back to court on Feb. 23, warning that he will order reforms himself if the two sides can't agree.

Scott Allen can be reached at allen@globe.com. Read more!