A chronicle of disappointment: Ambitious reform lingers in limbo - Raleigh News & Observer

LYNN BONNER, Staff Writer

The state hatched a grand plan in 2001 to improve mental health services. Five years later, nearly everyone involved says it has gone tragically off course.

Central to the change was having more people seek care in their communities from private contractors, not in large mental hospitals run by the state. Money that would have gone to support hospital care would instead fund community treatment. Local mental health agencies that had been seeing patients would instead act as HMOs, signing contracts with private operators to care for patients.

But the five-year history of the reform is a chronicle of disappointment more than accomplishment..

* In 2002, Gov. Mike Easley took most of the startup money that legislators put into a trust fund for community mental health programs -- $37.5 million of $50 million -- to cover other expenses during that year's budget crisis.

* More people are checking into mental hospitals, leaving less money to sustain the community programs that are supposed to supplant such hospital stays. Counties are grappling with shortages of local hospital beds and doctors and other professionals to deal with patients in crisis and keep them out of state hospitals.

* New community treatment options important to the reform were not approved by federal authorities until this year.

"Almost everything that was promised in reform in the community didn't happen," said Ann Akland, president of the Wake County chapter of the National Alliance on Mental Illness.

The new system was planned to have fewer state hospital beds and shape community services around patient needs. As Carmen Hooker Odom, head of the state Department of Health and Human Services, put it in April 2003: "We need to make sure that the system reflects an investment in people and in communities, not in buildings and programs."

Hooker Odom vowed to plow money saved from closing Dorothea Dix Hospital in Raleigh back into communities. It hasn't worked out that way. The Easley administration recently ordered that any savings from closing Dix should be used to pay the debt on a new psychiatric hospital being built in Butner.

The department is seeking about $100 million in the next budget for mental health services. That is much less than advocacy groups want and less, even, than the $155 million that legislators want. A portion of the department's budget request is for furnishings and computer systems for the new hospital.

Hooker Odom said hospital furnishings and computer systems are for patients. "You want beds for people, and you want a state-of-the-art [information technology] system," she said. "It is an expenditure for people, not buildings."

Early on in the reform effort, the state and local mental health agencies concentrated on reorganizing. The office shuffling took time, money and energy but had little to do with caring for people.

"We're wasting time on all this administrative junk, and we ought to be focusing on the patients," said Nicholas E. Stratas, a Raleigh psychiatrist who worked for the state mental health department in the 1960s.

Many mental health advocates now regret their initial support for the reform effort. The N.C. Psychiatric Association went from champion to critic.

"We got sidetracked looking at governance and who was going to get what pot of authority," said Robin Huffman, executive director of the association.

Hooker Odom said the changes have been difficult and chaotic but that mental health reform is pulling out of the dive that has come with dismantling the old system.

"I believe we're coming up," she said. "But we've had a very difficult time across the state in terms of going down that slope of sort of shedding off the old ways."

Staff writer Lynn Bonner can be reached at 829-4821 or lbonner@newsobserver.com


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A lack of options hinders the transition from institutional to community care - Raleigh News & Observer

Published: Apr 30, 2006 12:30 AM

For mentally ill, reform falls short

JEAN P. FISHER, Staff Writer

Dorothea Dix Hospital was home to Kathi Dunphy's 39-year-old daughter, Jacki, for six years. But a few months ago, Jacki started on a new medication for bipolar disorder that helped her reach her best emotional health in years, so her doctors decided she was well enough to leave.

But instead of going home, Jacki went to a Cary rest home, where most residents are frail and elderly.

The place is clean and the staff seems friendly, but Dunphy wonders how long her daughter will stay healthy there. Jacki is prone to depression and thoughts of suicide, and her health deteriorates without structure and daily activities.

"Last week, she said she'd give me $20 if I'd take her back" to Dix, Dunphy said.

Trading one institution for another was not what state leaders promised five years ago when they revamped how and where people are treated for mental illness.

People like Jacki -- The News & Observer agreed not to reveal her surname -- were supposed to be able to live in small groups or independently in their hometowns. They were supposed to have medical appointments, get job training, learn life skills, socialize -- all within their communities, outside of institutions.

Most everyone involved in the mental health system says those ideals are unmet. This year, however, there are signs that mental health care might finally get the significant funding that was promised. When state legislators return next week, mental health funding will be among the top issues.

Carmen Hooker Odom, state Health and Human Services secretary, acknowledges that transforming the state's mental health system has been difficult.

"To create that change, you have to go through the process of destroying the existing system," she said. "You don't have to be a psychiatrist to know that people do not like change."

Many people who are dismayed at how mental health reform has progressed agree in principle with its goal. The idea is to give people with brain disorders every chance to live full, productive lives amid family and friends.

"It's a good idea -- I totally embrace it," said Debra King, executive director of CASA, a Raleigh agency that manages affordable housing for people with mental illness. "But it's how you pull it off. I just can't figure out how we could have planned so long for things to have turned out so poorly."

Not a lucrative field

Five years into the reform process, the state still faces a desperate shortage of subsidized housing for the mentally ill. Patients released from state mental hospitals are frequently discharged to homeless shelters or, like Jacki, to adult care homes.

And despite predictions that free market forces would ensure an ample supply of mental health programs, many communities have not seen private businesses clamoring to set up new services.

It's not a lucrative field. Many patients live on disability income and are covered by Medicare and Medicaid, which typically pay less than market rates for care. Others are uninsured or covered by private insurance that strictly limits access to treatment and services.

Compounding matters, private businesses aiming to offer new programs didn't know what services the government would pay for, and at what rate. The state Medicaid program was expected to publish that information years ago; it came last month.

"Many providers didn't want to sign contracts, didn't want to step into this until they knew," said Janet Schanzenbach, interim executive director of the N.C. Council of Community Programs. The council represents local mental health agencies, which must line up community-based services and manage patient care.

As a result, when some families have sought community care, they have found few options.

Few choices

A lack of enriching day programs in the Triangle was the main reason Chary and Robert Sundstrom of Cary sent their 28-year-old daughter, Juli, who has schizophrenia, to a private residential program in Western North Carolina.

When Juli was younger, the Sundstroms enrolled her in college to keep her active and engaged. Chary Sundstrom went with Juli to classes at Meredith College, and if Juli grew disruptive, her mother was there to intercede. With that support, Juli earned a bachelor's degree in mathematics -- with honors.

"But I'm not going to live forever, so I can't follow her around forever," Chary Sundstrom said.

At CooperRiis, a working farm community in Mill Spring that residents help run, Juli has a job in housekeeping. She can take exercise classes, explore the 80-acre grounds and join other therapeutic activities.

"She's gotten better there," said Chary Sundstrom. "She loves it."

But CooperRiis is not a permanent residence. Its mission is to teach people how to maintain lives in the outside world, and Juli graduates in October. Her parents hope she can be placed in a program affiliated with CooperRiis, though that would keep her hours away. If that isn't possible, the Sundstroms will reconsider the Triangle.

Some new resources have opened in Wake County since the Sundstroms last looked. A clubhouse that helps members practice vocational and social skills, Club Horizon, opened in Knightdale in 2004.

But if Club Horizon isn't right for Juli, Robert Sundstrom wonders where the rest of the choices are.

"I just don't see a lot of these programs out there," he said.

Cash on the horizon

Bob Hedrick, executive director of the N.C. Providers Council, which represents private service providers, said families and advocates for the mentally ill need to give reform a little more time.

State leaders, anticipating a budget surplus for the first time in years, appear ready to make a significant investment in the mental health system. A legislative oversight committee is seeking $155 million in state money for mental health care. Hooker Odom said Gov. Mike Easley's office thinks a $100 million allocation might be doable.

"This will indeed be the year we will have our infusion of money," she said.

Hedrick said he is confident such an infusion will draw more mental health providers into communities that need services.

"Some people are judging mental health reform as having failed when in fact it's just getting started," he said.

Meanwhile, parents such as Kathi Dunphy are waiting and wondering whether their family members can hold out until the help they need is available.

When Jacki lived at Dix, she got art and music therapy and took workshops on cooking, personal care and social skills five days a week.

Now, living in the rest home, her only planned activities are twice-weekly shopping trips organized by the home's staff. Occasionally, her social worker takes her out for coffee. Her mother brings her home to stay with her at least one night every weekend.

"If they don't find her something to do, I don't think it will work," Kathi Dunphy said. "This is just not going to do."

Staff writer Jean P. Fisher can be reached at 829-4753 or jfisher@newsobserver.com.




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Wake in mental health crunch - Raleigh News & Observer

Thousands of patients may be in limbo as a waiver expires for the county to privatize some programs

Lynn Bonner and Jean Fisher, Staff Writers
Mental health services are in upheaval in Wake County.

Under a state order, the county must stop offering counseling and treatment to thousands of mentally ill patients and substance abusers within two months and find private companies that will do the work.

A separate state budget cut has county administrators preparing to end nighttime hours at their 24-hour crisis center.

And the county is now looking for a new leader to head the department that oversees mental health services. Human Services Director Maria Spaulding announced this week she will retire in January.

The transfer of mental health treatment from public to private hands could affect more than 3,000 patients and jeopardize jobs of more than 100 doctors, therapists and other staff.

County health officials said the state order is a detriment to care, putting the goal of privatizing services above treating patients.

"Our consumers are not commodities," said Dr. Peter J. Morris, medical director for Wake's Human Services Department. "They are not commodities to be bought and sold without some thought to their individual choice and individual needs. That takes a little bit of time and thought."

The state told county officials that it wants contractors handling a dozen services that had been the work of county employees -- everything from intensive community support for the mentally ill to inpatient treatment for substance abusers. The county has until June 30 to transfer management but is appealing the deadline for most of the services, Morris said.

A few tasks are being readied to turn over to private companies, but Wake has looked in vain for a business to take over its alcohol treatment programs. Morris said that he doubts anyone will step forward with an offer in the next few months.

If the state order stands, the county will have to find private companies to counsel 900 mentally ill patients. The county wants to delay until Sept. 30 the transfer of 500 people to private care but is asking to continue working with 400 people who see county welfare workers, housing counselors or others in the human services department.

If private providers don't take over services by July 1, and the state does not allow the county to continue offering them, "We would have to discontinue care for the clients because of lack of reimbursement," Morris said.

Under a 2001 state law, county mental health offices were to stop treating patients and transfer the work to private contractors.

Some county agencies signed over the work more quickly than others. Other counties, including Wake, won waivers because they wanted more time to find private replacements for public services. Those waivers are about to expire.

The state agency that oversees mental health will consider Wake's appeals for more time, said Dick Oliver, head of a state team that works with local offices.

But he said that Wake has had years to plan for the change and it should be easier to find private companies to do the work in an urban county than it has been in rural areas.

Some local mental health offices already have switched to private contractors, Oliver said. "The ones who have resisted it make it difficult for the process to be smooth."

Spaulding said she is frustrated that the state imposes changes without considering all the consequences at the county level.

"We've got to do the work," she said. "They just write these rules down, and that's always been irritating to me."

A limited crisis center

Another change that has patients and their families on edge is the likelihood that a mental health crisis center that is now open 24 hours, offering patients evaluations and referrals to doctors and hospitals, will have to close at night.

The state is cutting about $3.3 million from the county's mental health budget -- money that is used to support the center on Falstaff Road. Advocates for the mentally ill and county health officials said that patients will likely go directly to hospital emergency rooms if they need after-hours help. That is expensive and often inappropriate for people suffering a psychological crisis.

Kara Lengenfeld, who has borderline personality disorder, dropped in at the crisis center a few weeks ago when she started feeling unusually stressed and anxious. She talked to a counselor at the Falstaff Road center, and a couple of hours later, she was on her way to a private mental hospital for a 10-day stay.

Lengenfeld, who lives in a Raleigh group home, said she has used the center after hours. The idea of it being closed in the evening concerns her.

"That would be bad -- a lot of people go there at night," she said. If the center was unavailable at night, Lengenfeld doesn't know where she would go -- probably she would do without help. "I don't know anywhere else to go," she said.

Although the mental health changes are unsettling, Spaulding said that her departure is not related budget cuts or state efforts to reform services. She said the county will not suffer a leadership void because county staff can handle whatever comes.

"There's always a mental health emergency," she said. "Mental health changes always."

Spaulding, 56, began working for the county as its personnel director in 1985. In 1996, she became head of the new human services department, which combined social services, public health and mental health. With more than 1,800 employees, human services is the county's largest department. Spaulding previously worked in state government for 13 years.

"We are deeply appreciative of the contributions Maria has made not only to Wake County as a community but also as a compassionate citizen," County Manager David Cooke said in a statement.
Staff writer Lynn Bonner can be reached at 829-4821 or lbonner@newsobserver.com. Read more!

Few gains yet for the state's mental health - Raleigh News & Observer

Point of View:

RALEIGH - We have now seen the 2004-05 Annual Report of the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services, "Transformation: A Commitment to Make a Difference." Twenty-four pages, pretty graphics and filled with good intentions.

But five years into North Carolina's failing mental health reform, good intentions are not enough. And the state's own report bears this out.

The Annual Report lists nine "major accomplishments," "turning points" -- and not one addresses what is happening to real people, whether patients or staff. Six of the "turning points" are bureaucratic, on the order of signing performance contracts and completing service definitions (greatly delayed, as the Annual Report neglects to mention). The other three are inspecting children's group homes (in response to scandal), developing a database and starting the construction of the new hospital in Butner. The Annual Report does not mention that on the day it opens the new hospital will be too small by at least 100 beds -- and some say 200 beds.

According to the report, "In state fiscal year 2004-2005, the public MH/DD/SAS system served 330,083 people with community services; that is 15,777 more individuals than in the year [2000-01] the transformation legislation was enacted." But while the system served 5 percent more people, North Carolina's population went up 5.8 percent. The MH/DD/SAS system was not able to keep up with the state's population growth.

The Annual Report reveals a 16 percent decrease in per capita mental health spending, from $16 per capita in 2002-03 to $13.39 in 2004-05, further evidence of the state's declining and inadequate support for mental health.

And now the preferred term for Reform is "Transformation...to reflect the dismantling of the old public system and the full and complete replacement by a new organizational structure."

Thus "transformation" means the destruction of the old mental health system. This leaves our patients and us in a quandary. What happens if the new structure isn't quite in place as the old system is being "dismantled"? Won't staff and continuity of care be lost; won't patients be harmed?

In fact, this is exactly what is happening right now, around the state.

If good intentions were all that was needed to improve care for those in need, the Division of MH/DD/SAS would have fixed everything long ago. But what North Carolina needs most is real accomplishment that improves the lives of real people. This Annual Report makes clear that the state has little of that to report. This report provides scant comfort for a mental health system that in reality has inadequate resources, fraying infrastructure, demoralized staff and patients going without care.

(Margie Sved, M.D., is president of the N.C. Psychiatric Association. The division's Annual Report can be accessed at http://www.dhhs.state.nc.us/mhddsas/)
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© Copyright 2006, The News &Observer Publishing Company
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Democrats expect budget surplus - News & Observer

Gary D. Robertson, The Associated Press

House Democrats who talked frankly about Speaker Jim Black's future Tuesday night also got a look at the budget, and the news is good for a change.

Overcollections of state taxes have nearly doubled in the past three months to about $400 million, essentially assuring a budget surplus for the third consecutive year after four consecutive years of shortfalls, according to legislators and their research staff.

Add to that money unused by state agencies or unallocated last year and more than $1 billion in cash should be available for lawmakers when they return to Raleigh next month to adjust a $17.3 billion spending plan that takes effect July 1.

Budget-writers already are downplaying the cash influx, saying they have lined up all the money for programs neglected during the recession or high-priority items such as state employee pay raises and the repair of deteriorating state buildings.

Legislative fiscal analysts say revenue has grown by 3.4 percent ahead of the $11.7 billion target set by lawmakers for the first nine months of the fiscal year ending June 30.

They attribute the growth to new jobs in North Carolina since early last year, reflected in a steady 8-percent rise in tax withholding payments by those employees. Sales tax revenue also is growing a strong clip, according to documents.

The researchers predict a surplus of at least $605 million by the time the fiscal year ends June 30, although that could change because of the historic volatility of April 15 tax payments for both individuals and corporations. The legislature and governor usually wait until those numbers are in before completing their budget proposals.

There's also an additional $517 million that legislative leaders projected would be left unspent from the second year of a two-year budget that passed last year. State agencies also could return at least $100 million that they never spent this year.

“Overall, with reverted money, you're probably looking at $1.3 billion,” said Rep. Jim Crawford, a Granville County Democrat and one of six chief budget-writers in the House.

Crawford and colleagues say there probably will be enough money left in the final pot to pay for routine annual expenses not included in the budget.

High on that list of projects presented to budget-writers meeting Tuesday include $300 million for the state's repairs and renovations account, $200 million for the so-called “rainy day” reserve fund and $100 million for annual teacher performance bonuses.

Another $117 million likely will be required to cover higher-than-projected school enrollment, while beefing up a beleaguered mental health system might cost $160 million.

And with Easley expected to ask for a 5 percent raise for teachers, other rank-and-file state employees will be seeking the same amount.
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Orange-Person-Chatham seeks money - News & Observer

Mental agency asks for money

OPC tells state it needs assistance

CHERYL JOHNSTON SADGROVE, Staff Writer

CHAPEL HILL - A three-county agency that provides mental health, developmental disability and substance abuse treatment services is having trouble paying its bills.

The Orange-Person-Chatham Area Program, known as OPC, is asking the state for $2.7 million to help pay service providers this fiscal year and next.

That's about 6 percent of OPC's $44 million annual budget.

Representatives from the three counties, OPC and the state will meet to discuss the request today.

Until the agency gets financial help, OPC cannot pay providers in full, said Judy Truitt, OPC's director.

"We're kind of spreading our available funding as thin as we can," Truitt said. "We're paying everyone some portion of what we owe them but certainly not all that we owe."

So far, the cash shortage hasn't led to any loss of services for consumers, but it has had a "tremendous impact" on the providers of those services, Truitt said.

Lutheran Family Services in the Carolinas, which operates two group homes for OPC, is among those caring for clients without getting full payment.

Michael Andrews, the non-profit's vice president of communications, said his agency can probably do that more easily because of its large size, with upwards of 200 contracts.

"Lutheran Family Services is not a bank, obviously, but we're also realistic. We live in the real world. We are a faith-based organization -- we'll continue to do the right thing, to work with them," Andrews said.

"They do send payments along when they can," he added.

Between July 2004 and October 2005, OPC had to return more than $1.4 million to the state. Like all area programs, which the state now calls Local Management Entities, or LMEs, it used to receive money for specific services with the understanding that it would return anything left after the billing for that year's services was settled.

OPC returned $1.05 million for services for which it could not bill. It also discovered that new software was double-billing Medicaid, leading to another $360,000 that had to be returned, said David Jenny, OPC's financial officer.

"So that's what kind of started the cash-flow problem," Truitt said.

In addition, to meet the state's goals for mental health reform, OPC began to divest, or spin off, programs, which meant less revenue stayed with OPC.

"The programs that divest the easiest and the earliest are the programs that generate excess revenue ... so our ability to overrealize by staff being more productive ... has been pretty compromised by reform," Truitt said.

Leza Wainwright, deputy director of the state's Division of Mental Health, said OPC is the only LME that has requested money to meet its budget in the past few years.

"We certainly are interested in working with OPC and the counties to look at ways to make sure that OPC stays solvent," Wainwright said.

A slow approach

OPC would be in a better financial position if it had divested more quickly, Truitt said. The last programs are set to be spun off by July 1.

"We, for many reasons, felt that we needed to do that in a thoughtful, slow and planned way because we thought that would offer the greatest protection for our consumers," Truitt said.

"Then it becomes clear that earlier divestiture, when you match it with our financial situation, would have been a much better way to have proceeded."

Wainwright said LMEs that divested more quickly have not had the same financial trouble.

"We've not faced this issue with other LMEs as part of a divestiture process," she said.

But Moses Carey, an Orange County commissioner who serves on the OPC board, said it's difficult to compare OPC with other LMEs.

"When you look at the nature and quality of programs other counties have, they don't have the same scope," Carey said.

"OPC was the model, flagship, in terms of service provision. Other programs don't have the complex array of services that OPC is providing. Divestiture for them was turning over two or three services; for OPC it's turning over a host of programs. Some of them are very complex."

Truitt said she hopes the state will help OPC.

"They have been very concerned and willing to engage with us, and I could not be more pleased," she said.

Staff writer Cheryl Johnston Sadgrove can be reached at 932-2005 or cheryl.sadgrove @newsobserver.com.


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Tribe lashes Easley over casino, handling of mental health funds - News & Observer

Leaders study legal options

J. Andrew Curliss, Staff Writer
The chief of the Eastern Band of Cherokee Indians expressed outrage Wednesday at Gov. Mike Easley’s decision to halt talks over expanded gambling options in Cherokee at the state’s only casino

The tribe is exploring possible responses, including mediation or filing suit in federal court.

Chief Michell Hicks and other tribal leaders involved in the months of negotiations said the sides struck a deal in private three weeks ago. They said that, essentially, the final papers just needed to be prepared for signatures.

The agreement would have allowed for a second casino on tribal lands, increased jackpots at slot machines and allowed for credit at the casino, they said.

The tribe now has a video-only casino in Cherokee with 3,500 slots, blackjack and poker machines. It is run by Harrah’s.

They said the deal would have boosted a depressed area of the state, creating 2,500 jobs, adding millions to the state’s tax rolls and sending $10 million a year to a foundation controlled by the governor to use for mental health needs in the state.

But tribal leaders say Easley made a last-minute demand that the $10 million go directly to the state instead of passing through the foundation first.

Easley would not agree to be interviewed, but his staff called the tribe’s characterization of the talks “less than accurate.”

Cari Boyce, Easley’s director of external affairs, said the chief refused to address significant issues and so “it is not possible for us to have further negotiations.”

Hicks and the tribal attorney general, David Nash, said that Easley’s appointed negotiating team already had agreed to a deal -- one that included casino profits flowing through the foundation for mental health -- in meetings in January and March.

Tribal leaders maintain that they could not agree to make direct transfers to the state because of federal laws, unless the tribe receives something exclusive in exchange.

Tribes in other states that make payments directly to a state government, for example, receive the exclusive right to offer gambling in a defined area or to offer certain types of games.

Tribal leaders said they told Easley’s office that they would try to meet the governor’s goals, but Easley ended the talks.

“I don’t want to sit here and say that I’ve been lied to,” Hicks said in an interview. “But if you’re going to tell me no, then tell me no. Don’t walk me down the path and then, all of a sudden, the path has no end.”

Jobs for RTP

Tribal leaders pointed out that the governor was in Research Triangle Park this week, signing off on taxpayer grants to create 400 jobs in Wake County.

“When has the governor been west of Asheville to create jobs?” Hicks said. “When?”

The tribe had sought changes at its gambling hall near the Great Smoky Mountains since late 2004.

From the beginning, leaders sought to add Las Vegas-style live poker, craps and roulette. They also wanted to build a second casino, extend credit to players and increase jackpot limits.

Easley, the tribe said, wanted a larger cut of the casino proceeds to agree to live gaming. It amounted to roughly $50 million a year. The tribe could not agree, Hicks said.

Staff writer J. Andrew Curliss can be reached at 829-4840 or acurliss@newsobserver.com Read more!

Eureka shooting tragedy runs deep - Eureka (CA) Times Standard

John Driscoll The Times-Standard

EUREKA, CA -- Acquaintances of Cheri Lyn Moore, the 48-year-old woman who was shot dead by police Friday afternoon, said Moore became depressed around the birthday of her late son -- who they said killed himself about five years ago.

A man who said he had been staying with Moore for the past three weeks said she was kind and not dangerous. He said he believed police could have subdued Moore without harming her.

Gary Adrian Raines did say, however, that Moore had bought a flare gun “for protection,” though he thought she was jesting when she told him that. He was shocked when he saw the scene of the shooting.

”I saw blood on the carpet today,” Raines said, “and I was scared s--tless.”

Moore was shot multiple times after a two-hour standoff at her apartment at the 500 block of G Street. Humboldt County Coroner Frank Jager said he didn't know exactly how many times she had been shot or with what type of weapon. Moore's body will be sent to Redding Monday or Tuesday, he said, where a board-certified forensic pathologist is available for a thorough examination.

”There's a lot of work to be done,” Jager said.

Jager said that Moore was known to county mental health workers, but had little other information about her Saturday. He said Moore had a 25-year-old son. Friends said Moore may also have a daughter.

Jager said that new information would probably be released by the multi-agency team investigating the shooting.

District Attorney Paul Gallegos, who was on the scene Friday, did not immediately return a phone call placed Saturday.

Saturday afternoon, Cheri's older brother Gary Holt called the Times-Standard inquiring about the incident. He said he planned to travel to Eureka from his Medford, Ore., home to talk with police. Holt said he intends to look into whether the shooting was justified.

”We're not sweeping this under the carpet,” Holt said.

He also added one more tragic note. Holt said that Moore's father died in his sleep Friday night.

An in-home care worker for a man in a neighboring apartment said Friday was Moore's dead son's birthday. Every year around this time, said Tammy Henry, Moore would get depressed and agitated. She also described Moore as a woman who had repeatedly been taken advantage of by some acquaintances, who stole from her until she finally stopped having people over.

Henry believes Moore was in dire need of help.

”She liked to have attention,” Henry said. “Not so much that she deserved to die.”

After being dispatched for a welfare check at about 10 a.m. Friday, police and SWAT team members cordoned off the area and evacuated the building except for Henry and Glenda Thomas, caretakers for a patient who could not be moved from his apartment, and possibly one other man.

Moore yelled from her window at times, and threw a fire extinguisher, a bike helmet and other items from her second-story apartment during the stalemate. She also communicated with acquaintances and police by cell phone before shots rang out. One man in touch with Moore by phone was told by police to stop conversing with her.

Emergency personnel went into the building after the shooting, then quickly left. Hours later, the county coroner's office removed Moore's body.

It was unclear as to whether negotiations with Moore broke down, triggering events that led to the shooting, or if something else started the chain of events.

On Saturday, Moore's door could be seen split around the knob and lock, possibly from a forced entry. SWAT team members were seen leaving the building with a battering ram shortly after the shooting. At least six bullet holes tore through a neighboring apartment, and police had apparently cut through sheet rock to pull two bullets that had lodged in the wall.

Lea Nagy with the National Alliance on Mental Illness, who acts as a liaison between county mental health officials and families of mentally ill patients, was not familiar




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with the Friday incident. But Nagy said that there has been a focus through the Mental Health Services Act on intervening more quickly during crisis situations.

She said education of the public and police officers is critical -- and is ongoing -- especially because of the complications of standoff scenarios. Police try to do the best job they can, Nagy said, but often it's difficult to tell what an unstable individual will do.

”I think the county is aware that people need to get earlier intervention to keep this kind of thing from happening,” Nagy said.



Eureka Police Department statement



On Friday, April 14, at 9:52 a.m. the Eureka Police Department Dispatch was contacted by an employee of Humboldt County Mental Health. The staff person requested that police officers be sent to 516 G St. to check the welfare of a female who was off her medication and making threatening statements.

The employee advised Eureka police that the female would be extremely hostile to law enforcement if they contacted her. The uniformed officers who responded could hear very loud music and yelling in the apartment but could not get an answer at the door or by phone.

Eureka Police officers were assisted by the building owner in obtaining a key to the apartment. As the door to the apartment swung open, a female, partially shielded by a wall, was yelling and pointing a handgun at the officers. The officers took cover. The door to the apartment was slammed shut and locked by someone inside the apartment. Additional assistance was summoned at this time.

Attempts by the crisis negotiation personnel to speak with the female or anyone else in the apartment were unsuccessful.

Ambulance and fire personnel were staged nearby as the female had made threats to set fire to the building and to shoot people outside.

A decision was made to have the SWAT team enter the apartment if police observers, positioned across the street, believed the female had put the weapon down and they knew her location in the room. When this occurred, the SWAT team entered.

Upon the SWAT team's entry, the suspect was in possession of a weapon. The suspect was shot.

Medical aid was administered at the scene, but the suspect died. It was determined no other persons were in the room.

At the direction of EPD Chief David Douglas, the Humboldt County Critical Incident Response Team was requested to conduct the investigation. The California Department of Justice assisted in the evidence collection at the scene and is conducting further forensic examinations.

The Humboldt County Coroner took custody of the deceased woman and is handling the notifications and name release.



Note: In a follow-up phone conversation, Officer Suzie Owsley told the Times-Standard that officials have not determined what type of weapon the deceased woman had, but said a flare gun would count as a handgun.

Witnesses at the scene specifically reported seeing a bright orange flare gun.

Interviews with SWAT members are ongoing and would help make a determination as to type of gun, she said.

While a man had contacted the woman by cell phone -- and told the Times-Standard that police had told him not to contact her -- Owsley said she had no further information on the crisis negotiation team's attempts to contact the woman.



Read more!

Odom Question And Answer -- Asheville Citizen-Times

During a recent visit to Asheville, Carmen Hooker Odom, Secretary of the Department of Health and Human Services, was interviewed by the Asheville Citizen-Times Editorial Board about mental health reform. This is an edited version of that interview. To read the complete version, go to the opinion page at www.CITIZENTIMES.com.

Odom: I want to thank you for taking time out to meet with me. We came yesterday and started out in Forsyth County and then came here to Buncombe County and Hendersonville and met with folks around here. It's primarily a legislative visit. I like to visit legislators in their districts because you get a good feel and it's never hard to come to Asheville, let me tell you. So that's primarily the purpose of our trip and then (we) wanted to have the opportunity and again appreciate your making time, just to sit and chat with you, about anything that you want to (talk about). I know that mental health has been a big issue, and is a big issue here, and that your paper has been very thoughtful in exploring all the issues around mental health reform that are occurring, so I'm fully prepared to talk about that, but anything you want.

ACT: There's obviously a huge funding issue and there've been some breakdowns in the way the mental health reform has been rolled out, and I guess I'd like to just have you talk, for a little bit about what it's been like from your perspective. Do you feel somewhat caught between the legislature and the people who are your clients or the consumers of the services? Do you feel like that maybe your department's ended up getting sort of a bad rap because of things you couldn't control, or do you feel as though there have been some mistakes made?

A brief history

Odom: Let me just go back a little bit to sort of the start of this whole mental health reform initiative, which I always keep reminding people, it was a legislative initiative and it was not something that emerged out of our department. There were sort of three things that were going on from my observation, and my understanding of the history that culminated in this massive mental health reform law, was that there were certain counties, county commissioners, who were very upset with their area programs. They experienced failures, financial problems, just a whole lack of accountability and not really communicating with the Board of County Commissioners. So there was enough of that kind of, sort of angst, within the County Commissioner groups, so that was one river of this confluence.

The other was consumers. Many consumers, and in this wonderful age of choice and self directed care and civil rights for people with disabilities, expressing itself through the Olmstead decision and ... the ADA (American Disability Act), an empowerment by consumers saying that we want choice. We believe that we should have the ability to choose the services, the kinds of services, to have a real hand in determining what they are through self directed care and all those kinds of things. So that was another one of these rivers flowing, or streams, flowing in.

Reaction from providers

And then there were the providers, who legitimately, in many areas, felt locked out. Some of the area programs were indeed very; sort of monopolistic, and they wouldn't have any kind of avenues open for other providers. And so they were very insistent that this be opened up and that there be a level playing field and obviously as you know, they felt that area programs should not be delivering services, that there was just too much of a tunneling and a real targeting to their own services. And, you know, when you're a manager and a service provider there's always that potential to direct care to your place and then the financials and the potential conflict of interest is great.

So all those things came together and it yielded this massive mental health reform law. Hindsight is wonderful, but I really don't think that many legislators really had a comprehensive understanding of how massive the change this law requires us to make. I like to say that, if it had just been mental health reform on just a few areas where we would test it out, see if this was the direction, that you would have incremental reform steps. Well that's not what this legislation did. This is really comprehensive, transformational change and if you've studied at all about transformational change, you know that you've got to sort of get rid of all the old stuff in order to build the new stuff and that's what this legislation called for.

And then, of course it was the department and the division's responsibility to carry this out.

Need for buy in

Now, given that that's the background, it is my belief, as I've been obviously struggling through trying to implement this as well as possible, that again if you look at most textbook case studies on organizational change, you have to have buy in by the organization that your asking to change.

A perfect example is Blue Ridge. Everybody loved them, they had a very good track record and they were doing well. I don't think they felt that they needed to have to change, so certain places did buy in to change but others didn't. So until you have that embracing of the need to change it's very difficult. Our division, as difficult (as) it is to get state bureaucracies to work like a finely tuned engine, they weren't ready or prepared for this kind of change. So we've been struggling, mostly with that kind of governance change at the local level and the ability of us as a governmental entity; which is very difficult to change, changing and developing new skills.

And so, yes. I take a lot of responsibility for things that have not run smoothly. Not because of ill intent or lack of commitment or not believing in the vision in where we want to go, but just because of the very nature of this change. It has been really hard for us as the division and the department as it has been out in the local management areas. The other thing is that when the area programs were required to transform into becoming a management entity, that's a whole different line of business. And it is a business; we are talking about really running a little managed care business now. They are invested with the responsibility of managing our public mental health, developmental disabilities, substance abuse system.

Many of them saw themselves as advocates and service providers and a little bit of administration and management, but that wasn't their big thing. So, you've got boards all in the area, board members, who many of them came out of the advocacy community, trying to figure out, OK, this is a new business, I'm not sure my skills fit or whatever. So there's been that kind of struggling that has gone on.

In this area, you've gone from Buncombe County being a single area program to now this eight county LME (local management entity) with all the governance issues that entailed and while I think the first few months people were really enthusiastic about it and it certainly was a demonstration of what is so clear here out in this western part of our great state, is the tradition of people working together.

And so I think that was sort of the inspiration of going to this eight county LME. But, you know, I don't need to tell you, you probably covered all of those arduous and many times, rancorous and confrontational governance issues. That's all really difficult. My understanding is that Western Highlands is now sort of coming out of all that chaos and they've got a new director and I think the governance issues are pretty well (resolved). But that was really tough for them to go through that.

And I can understand why people in Buncombe would say, “My God, we had it so great and now it's all in confusion and why did we ever do this and everything was so much more wonderful.”

It probably was, but that was a local choice to make, the state never mandated that they do this.

Buncombe County could have been a single county entity LME, but as I say, sort of, I think the tradition of this wonderful area, that you try to work with each other . ... It was not something that the state mandated or told them that they had to do.

ACT: One of things that we've sensed here is a frustration on the part of the LMEs because they didn't feel there was enough money to pay the providers. The providers, in some places, have not gotten paid for long periods of time. There was not enough money to set up community based alternatives. Has the legislature fallen down in not having provided your department with enough money to implement the law?

Odom: Well, another lesson I've learned through this thing is never pass this kind of reform when you go into ... the deepest fiscal crisis since the Great Depression. So, I mean this state, unfortunately, suffered over this past four years so tremendously from that fiscal crisis and therefore as much as everybody wanted, maybe, to put funds in, there just weren't funds to put in if you're going to try to stabilize a really, really crisis situation in the fiscal health of the state.

You know, people often ask me whether there's enough money in the system. And my gut reaction is, probably not. But if you look at Medicaid and state funding and some of the county funding, there's $2 billion in our mental health developmental substance abuse system.

Now, my question is and we're trying to discern this is that $2 billion appropriately allocated? And my feeling is that it is not and that we need to figure out how to more smartly allocate the money that we do have. Read more!

Revving Up Reform - Raleigh News & Observer Editorial

Published: Apr 16, 2006 12:30 AM
Modified: Apr 16, 2006 02:30 AM

The call by a legislative committee for millions for better mental health is encouraging. Let’s hear from other state leaders - N&O

--------------------------------

North Carolina’s mental health system exists to serve fragile people with stubborn, often complicated illnesses. Helping those sufferers isn’t cheap, and the costs are driven up even further when help for people with developmental disabilities and drug and alcohol addictions is included.

The state rightly is reforming its system of mental health care delivery, but the complexity of the endeavor means it can’t be done in penny-pinching mode. Reform envisioned by the Department of Health and Human Services will keep clients closer to home and give local mental health agencies the money and authority to treat residents in their areas. State-local coordination will be key.��

The pace of reform has been slow, but fortunately, a legislative committee responsible for overseeing the effort is paying attention. Committee members have approved a preliminary plan that would raise $160 million to improve local treatment programs, build needed housing for the mentally ill and pay doctors to treat clients. That’s a good start, and it shows that the committee is trying to guide reform.

The whole process has been sluggish, on the part of both the legislature and the governor’s office. For decades, North Carolina has relied on big, centralized psychiatric hospitals and less-than-rigorous local mental health services. That has meant patients frequently have been shipped far from home for treatment -- making it hard for caring family members to visit and support their relatives -- or have received inadequate services at home.

Lawmakers approved sweeping reforms in 2001. It wasn’t their fault that a national recession hit about the same time. Of $50 million the legislature provided for local services, Governor Easley took away $37.5 million to patch holes in the budget.

Easley didn’t ask for the tax crisis, either. But had reform been the obvious priority it should be, he instead would have insisted on new revenues to balance the budget.

As it is, raiding the fund threw the reform train badly off track. The $30 million that the legislature has since put back in the fund doesn’t have the same spending power. That much and more probably should have been added to the fund in any event by now. And the legislature can’t count on the relatively small amount of money that might be raised if part of the Dorothea Dix mental hospital campus in Raleigh is sold.

It’s now critical for Easley and his administration to ramp up their efforts on behalf of mental health reform, drawing on their persuasive abilities and political heft. The legislative committee will need that help, to win the necessary funding from a legislature that will be beset by other demands for revenue. If reform is done by parcel and piecemeal, it likely will be worse than no reform at all, since it will produce tragic gaps in services. And it’s time the effort was accelerated.

North Carolina patients shouldn’t have to suffer at the hands of the current system. Counties shouldn’t be left in the painful social and legal fix that would result. State leaders should settle for nothing less than thorough, well-thought-out and well-financed reform. Read more!

Jesus Is At Club Nova -- Raleigh News & Observer

About Mental Health

LISA G. FISCHBECK, Special to the News & Observer
The Rev. Lisa G. Fischbeck is vicar of the Episcopal Church of the Advocate in Carrboro/Chapel Hill.

It's 12:30 on Thursday. In the 100-year-old house on Main Street in Carrboro, the members of Club Nova gather in. The front room is crowded, as one member answers the phone; another sits at a computer working on daily schedules, while others wait for lunch. The porch chairs are all occupied with people talking to one another, smoking cigarettes, rocking or simply staring at the floor for a while. The kitchen is bustling, as members work to prepare and serve food to others.

Club Nova is a "club house model" program for people with severe and persistent mental illness -- a program that provides a place to them to gather, to develop skills and confidence, to get assistance in negotiating life in the community and in the world, to get assistance in managing their mental and physical health. On any given day, the people of Club Nova gather in from downtown Carr-boro, Chapel Hill and the far-flung corners of Orange County. The people gather in, and Jesus is there.

Jesus is there. Because Jesus dwells with those who are sick, and those who are poor and those who are outcast from our society. He is there because he knows, he understands and he loves those who are rejected or ignored by most of us, or who simply challenge the patience and the skills we have. He sees and respects their dignity, the gifts they bring to the world, the ways they reflect the image of the Creator. And unlike our governments and Medicaid and the insurance industry, Jesus does not discriminate between mental illness and physical illness. He gives of his time and his resources for the care and healing of all.

Jesus is there. Because he knows that those who give their lives to the care and support of those with severe and persistent mental illness need care and support themselves. He knows that under the best of circumstances this work they do on behalf of all of society is challenging and requires huge amounts of patience, reason, skill and attentiveness -- but even more so in these challenging and even desperate times.

Mental health reform, legislated with all good intentions in 2001, is yielding chaos, as deadlines approach for transitions in funding and care. Formerly government-supported programs are struggling to find private funding and, in some cases, to find for-profit businesses to buy them up. Those who are mentally ill are being forced to choose between one program, which provides them with necessary psychiatric care, and another, which provides them with necessary social structures and support.

Jesus is there, because like the people who work at Club Nova, he will not turn away from those who are in need.

Jesus is at Club Nova, day by day. But that's not the only place he dwells. He also dwells in the hearts and minds of all who advocate and pray for the mentally ill and for those who work and care for them day by day on our behalf. Jesus is there. Read more!

Unstable woman shot in deadly stand-off - Eureka (CA) Times Standard

Deadly stand-off

Chris Durant The Times-Standard
Eureka Times Standard

EUREKA, CA -- One person was killed Friday after a tense two-hour stand-off with police on the 500 block of G Street.

The Eureka Police Department would not discuss details, but did confirm one person was dead.
The incident began as a welfare check around 9:50 a.m.

Around 10:15 a.m. the scanner indicated a suspect -- believed to be a woman -- was brandishing a weapon and police responded, closed off the street and did their best to prevent people from wandering down G Street.

There was a surreal feel to the incident as officers with assault rifles positioned themselves in strategic locations while music, like “Freeze Frame,” was blaring from the woman's apartment, providing an eerie soundtrack to the scene.

The unidentified woman would randomly scream out the window, wave her fist or point and then throw paper or decorations outside.

At one point she tossed items like a fire extinguisher, a bicycle helmet and an umbrella out of her window.

A man, Marcus Smith, who identified himself as a friend of the woman, said she was mentally unstable and hadn't taken her medication.

”I can go up there and get her to come down, I guarantee it,” Smith said.
He said she didn't trust the police and the only weapon she had was a flare gun.
”She's asking for her doctor,” Smith said.

He also said she had a problem with her landlord.

Smith called her on his cell phone and tried to convince her to come down. The following is Smith's side of a cell phone conversation, reportedly with the woman.

”So all these cops go away,” Smith said to the woman. “How can I help? There's a lot of guns down here.”

”All they know is they think you got a gun,” Smith added. “You don't want to get shot. They're not going to do that. You know better than that.”

Smith only knew the woman as “Sherrie.”

When Smith told police personnel he had her on the phone, they called an officer who was in the apartment building to talk to him. Smith said they asked him not to call her anymore.
Scanner traffic at the scene stated at one point she was ready to give up.

”And she'll give up completely if she's given a pack of Marlboros,” an officer said on the scanner.

The cigarettes were given to police but it was unclear if the cigarettes were given to the woman.

At 12:35 p.m. about a half dozen bangs echoed down the street and fire and ambulance personnel positioned about a block away immediately pulled up to the apartment building, rushing in with medical supplies.

They emerged about five minutes later, put their supplies back in their trucks and left.
While police had evacuated most of the building, three people remained inside. From a neighboring apartment, Glenda Thomas, an in-home care worker, called the Times-Standard to report that she and her friend could not move their patient, and were stuck inside.
Thomas said that the suspect had been agitated in recent days, and said that she had threatened to burn down the apartment earlier in the week.

Just after shots rang out, Thomas called back. She said she heard police open the suspect's door and yell, “Everybody get down.”

”Twelve or 13 shots went off and we all hit the floor,” Thomas said. “I'm afraid to open the door and see what's out there.”

About an hour after the standoff ended Eureka Police Chief Dave Douglas and Detective Dave Parris were seen talking to Humboldt County District Attorney Paul Gallegos on the street outside the apartment.

Humboldt County Coroner Frank Jager said he was aware of the death but as late afternoon Friday he was not officially called to the scene. He said it would be a while before his office would remove the body because the apartment was being thoroughly processed for evidence. Read more!

Mental health on legislators’ minds - Raleigh News & Observer

Lynn Bonner, Staff Writer

Legislators studying problems with the state mental health system want to spend $160 million to shore up services. Their plan, which is still preliminary, includes money to bolster local treatment programs, build housing and pay doctors.��

Legislators have a renewed interest in mental health services, as counties have complained that the state has botched efforts to have patients treated close to home rather than in state psychiatric hospitals.

Local mental health agencies were to stop treating patients and become something akin to HMOs, directing patients to private companies under contract to provide services. But patients have had trouble finding help in their communities.

Money for local mental health treatment was supposed to come from the savings the state expected when it admitted fewer patients to the psychiatric hospitals, but that hasn’t happened. Admissions to state mental hospitals have gone up, so the state has squeezed only $15 million out of hospital budgets in the past five years.

“Someone thought we would have enough money in savings from hospital downsizing to build a new system,” said state Sen. Martin Nesbitt, an Asheville Democrat who helps run the legislative committee on mental health, developmental disabilities and substance abuse services. “That did not occur.”

What has occurred is growing rancor -- from patients, advocates, local agencies and now legislators.

Without more money for local services, the state will have trouble going through with its plan to close Dorothea Dix, the psychiatric hospital in Raleigh, said Christopher Rakes, a member of a Wake advisory board on mental health.

“They haven’t found space in community services for the patients,” Rakes said. “I don’t think there’s enough money. If there is, it’s not being spent wisely.”

The state’s mental health reform got off to a difficult start five years ago. In 2001, legislators put $50 million into a special fund to help develop local services. But the state was in a budget crisis, and Gov. Mike Easley took most of it, $37.5 million, to pay other bills. The legislature has added $30 million more to the fund, but there’s a consensus that it isn’t enough.

Money for the counties

In the last fiscal year, the state and federal governments spent at least $1.1 billion on treatment for the mentally ill, the developmentally disabled, alcoholics and drug abusers, according to the legislative plan. More than half the money went to state institutions, and about 44 percent paid for community programs.

The state sends $324 million to counties and groups of counties to help them pay for patients who are not covered by Medicaid, the federal government’s health insurance program for the poor and disabled. Amounts counties receive per person vary wildly. The Tideland Mental Health Center, which covers Beaufort, Hyde, Martin, Tyrrell and Washington counties, receives $56.80 per person in state money, while Mecklenburg County receives $24.39 per person.

Legislators want to set a $41.50 per person minimum for counties. That would mean Mecklenburg would receive $13.5 million more each year, Wake would get nearly $11 million more, and Durham would take in an additional $967,000.

Everyone involved is hopeful that mental health will finally get more funding this year. The Department of Health and Human Services has told legislators that it is seeking a substantial increase in state money for mental health. Mental health advocates say they have been told by Easley’s advisers to expect more in his budget proposal. Department representatives would not say this week how much they have asked for, and Nesbitt, the lawmaker from Asheville, said he could not find out.

Mike Moseley, head of the state agency in charge of mental health, said he could not comment on the legislative plan in detail but said it highlights areas that need attention, such as community treatment and local crisis services. But the state also needs money to furnish and equip the new psychiatric hospital under construction in Butner, and money for staff in drug and alcohol detox units -- needs Nesbitt’s group has not addressed.

Tension within system

The legislative committee has not yet set priorities for its request, but some projects will be easier to fund than others. The plan includes more than $13 million to pay for patients’ apartments, $20 million for the Mental Health Trust Fund that boosts community services, and $10.5 million in startup money for local crisis care. But $104 million in permanent money will be harder to secure, Nesbitt said.

The legislative plan laid bare the tension between legislators and the Department of Health and Human Services, criticizing the mental health division for producing meaningless annual plans while providing inadequate guidance to county mental health agencies.

Department Secretary Carmen Hooker Odom made decisions “in a manner that increases distrust among stakeholders and threatens to further destabilize a fragile system,” the plan said. Legislators may recommend the state spend nearly $1.5 million on consultants to help the department develop a strategy and advise the county agencies.

Hooker Odom could not be reached for comment Wednesday, and Moseley said he did not want to get into a tit-for-tat with legislators. When asked whether the department needed consultants’ help, Moseley threw up his hands.

Staff writer Lynn Bonner can be reached at 829-4821 or at lbonner@newsobserver.com. Read more!

Group homes get stiffer rules - Charlotte Observer

Posted on Tue, Apr. 11, 2006email thisprint thisreprint or license this

Easley orders facilities to hire more staff; pay per child also increased
ERIC FRAZIER AND PAM KELLEY
efrazier@charlotteobserver.compkelley@charlotteobserver.com

Some of North Carolina's most vulnerable children will receive safer homes and better mental health treatment, thanks to the correction of a nearly five-year-old mistake that placed them at risk and cost the state millions.

Gov. Mike Easley signed an executive order, which took effect last week, imposing tougher rules on group homes. The order requires group homes to upgrade treatment programs, hire more staff and train them better. The order ended more than a year of wrangling between state officials who said the old rules were too weak and group home operators who argued the new ones were too aggressive.

Group home operators' objections delayed the changes. But state officials said they needed to act now because the old rules left children in danger.

"Gov. Easley believed this action was necessary to make sure that residents in these homes are safe," his spokesperson, Sherri Johnson, said Monday. "Safety is his number one concern."

About 800 group homes are affected by the changes. Located in residential neighborhoods, the homes treat children suffering from emotional problems and mental illnesses such as bipolar disorder. Most of the children are too troubled to stay home with parents, but not ill enough for a psychiatric hospital.

The new rules are accompanied by new rates that went into effect last week, giving group home operators with four or fewer beds about $252 per child per day, an increase of about $20 per day.

Several group home executives said Monday that the rules are a good step for children. But they don't believe the $20-a-day rate increase that accompanies the rules will cover the cost of increased requirements.

"We're optimistic the quality and level of professionalism will increase," said Mary Jo Powers, senior vice president of program operations for Charlotte's Thompson Child and Family Focus.

Deanna Janus, president of Cary-based Pride in North Carolina, which runs group homes, says she's hopeful the tougher rules will force low-quality operators out of business. But she worries the higher costs will also force her to close some smaller homes.

The $20-a-day increase doesn't come "anywhere close to funding the increase in the cost of the rules," said Craig Bass, CEO of Charlotte's Alexander Youth Network.

With rules in place, the state last week lifted a moratorium Easley ordered in January 2005 barring new group homes from opening. More than 80 license applications, many of which had been put on hold, are now being considered, officials said.

Easley's moratorium came days after an Observer investigation showed how the state's troubled group home system was leaving children in danger. An administrative error several years ago allowed group homes to collect tens of millions of dollars despite having low operating standards.

The state had increased pay rates to the homes, the stories showed, with the understanding that the homes would also be required to hire more staff to watch children.

The pay increase went through in 2001, but the state neglected to pass administrative rules requiring higher staffing levels. Entrepreneurs rushed in, starting so many new group homes that state regulators couldn't keep tabs on them all.

The system came under scrutiny in September 2004, when 12-year-old Shirley Arciszewski died of asphyxiation after an ill-trained Charlotte group home worker tried to restrain the girl by lying on her. The home hadn't been inspected in two years.

Authorities also swept across the state last year on Easley's orders, checking every group home like Shirley's for violations.

The state closed 10 homes, and issued 106 sanctions against 71 homes for serious problems ranging from abuse of children to neglect of medical needs. Lawmakers approved $2.5 million to hire nearly two dozen new inspectors. The upgraded staffing rules and treatment protocols proved tougher to enact, however.

Many respected nonprofit homes complained that the tougher rules would put them out of business unless the state also raised payments to the homes. Though they favored tougher rules, they argued that rules proposed last year were more stringent -- and more costly -- than those that were supposed to accompany the 2001 rate increase.

State officials initially argued that the group homes didn't need a reimbursement increase. But then a state-sponsored analysis found that the rule changes would cost an additional $121 million over five years.

The N.C. Department of Health and Human Services has told group homes they have until June 3 to show they are meeting the new rules.

Eric Frazier: (704) 358-5145.

What the Rules Say

The new rules mainly affect Level III group homes, the type of home that has proliferated in the state in recent years. Each home must have:

• A qualified professional perform a minimum of 10 hours of clinical and administrative duties each week (at homes with five or fewer beds).

• Face to face clinical consultations at least four hours each week between children and a licensed professional.

• Two direct-care staff present and one awake for up to four children; both must be awake with five to eight kids. Three must be present and two awake for nine to 12 children.
Read more!

Patient, Nonprofit Victimized - Raleigh News & Observer

RUTH SHEEHAN, Staff Writer

Anthony Kemp was a patient at Dorothea Dix Hospital when he first met Barry Keyes.

He'd been staying at the shelter on Raleigh's Wilmington Street when the voices inside his head began telling him to throw himself off a bridge.

His social worker suggested he line up an agency called Triangle Disability Advocates, a faith-based nonprofit, to help with his finances.

"She told me they'd help me get my Social Security money, keep track of it while I was at Dix," said Kemp, now 30.

At first Kemp resisted the idea, but when he met Keyes, a volunteer with the agency, he immediately felt at ease.

"He was a real nice guy," Kemp said. "I liked him."

Because patients at psychiatric hospitals have few expenses, Kemp was able to essentially bank his Social Security disability payments (about $670 per month) during his 10-month stay.

When Keyes took on the account, Kemp already had a lump sum of $3,420. The scam apparently started immediately. Keyes sent Kemp a letter indicating he would take 15 percent of the total; instead, he took 25 percent, or $855.

When Kemp was released from the hospital to a temporary home for the mentally ill, Keyes continued handling Kemp's finances. Once a month, he would show up at Kemp's room with a check for $240, for food and incidentals.

"If I asked for more, he'd say, 'Oh, do you think you really need that?' " Kemp recalled.

At the end of each visit, Keyes would pull out a yellow legal pad and write the amount that he'd given to Kemp. Kemp would sign. The legal pad was filled with name after name, "receipt" after receipt, in this fashion.

In all, Keyes had 24 clients he visited, paying their bills as needed, doling out spending money, banking the rest. Kemp never gave it another thought.

Then, one day, a woman showed up with Kemp's check -- another worker from Triangle Disability Advocates.

Kemp asked her for the balance on his account. That's when she broke the news. Keyes had been caught stealing from his clients. Instead of several thousand dollars, Kemp had a balance of $94. Last fall, Keyes pleaded guilty to embezzling $69,000 from his clients.

But here's the real crime. Nearly two years after the theft was discovered, Kemp and the 23 other severely mentally ill people who were ripped off still haven't received their money.

Michael Hosick, executive director of Triangle Disability Advocates, discovered Keyes' misdeeds in May 2004.

"We operated on faith that everyone was doing the right thing," he said. His agency is apparently not responsible for reimbursing the clients because it is a nonprofit that merely acted as a conduit for the government payments.

Hosick said the government will reimburse -- but not until after Keyes, now under house arrest, is sentenced in June. How much they get is still in dispute.

Hosick reviewed Keyes' "receipts" and thinks his former worker has grossly underestimated the amount taken. He thinks the amount is over $100,000.

Meantime, Kemp and the other clients are still out their money -- with no safety net.


Read more!

Spend our energy restoring public role - Fayetteville Observer

By the Rev. Mac Legerton
Pembroke

As individuals, we resist change the strongest in the areas of our lives where there is the greatest fear. The same is true with our policymakers. They are not free to admit they are wrong, so they often defend their decisions even when time reveals how wrong they really are. This is the case with mental health reform in North Carolina.

The recent mental health reform in North Carolina could perhaps win the prize as the worst policy change made in our state’s recent history. From the standpoint of families challenged with mental illness, it is causing significant harm and misery. From the standpoint of public managers remaining in mental health and new private service providers, the system is in shambles. The system has been totally deconstructed and the negative impacts of it are everywhere.

From the standpoint of long-term benefit, it will end up costing the taxpayers more than the old system. These costs include the rising costs of private care and the shift of costs from ongoing services to emergency and crisis care — that are always more expensive. Added to this is the rising number of persons incarcerated with mental illness due to lack of access to services.

We need to spend our energy restoring the public role in mental health instead of tearing it down further or casting blame. We’ve thrown the baby out with the bathwater. We’ve gone too far and too quickly. We’ve lost our balance and perspective. It is the public — what we hold in common — in public/private partnerships that unites us. We need public management of a public/private mental health partnership.

We have lost our sensibilities as a people for those whose suffering is least understood. It is we who have become insane.

The Rev. Mac Legerton is president of the National Alliance on Mental Illness in Robeson County.The Fayetteville (NC) Observer Read more!

Mental health reform experiences difficulty - Waynesville Mountaineer

by PEGGY MANNING
Senior staff writer
ASHEVILLE — The closing of a children’s crisis center in Haywood County was the most recent result of state mental health reform, but as the transition continues more people may experience difficulty getting help for mental health or substance abuse problems.

On March 20, new Medicaid definitions became effective, and last week Carmen Hooker Odom, secretary of the N.C. Department of Health and Human Services, announced that the state will contract with Value Options, a Virginia-based health management company, to review Medicaid services.

The Medicaid definition changes forced the closure of the Children’s Recovery Unit operated by the Smoky Mountain Center for Mental Health, Developmental Disabilities and Substance Abuse Services.

The Balsam Center for Hope and Recovery opened its children’s wing in August 2005 and was forced to close Jan. 31 because the Medicaid plan no longer includes facility-based crisis services for children.

The Smoky Mountain Center — which represents Haywood, Cherokee, Clay, Graham, Jackson, Macon and Swain counties — will continue to operate its facility-based crisis unit for adults. The Medicaid changes will not impact the Balsam Center’s services for adults, at least not for now, said Tom McDevitt, Local Management Entity (LME) director.

“After two years of operation we have found that 73 percent of our admissions are non-Medicaid,” McDevitt said.

Those are the same people who would have to go to Broughton State Hospital if the Balsam Center was not available, he said.

A day-long symposium was held in Asheville Monday to provide a framework of common understanding about ongoing mental health reform and to develop a regional plan of action to improve mental health and substance abuse services.

“We don’t have to compete. We can join forces and look for new ways to collaborate for mental health and substance abuse services,” said Jim Van Hecke, president of the Addiction Recovery Institute in Tryon, which is spearheading the WNC Initiative on Mental Health and Substance Abuse.

About 200 mental health providers, government officials, hospital officials, legislators and law enforcement and judicial officials, school and business leaders from 17 counties attended the Western North Carolina Leadership Symposium on Mental Health and Substance Abuse: A System in Crisis.

Lynn Bailey, director of the exceptional children’s program for the Haywood County school system, was among the participants at the symposium, which offered panel discussions and group breakout sessions on a variety of mental health issues.

“We have had a good collaboration with mental health professionals to provide school-based mental health services. It was great to hear from a variety of people who may have paved the way to continue doing that,” Bailey said.

“We desperately need that collaboration because students with severe mental health issues need help so they can come to school and learn,” Bailey said. “Even though there’s a lot of frustration, I saw a lot of hope at the symposium for continuing to help children and adults with mental health or substance abuse problems,” she said.

It will take a united approach to adequately solve the dilemma of the changes coming down the pipeline for mental health reform, Van Heck said.

The system can not meet its crisis/emergency mental health and substance abuse needs on the back of Medicaid, McDevitt said.

The transition to relieving LMEs of the responsibility on July 1 of granting authorization for treatment will not only take away 20 to 25 percent of the Smoky Mountain Center’s funds, but that decision also will mean many rural areas like Western North Carolina will not have the financial ability to retain and subsidize their medical corp.

“Many rural areas already have a shortage of medical corp staff available to participate in the new diagnostic assessment service requiring two-member teams to conduct a more comprehensive assessment,” McDevitt said.

A less personal approach to admissions and treatment will also be a formula for disaster, he said.

“Can they do it without implications to families and the community?” McDevitt asked. “Right now the LME has to respond back to the county and stakeholders,” he said.

The N.C. Department of Health and Human Services is planning to construct a new 432-bed regional psychiatric hospital in Butner. Dorothea Dix Hospital in Raleigh and John Umstead Hospital in Butner will continue to offer services, but will downsize until remaining patients and admissions can be accommodated at the new facility, expected to be completed by late summer of 2007.

“When the state hospitals downsize beds, those patients will fall back to the counties, but they may not all be Medicaid eligible,” McDevitt said.

Currently, only 40 percent of adults needing mental health services are Medicaid recipients and only 15 percent needing substance abuse services have Medicaid coverage.

Haywood County’s share of Medicaid payments is $3.6 million this year, which requires $.08 of the county’s property tax rate.

North Carolina is one of only two states that supplement Medicaid costs. New York also requires a local match. The federal government pays 63.5 percent for Medicaid covered services, while states pick up 31.02 percent of the cost and counties pay 5.48 percent.
An advisory committee, made up of representatives from each county, will help guide the work of the Initiative.

For the next three months, the initiative will work with designated county facilitators to expand the dialogue on mental health and substance abuse issues in each county.
Participants of the Initiative also will work on county and regional strategic plans to improve public awareness, professional training and client services and develop a regional network of support.

Peggy Manning can be reached at 452-0661, ext. 127, or at peggy @themountaineer.com.
To read the HHS/Division of Mental Health annual report go to:
http://www.dhhs.state.nc.us/mhddsas/manuals/index.htm#Reports Read more!

CMS Describes New System For Paying Psychiatric Facilities - American Psychiatric Association

Mark Moran

One feature of the proposed rule is a redefinition of labor markets whereby rural hospitals would be reclassified into urban areas, causing them to lose a 17 percent favorable adjustment in payment.

Inpatient psychiatric facilities would receive an average 3.2 percent increase in their Medicare payment rates for discharges occurring on or after July 1, 2006, under a proposed rule issued by the Centers for Medicare and Medicaid Services (CMS).

The payment increase would affect approximately 1,800 inpatient psychiatric facilities, including freestanding psychiatric hospitals, certified psychiatric units in general acute care hospitals, and critical access hospitals that are paid under the inpatient psychiatric facility Prospective Payment System (PPS).

The PPS for inpatient psychiatric hospitals was mandated by the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act (BBRA) of 1999 and made effective January 1, 2005, ending a 20-year exemption from prospective payment (Psychiatric News, December 3, 2004).

Payments for inpatient psychiatric facilities under the PPS are based on a single federal per diem rate that includes both inpatient operating and capital-related costs. The proposed per diem rate for Rate Year (RY) 2007 is $594.66, up from $575.95 in RY 2006, according to the CMS.

This base rate is adjusted for four patient characteristics: age, diagnosis-related group (DRG) assignment, the presence of certain other diseases or conditions (comorbidities), and the patient's length of stay. The base rate is also adjusted to reflect the following facility characteristics: the presence or lack of a qualifying emergency department, teaching status, rural location, and each facility's wage index.

In this first update to the system, CMS is proposing a number of refinements to the payment policies affecting inpatient psychiatric facilities. Among the most critical is a proposed redefinition of labor markets.

Irvin (Sam) Muszynski, J.D., director of APA's Office of Healthcare Systems and Financing, explained that one effect of this is that many rural hospitals would be reclassified into urban areas and thereby lose their favorable 17 percent facility adjustment established to support the financial stability of rural facilities.

"We think this is a problem and will recommend that it be fixed so these hospitals will not be negatively affected," Muszynski said.

A second feature is a proposal to make uniform the time requirements for certification and recertification of patients. Under the CMS proposal, certification would be required for all hospitals and units at the time of admission-or as soon thereafter as is reasonable-and the first recertification would be required as of the 12th day.

"We are opposing this and will recommend that recertification be at the 18th day, as currently required," Muszynski said.

Other issues addressed in the proposed payment update include the following:



o A proposal to adopt a new method of determining inflation in the costs of goods and services provided in inpatient psychiatric facilities reflecting inflation in three types of hospitals that are currently excluded from the inpatient PPS for acute care hospitals: inpatient rehabilitation facilities, inpatient psychiatric facilities, and long-term-care hospitals.

o A proposal to increase the fixed dollar-loss threshold amount for outlier payments from $5,700 to $6,200 to keep overall outlier payments at 2 percent of total payments as per diem rates increase. This threshold is the amount by which the hospital's costs for treating a case must exceed the Medicare payment amount for that case before Medicare will make an additional payment to the facility.

o A proposal to increase payment for electroconvulsive therapy (ECT) based on the latest hospital median cost data for ECT.

The proposed rule was released January 13 and published in the January 23 Federal Register.

At press time, APA's Department of Government Relations was preparing comments about the proposed rule that will address, among other issues, the following: interrupted stays, ICD-9-CM coding issues, physician recertification, and same-day transfers (when a patient is admitted to an inpatient psychiatric facility and is later transferred to another type of facility on the same day).




Read more!

Mental health budget cut 28% - Durham Herald Sun

BY GREGORY PHILLIPS
gphillips@heraldsun.com

Apr 7, 2006 : 12:11 am ET

DURHAM -- During a meeting to receive a proposed budget for next year, Durham Center board members learned Thursday of a letter from the state telling them $1.4 million of the money they had this year won't be there.

The Durham Center, the county's mental health, substance abuse and developmental disabilities authority, knew the state planned to cut money after announcing it was outsourcing the authorization of Medicaid-funded care.

The center is challenging the legality of that. But the preliminary budget allocation the state gave the center includes a 28 percent cut in management funds from $5.1 million to $3.7 million, which director Ellen Holliman said is more than she was expecting.

Earlier predictions had suggested a 23 percent cut at most, which could have led to the loss of 15 of the center's 55 remaining employees.

Holliman said she didn't know if that number would increase if the state's numbers are approved by the General Assembly this summer, but said the center may look at pulling screening, triage and referral of cases back in-house and use existing staff to cover it. The center currently pays a private firm about $800,000 annually to screen and refer cases, Holliman said.

"We're trying our best to find any way we can to keep as many staff as we can," she said. "You can't absorb that kind of cut without it affecting staff."

That could be hindered by an additional blow the state dealt the center last month -- the announcement that all after-hours screening and referral services in Durham will be handled by the neighboring Five Counties authority come July.

That, coupled with a plan to have private contractor Value Options authorize all Medicaid-funded care for the state after June 1, is the state's way of cutting $28 million from the budget.

The center has challenged the legality of that plan on several fronts, claiming it violates statutes and a contract the center has with the state to authorize care through June 2007.

Holliman told the board the state is required to respond by April 17 to an injunction County Attorney Chuck Kitchen has filed to stop the state's plans from taking effect. Board members suggested soliciting public displays of support from the city and county (which has already filed suit on the Center's behalf) and lobbying state legislators to build momentum for the legal action the board has taken.

Board members said moving after-hours referral services to another county goes against the state's purported goal in reforming mental health care, to localize management.

"The state can't just force us into a partnership with another county," Chairman Doug Wright said.

The center's $50 million proposed budget, which the board will review at its May meeting, was prepared based on this year's allocation from the state, Holliman said. Its actual size come the next financial year may ultimately lie in the hands of a judge.

"The cloud we're under is incredible," Holliman said. "And it's not just us, it's statewide. Everything's up in the air." Read more!

Meadows submits plan to fix violations - Wilmington Star

The Meadows of Wilmington has reached an agreement with the state about how the assisted-living facility will correct its cockroach and care violations.

The N.C. Division of Facility Services cited the 4200 Jasmine Cove Way facility with seven violations after it was called in by local investigators in early February. The state’s violations brought to light the facility’s failure to keep a clean facility as evidenced by a cockroach infestation; ensure staff members are tested and negative for tuberculosis; get a resident outside care for immediate health care needs; document residents’ treatments; administer medications to residents; and meet Declaration of Residents’ Rights standards.

According to its correction plan, The Meadows of Wilmington has already changed several of its policies and completed staff training. The actions include
Schedule regular pest control treatments and education of residents regarding use of sealed containers for snack food.

COMPLETe tuberculosis testing Feb. 22 for all staff members who didn’t have test results in their personnel files.

STRENGTHEN protocol regarding patients who have head wounds or display mental health decline, requiring monitoring, documentation and notification of physicians and family.

REQUIRE consistent documentation of residents’ treatments and medications to be reviewed by a nurse consultant from Careamerica, the facility’s parent company.

INSTRUCT staff to seek out residents in need of blood sugar checks rather than waiting for residents to go to them.

TRAIN incoming staff on diabetes management, proper documentation and medication management. (Current staff underwent this training by March 8.)

Mike Elliott, co-owner of the Leland-based Careamerica, did not return a call seeking comment Friday afternoon, but previously said The Meadows of Wilmington is a safe place for residents that has no more problems than the next facility.

Jim Jones, spokesman for the division, said state and local investigators will monitor The Meadows of Wilmington to ensure it is compliant and that its violations have indeed been corrected. If it hasn’t corrected the problems, he said the facility could be subject to fines.

“Of course, we hope they’ve totally corrected the problem,” Jones said.

Cheryl Welch: 343-2315
cheryl.welch@starnewsonline.com Read more!

Shortage of child psychiatrists takes nationwide toll - Associated Press

Friday, April 7, 2006; Posted: 11:37 a.m. EDT (15:37 GMT)

NEW YORK (AP) -- In state after state, bleak statistics and grim anecdotes lead to the same diagnosis: America suffers from a serious, long-term shortage of child psychiatrists that is taking a toll on young people, their parents and their doctors.

Wyoming is down to two child psychiatrists; another left last year. In Augusta, Georgia, Dr. Sarah Sexton tells would-be new patients she might be able to see them in July. Elsewhere, doctors take no new patients at all.

"There is no state where it is not a problem -- none," said Dr. Gregory Fritz, director of child psychiatry at Brown Medical School in Providence, Rhode Island. "We see it in the emergency ward every night, where problems have gotten out of hand over time due to lack of intervention, and progress to a point where a kid is suicidal or dangerous."

The shortage has been noticed within the profession for years, but psychiatrists say the consequences are worsening as the stigma of mental health problems recedes and more families seek help for their children, including prescriptions for psychiatric drugs.

Demand for such drugs is intense, and the shortage of psychiatrists "forces kids to see other practitioners for medication management who might not have the training or experience to appropriately treat them," the National Conference of State Legislatures warned in a report last month.

The shortage is attributed to two main factors: the extra two years of training required for child psychiatrists, on top of four years of medical school and three years of general psychiatry; and a reimbursement rate that doesn't reflect the extra time required for a psychiatrist to interview parents, teachers and others familiar with a child's behavior.

"You always have to deal with a parent or caretaker -- it doubles the interview time," Fritz said. "But the reimbursement rate is the same as if you're evaluating an adult."

The main organization representing the profession is the American Academy of Child and Adolescent Psychiatrists (AACAP), which gauges the number of practitioners in the field at about 7,000. The U.S. Bureau of Health Professions projects there will be about 8,300 child psychiatrists in 2020, only two-thirds of the estimated 12,600 needed.

The shortage already is staggering. The Center for Mental Health Services estimates that at least 5 percent of America's children and adolescents have acute mental health disorders.

Yet a study commissioned by the AACAP in 2003 found there was, on average, only one child psychiatrist for every 15,000 youths under 18 -- in theory, producing a burdensome caseload of 750 seriously disturbed children per doctor. West Virginia had 1.3 child psychiatrists per 100,000 young people.

Because of the shortage, pediatricians, family doctors and child psychologists have been filling the void, though their training is far less thorough. Several states are encouraging tele-psychiatry in which physicians in underserved rural areas can consult long distance with urban- or university-based child psychiatrists.

"We have to use our expertise in as broad a way as possible, to help the physicians actually providing the care," said Dr. Steve Cuffe of the University of South Carolina.

Often, according to the National Alliance on Mental Illness, parents unable to find or afford private psychiatric care are told the only way to get needed treatment is to relinquish custody of their child to the state.

"The human cost is far too great," Theresa Brown, a Westbrook, Maine, mother said in U.S. Senate testimony, describing her yearslong and unsuccessful struggle to obtain mental health services that would have enabled her to keep custody of her daughter.

Compounding the problem is the surging use of drugs for children with attention deficit disorder or other behavioral problems. One recent study estimated that 2.5 million children a year are taking such drugs; Fritz said most are prescribed by pediatricians and other non-psychiatrists.

"They're probably overused, and often without appropriate assessment and monitoring," he said. "If there were more child psychiatrists, they wouldn't be used as casually as they are."

Several steps have been proposed to ease the shortage, though none are expected to produce swift changes. One concept is to either shorten the five-year psychiatry program or enable students interested in child psychiatry to begin working with children sooner in their training.

Another step was taken last week when the House of Representatives approved an amendment that makes students preparing for work in youth mental health eligible for loan forgiveness. But the measure's Senate prospects are uncertain, and a broader bill addressing the psychiatrist shortage has languished in committee for two years.

"Everyone knows there's a shortage of nurses, of science teachers," said Michael Zamore, an aide to amendment sponsor Rep. Patrick Kennedy, D-Rhode Island. "When it comes to mental health, it's hidden in the closet." Read more!

Lot of talk, little action on Dix site - Raleight News & Observer

The mental hospital will close by 2008, but the future of the 315-acre site is a mystery

Ryan Teague Beckwith, Staff Writer

RALEIGH -- A year ago, it seemed everyone was talking about the future of Dix Hill.
A design firm presented plans for apartments, shops and offices there. Raleigh and Wake County officials presented a plan with room for a hotel, school and museum.

Proponents of a major park or botanical garden spoke out.

And then: nothing.

Since last year, official planning for the campus of the Dorothea Dix state mental hospital has come to a standstill. At the same time, park advocates are struggling to present a united front.

The Friends of Dorothea Dix Park, a nonprofit coalition of community and environmental groups, has split with mental health advocates and supporters of a botanical garden over the design of a park.

Some think the lack of progress and the other setbacks are related.

"I think there's a lot of tension building," said state Sen. Janet Cowell, a Wake Democrat. "The problem right now is you've got all sorts of people talking about what they think, but there's no formal body out there to run the process."

Willie Pilkington, a Wake hobby gardener who is advocating for a botanical garden on the site, said the silence breeds suspicion.

"Any time it's silent, you wonder what's going on," he said. "I'm asked almost every single day if I know anything about what's going on with the Dix property. My answer is that I know as much as anyone else, which is nothing."

Rep. Jennifer Weiss, a Wake Democrat who is a co-chairwoman of the legislative committee in charge of the site, defended the delay. She noted that a provision in the state budget prevents the campus from being sold until late 2007.

"There's not a big hurry to make a decision," she said.

New hospital in works

Since the mid-19th century, Dix Hill has been the site of a state-run mental hospital.

But with a new hospital being built in Butner, Dorothea Dix will close in late 2007 or early 2008. Now, the state has to decide what to do with the 315-acre campus and a hundred buildings on it.

A series of public meetings sponsored by state and Raleigh leaders last year put the issue in the spotlight. But park advocates say the lack of a public forum since then is hampering their effort.

The Friends of Dorothea Dix Park had hoped to use further meetings to make a case and to get more information about the site, which is just southwest of downtown Raleigh.

"We're very frustrated," said executive director Janis Ramquist.

Members have drawn up a proposal anyway, but it is intentionally vague. It calls for leaving most of the site as open space, especially an area they call the "Great Lawn" on the southwest side.

They also propose a few long-term changes:

* Tear down most office buildings used by the N.C. Department of Health and Human Services.

* Create a museum dedicated to mental health in one of the historic buildings.

* Build two pedestrian bridges across Western Boulevard to link to trails at Pullen Park and in South Raleigh.

The proposal leaves unanswered questions. When would the buildings come down? Where would the estimated 1,100 state workers go? How would the park's construction and maintenance be funded?

Tony Avent, who owns a Raleigh-area nursery, helped draw up the plan. He said the group didn't want to get into issues it has no control over.

"The plan has to be fairly vague because we have no power," he said. "...The legislature is going to make those decisions."

Group members also said they were not qualified.

"We feel like the detail needs to be filled in by a world-class park designer," said Jay Spain, president of the Friends of Dix board of directors.

Mental health concerns

The plan also says nothing about mental health treatment, an issue that has proven divisive.

Local mental health advocates first hoped to build a short-term treatment center on the property, but they later decided it would be better next to a general hospital.

In May, the Wake chapter of the National Alliance on Mental Illness endorsed the park idea. But late last year, it quietly dropped out of the Friends of Dix coalition.

Ann Akland, president of the chapter, said she still supports keeping a good part of the land as a park but the chapter has decided to stay on the sidelines in the debate over its design.

Instead, it argues that any profits -- from selling the land to developers or leasing it to the city for a park -- should go in the state's trust for treating mental illness.

Ramquist, head of the Friends of Dix, said the group still has ties to other mental health proponents.

"We have a number of individual advocates who feel very strongly that if it's not going to be a hospital, then it should not be developed," she said.

A botanical garden?

The idea of a botanical garden has also been contentious.

For more than a decade, local gardeners have advocated for a major botanical garden to supplement the J.C. Raulston Arboretum at N.C. State University. They say it could draw tourists from all over the Southeast.

But advocates have split over its size. Pilkington, head of the Wake County Botanical Garden Society, argues that the garden should take up most of the 315 acres. A plan drawn up for the state called for a few acres.

The Friends of Dix plan doesn't show a botanical garden, but members say they haven't ruled it out.

"There's some give and take," said Benson Kirkman, a member of the group and a former Raleigh City Council member. "You have to really assess what's practical and what's not practical and not take it to the extreme."

Pilkington said the Friends of Dix proposal didn't show enough imagination.

"They are adamant that they are going to get a public park for running their dogs and throwing their Frisbees and putting their blankets out," he said. "That's cool if that's all the city of Raleigh and the state think they can produce."

For now, the debate is happening behind the scenes. Once the state legislative committee begins meeting, however, these issues will be back before the public.

Weiss said she hopes to schedule meetings before the legislative session begins in May.

And park advocates remain upbeat. They say they still have the support of the public and enough time to make their case for a grand public park. They say it will work out in the end regardless of how long it takes.

"This is not a procedure like flipping the light on or getting somebody's appendix out," said Assad Meymandi, a Raleigh psychiatrist and philanthropist who is backing the park. "It is a process, and there will be twists and turns."

Greg Poole Jr., one of the chief advocates with the Friends of Dix, took the long view.

"You don't build parks like this overnight," he said. "Nobody has, and nobody probably ever will."

Staff writer Ryan Teague Beckwith can be reached at 836-4944 or rbeckwit@newsobserver.com.
Read more!

Living on Impulse - New York Times

By BENEDICT CAREY
New York Times

Play hooky, disappear for the weekend, have a fling, binge-shop like a Wall Street divorcée. Spontaneity can be a healthy defiance of routine, an expression of starved desire, some psychologists say.

Yet for scientists who study mental illness and addiction, impulsive behavior the tendency to act or react with little thought has emerged as an all-purpose plague.

In recent years, studies have linked impulsiveness to higher risks of smoking, drinking and drug abuse. People who attempt suicide score highly on measures of impulsivity, as do adolescents with eating problems. Aggression, compulsive gambling, severe personality disorders and attention deficit problems are all associated with high impulsiveness, a problem that affects an estimated 9 percent of Americans, according to a nationwide mental health survey completed last year.

Now researchers have begun to resolve the contrary nature of impulsivity, identifying the elements that distinguish benign experimentation from self-destructive acts. The latest work, in brain research and psychological studies, helps explain how impulsive tendencies develop and when they can lead people astray. A potent combination of genes and emotionally disorienting early experiences puts people at high risk, as do some very familiar personal instincts.

"What we're seeing now," said Charles S. Carver, a psychologist at the University of Miami in Coral Gables, Fla., "is a rapid convergence of evidence indicating that when the prefrontal cortical areas of the brain, the brain's supervisory management system, are not functioning well, this interferes with deliberative behavior, and the consequences are often unpleasant."

Few experts dispute that impulsiveness pays off in some situations and, perhaps, had evolutionary benefits. When life is short and dangerous, and resources are scarce, there is a premium on quick response. In studies of baboons and monkeys, researchers have found that animals that are impulsive as adolescents often become dominant as adults, when they moderate their confrontational urges.

In humans, impulsive behavior typically peaks in adolescence, when the prefrontal areas of the brain continue to develop, or soon after, in the young adult years, when it is culturally expected that people will test their limits, psychologists have found.

Yet new research suggests that a taste for danger or conflict is not enough to produce persistent, ruinous impulsivity.

In a study published online last month in The Journal of Psychiatric Research, Janine D. Flory, a psychologist at the Mount Sinai School of Medicine in Manhattan, led a team of investigators who studied 351 healthy adults and 70 others with impulse-related disorders like antisocial and borderline personality disorders. The participants took a battery of tests to measure inhibition, appetite for risk and the inclination to plan.

Analyzing the responses to questions intended to gauge thrill seeking like, "I like to explore a strange city or section of town by myself, even if it means getting lost," and, "I like to try foods I've never tried before," the researchers found that an appetite for risk was associated with smoking in both groups.

But in the healthy volunteers, the appetite was also associated with higher education. In previous studies, healthy risk seekers scored highly for curiosity and openness to new experiences. On measurements of instinctive planning "I am better at saving money than most people" and "I hate to make decisions based on first impressions" the researchers found that less deliberative habits were related to heavy drinking in the healthy group and the troubled group.

In cases with personality disorders, deficits in planning were also associated with a history of suicide attempts. The combination of sensation seeking and lack of deliberation characterizes millions of healthy people but appears to be extreme in those whose impulsivity leads to chronic trouble or mental illness, Dr. Flory said.

"The way I think of it is that one factor has to do with the urges people have, and the other has to do with the brakes they apply," she said.

How and when people apply the brakes is crucial to distinguishing those who can flirt with regular heroin or cocaine use while finishing an Ivy League degree and those who die trying.

The people who can binge, gamble or try hard drugs and get away with it have a native cunning when it comes to risk, this and other studies suggest. They are prepared for the dangers like a mountain climber or they sample risk, in effect, by semiconsciously hedging their behavior sipping their cocktails slowly, inhaling partly or keeping one toe on the cliff's edge, poised for retreat.

"These are highly self-directed people," said C. Robert Cloninger, a professor of psychiatry and genetics at Washington University in St. Louis and author of "Feeling Good: The Science of Well-Being." "They have goals and are resourceful in pursuing them."

Those who are upended by their own impulses, by contrast, are more likely to trust their first impressions implicitly and absolutely, the studies suggest.

"I am a very intuitive person, I can tell very quickly when someone's lying to me, when they're telling a shaggy-dog story," said Thomas Crepeau, 55, a computer systems analyst in Washington who said his impulsive temper helped worsen a contentious marriage.

Mr. Crepeau, who has since benefited from therapy, said he used to act on his hunches immediately. "Other people might allow me 20 words before cutting in, but I would allow them four," he said. "I never had the patience to just wait it out and see if the other person was wrong."

This difference in ability to hedge or self-regulate is partly based in genetic variation, experts say. In a study published in March, investigators at the National Institute of Mental Health took blood samples from 142 healthy volunteers and analyzed a gene called MAOA. The gene directs the body to produce an enzyme that reduces the activity of a brain chemical called serotonin, which strongly influences mood. Earlier studies have linked variations in this gene to impulsive aggression.

The researchers conducted M.R.I. scans on participants' brains while they were performing tasks intended to measure impulse control. In one of the tests, the participants watched as a computer screen presented a series of arrows, boxes and X's, three at a time, as a slot machine does.

The patterns appeared in quick succession, and the participants were instructed to hit a button indicating which way the arrow was pointing. They also had to restrain from hitting the button when one particular pattern appeared. Their mistakes provided a measure of how well they could restrain their reflexes.

The researchers found that, during the computer game, men who had one common MAOA variant, known as the "high-risk" variant, showed significantly less activation than peers with the "low risk" version of the gene in an area called the dorsal anterior cingulate. The cingulate is part of the brain's prefrontal area its supervisory manager which is involved in shaping deliberate behavior, in measuring a proper response or reflex.

The participants in the study with the high-risk gene also had deficits in areas of the brain involved in moderating emotion, supporting many earlier studies finding similar gene-related differences.

"On the one hand, these deficits in emotional regulation set people up for strong emotional reactions early in life and make them more vulnerable to trauma, we believe," said Dr. Andreas Meyer-Lindenberg, the study's lead author. "On the other hand, the deficit in cognitive, inhibitory function creates a propensity to act on those emotions later in life."

And life never stops testing those supervisory mental skills. Drug use weakens deliberative regulating skills quickly and cumulatively over time. Coping with periods of extreme stress at any age starting a new job, breaking up with a romantic partner, recovering from a car accident can overload the prefrontal regions, leaving fewer resources available to manage emotions, Dr. Carver said.

One reason true impulsivity has been difficult to capture in the lab, said Dr. Martha Farrah, director of the Center for Cognitive Neuroscience at the University of Pennsylvania, is precisely because "it is most manifest in these very high-stakes situations, when people are trying to get what they want, to stay focused, maybe trying to kick a drug habit." And that is when they break down.

None of which is to deny the power of early psychological wounds, regardless of genetic makeup.

People with borderline personality disorder, for example, an enigmatic condition characterized by neediness, emotional reactions and self-destructive behavior like self-mutilation, often misread others' motives and are savagely impulsive in response. "The impulsive behavior always has specific meanings for them," said Dr. Glen Gabbard, a psychiatrist at the Baylor College of Medicine in Houston.

One of his patients, he said, recently called her boyfriend at work, who told her he couldn't talk just then, he was swamped. She took that to mean that he was about to dump her.

"She called him back immediately after hanging up and broke up with him on the spot, as a pre-emptive strike," Dr. Gabbard said.

For her and many others, he said: "It is the psychological meaning of the event that matters most, and for her it was abandonment. Her own father left the family when she was 4 years old, and she sees abandonment everywhere."

In Mr. Crepeau's case, he enrolled in a "compassion power" group-therapy workshop and learned that his contentious nature grew in part out of a history of being dismissed and ignored. Once he understood how this history shaped his impulsiveness, he was able to begin delaying his reactions.

Mr. Crepeau now teaches workshops that help people deal with impulsivity and other relationship problems. In a recent class, he had to contain himself when one of the workshop attendees, asked to present a homework assignment, took the opportunity to brag at length about his accomplishments.

"I couldn't believe this guy; not long ago I would have stepped in" and told him off, Mr. Crepeau said. "But I just waited, and politely told him he needed to do the assignment over." Read more!

Mentally ill homeless need help with system that's insane - Winston-Salem Journal

Click here to view other articles, videos, charts and statistics from The Winston-Salem Journal's "Profile of A Breakdown Series."


If you've ever spent time talking to street people, you know that many of them are as insane as the mental-health system that keeps failing them.

I'm not talking about those who are outside because of job loss, medical bills, divorce or other reasons. I'm not talking about those who lose their homes and families because they can't put the bottle or crack pipe down.

I'm talking about the homeless with mental problems who either get no treatment or shoddy treatment. For example, every year, the state's four psychiatric hospitals release hundreds of mental patients to shelters in Winston-Salem and other cities. That flood is part of the state's terribly flawed plan to privatize mental-health care.

If state leaders ever figure out how to fix that plan, maybe they'll get more of these folks off the street and into treatment centers and, with counseling, their own homes. Leaders in Winston-Salem and Forsyth County are pushing for approval of a multimillion-dollar plan of their own aimed at curbing chronic homelessness here, but it will take years to execute.

Meanwhile, too many mentally ill homeless wander our streets. They cost us a lot of money in social services. They're often a danger to themselves and others. They need help now.

There are some good ideas out there on how to help them. Kermit Bailey of the nonprofit Triad Disability Advocates, which he operates from his Kernersville home, has one. It starts with a deceptively simple concept.

To really assist the homeless, he says, "The entire community, especially the churches, must understand that they are working with mentally ill people." Bailey, a bald and bespectacled guy in a clerical collar, gets animated as he talks, cutting cynicism with humor - and hoping somebody will listen.

It's hard enough to help homeless folks kick booze and drugs and find jobs. Getting them help with mental problems - especially when some of them have both mental problems and drug and alcohol problems - is even harder. Maybe that's why the problem of getting care for them isn't being tackled as aggressively as it should be.

Bailey, an Episcopal deacon who is 69, estimates that at least 80 percent of the approximately 500 homeless people in Forsyth County are mentally ill. I question his count, which sounds high.

I don't question his dedication.

He concentrates on managing money for the mentally ill and mentally handicapped who receive disability payments, but he once focused on helping them apply for benefits for mental and physical disabilities from the Social Security Administration. Other groups are still doing that. Those benefits can mean the difference between living outside or under a roof.

A lot more people could get help with their benefits, Bailey says, if houses of worship and other community groups trained members to shepherd the mentally ill through the application process. These groups could also pressure Congress to streamline that process, Bailey says, so that more worthy cases are approved faster.

There are rainbows in the application process, but no pots of gold. Success is just getting somebody disability payments that will allow that person to have his or her own place and stay off the streets. Most of Bailey's clients with mental illness are chronic cases who will never fully recover, just as is true for so many homeless with mental problems.

Putting them in homes and matching them with counselors so that they can stay in those homes is the right thing to do. It can also save a lot of money in social services.

It's not easy. Bailey's clients often are people whom few others will listen to. Many of them talk on and on when they finally get an ear.
Bailey can understand.

He does much the same thing when he finally finds someone who will listen to him talk about a system more flawed than all the people it should be helping.
"It's maddening," he says.

• John Railey writes local editorials for the Journal. He can be reached at jrailey@wsjournal.com Read more!

Medicaid mental health review duties to be moved out of state

by Leslie Boyd, STAFF WRITER
published March 30, 2006 6:00 am

Decisions about mental health care for patients in North Carolina soon will be made in Virginia by corporate-employed psychiatrists who never meet them.

The move by the state to use a for-profit contractor for Medicaid case reviews takes these duties out of the hands of local mental health agencies.

Value Options, which already contracts with the state for Health Choice, the state-sponsored program for children whose families lack health insurance, and for out-of-state care for people with mental illness, will take over review of all Medicaid-funded mental health care.

“One basic tenet of reform was that services and management and assessment would be in the community,” said Arthur D. Carder Jr., CEO of Western Highlands Network, the eight-county local management entity, or LME, that recruits and manages a network of mental health care providers. The LMEs still will manage the spending of state-funded care.

“What I want to know is how we will handle services that are paid for with both state and Medicaid dollars,” Carder said. “And what about the people who are denied services through Medicaid? The law says the state can’t pay for a service that was denied through Medicaid. People could lose care, and who’s going to pick up the slack? The counties?”

Carder and other mental health providers and advocates worry that a corporate-paid psychologist in Virginia might not make the best decisions for a patient in North Carolina they’ll never see.

“All they’ll know is what’s on paper,” said Gayle Littlejohn, director of The ARC of Buncombe County, an advocacy group for people with developmental disabilities. “Somebody has to know that person. It’s like grading the SATs — you feed that paper into a machine somewhere and it decides. But these are people we’re talking about, and it seems they’re just becoming numbers.”

No firm date has been set for Value Options to take over the review function, said Mark VanSciver, a spokesman for the Division of Mental Health, Developmental Disabilities and Substance Abuse Services.

Carmen Hooker Odom, secretary of the N.C. Department of Health and Human Services, said anyone who believes the review process involves seeing the patient isn’t familiar with the process. It is a review of services used and of records, she said.

“If you’re saying you need face-to-face, you don’t know what you’re talking about and that proves my point,” she said.

Officials at local management entities — there are about 30 across the state — say they were given no warning that this service was going to be contracted out. In fact, several were putting together proposals to provide the service on a more regional level.

Carol Duncan Clayton, director of the N.C. Council of Area Programs, a group composed of LME leaders, said the local agencies have gotten little direction from the state. “They went through four application processes in the last nine months,” Clayton said. “There have been very unclear expectations.”

Several months ago, Odom said she wanted more consolidation in the system and that 1o LMEs would assume the review duties and the after-hours call center duties for their regions. Carder said Western Highlands had received provisional approval to assume the duties here.

“Contrary to what they think, there was no approval granted,” Odom said.

“(The federal government) requires it to be done a certain way and from the submitted proposals, none of (the LMEs) meet the minimum standards. We said we would review proposals by the LMEs … as long as they met the requirements. They didn’t, so I made the decision to go with Value Options.”

Clayton said there are no federal regulations for this process — those are written by the state.

“Why weren’t the same requirements written into each application?” Clayton said. “No. The game changes every time and then no one is declared a winner.”

Odom said patients still will have the right to appeal decisions made about their care, but local advocates worry people won’t know where to turn.

“They’ve always been able to go to the local agency,” Carder said. “We won’t be able to do anything for them on Medicaid issues with this.”

One LME, Durham Center, filed suit Tuesday to stop the transfer of duties. “We feel very strongly that the management of care has to be at the local level,” said Ellen Holliman, director of the Durham Center, which oversees the mental health system in Durham County.

Holliman also said she believes that since providers file requests for services with Value Options they will ask only for services they provide. “They’re not likely to request a service they don’t provide,” she said. “The LME would look at all providers’ services and request the best one for that patient. We are responsible to our patients. To whom is Value Options responsible?”

Holliman also hopes to stop the transfer of after-hours call center duties, but Odom said that decision would be made in a meeting Wednesday evening.

“Most of them contract out that service already,” Odom said. “Some of them contract it out to a place in Oregon.”

Carder worries about the erosion of authority at the local level.

“What will happen next?” he said. “Will the secretary decide to turn everything over to a single for-profit provider?”

The local management entities will lose administrative funds when the change is made, but Odom said no one knows yet how much. “We’re still working on the calculations for that, but certainly, the LMEs will not be paid for work they are no longer doing,” she said.

Carrying the burden of caring

The burden of caring for people with serious mental illness often falls to local jails and homeless shelters. People who don’t have access to adequate treatment are likely to self-medicate with alcohol and street drugs. In crisis, they land in hospital emergency rooms, where they may wait for hours until a hospital bed is found.

They are transported to state hospitals by law-enforcement officers, who often spend an entire shift dealing with a single patient.

According to the National Institutes of Mental health, about one in four Americans (26.2 percent) has a diagnosable mental illness in any given year. About one in 17 (6 percent of the population) has a serious mental illness.

Contact Leslie Boyd at 828-232-2922 or via e-mail at lboyd@ashevill.gannett.com. Read more!

Nesbitt wants $100M more for mental health system

by Leslie Boyd, STAFF WRITER
published March 31, 2006 6:00 am

ASHEVILLE — State Sen. Martin Nesbitt said Thursday that his legislative committee will recommend shoring up the state’s faltering mental health system with at least $100 million in new funding.

Nesbitt, D-Buncombe, was a member of a panel discussing mental health reform, which was mandated by the state Legislature in 2001, and has thrown the system into disarray.

About 100 people attended the discussion at Mountain Area Health Education Center in Asheville.

The Legislature, Nesbitt said, is not likely to follow the path laid out by Department of Health and Human Services Secretary Carmen Hooker Odom.

Odom has moved to consolidate the system of local agencies into larger regions. She announced last week a decision to hand over reviews of Medicaid cases to the for-profit, Virginia-based Value Options, which has offices in Raleigh and has several other contracts with the state.

Nesbitt, co-chair of the State Legislative Oversight Committee for Mental Health, Developmental Disabilities and Substance Abuse Services, said he was shocked to learn of the decision.

“The point is this was supposed to be local,” Nesbitt said. “This would be like telling Buncombe County you don’t need a school board anymore; that all the decisions will be made in Raleigh, or that we’re going to abolish the local health departments and let Value Options take over.”

Nesbitt said he learned of the decision at 5:30 p.m. the night before the announcement was made at a meeting of his committee.

The committee has met monthly since September to examine mental health system needs. It will present recommendations to the General Assembly during the session that opens in May.

“We’ve tried to get a report from (DHHS) to tell us how much money is needed to get this system back on track,” Nesbitt said. “We asked for it two years ago and gave them a year to do it. They came back a year later and asked for another year. We gave them nine months, and we were told last week they finally hired a contractor to prepare the report and it should be done by August.”

Without the report, Nesbitt said, the committee doesn’t know exactly how much the system needs, but it will recommend at least $100 million in new funding. It also will recommend that the local agencies have the power to oversee care and make decisions.

John Rowe, a longtime member of NAMI Western Carolina, an advocacy group for people with mental illness, talked about problems that have beset the new system:

• New Medicaid rules have left many people with developmental disabilities with a sharp decrease in one-on-one services.

• People in crisis lack services.

• Bridge funding is needed to help establish mental health services in the community.

• An announcement last month that money saved by the closing of state hospital beds would not go toward community services but instead would pay debt service for a new hospital being built in Butner.

John Tote, director of the Mental Health Association of North Carolina, recommended that people contact their legislators and let them know that the mental health system is a priority.

“This is an election year,” Tote said. “Make them listen.”

Mona Cornwell, a NAMI member, said the struggle between the Legislature and the Health and Human Services department worries her.

“I’m just afraid people’s suffering will get lost in all this finger-pointing,” she said.

Contact Leslie Boyd at 828-232-2922 or via e-mail at lboyd@ashevill.gannett.com.
Read more!

Mental Health Coverage Affordable, Study Finds

By Christopher Lee
Washington Post Staff Writer
Thursday, March 30, 2006; Page A21

A new study involving federal employees has found that providing better mental health coverage does not lead to an explosion in insurance costs, a potentially important development in an old national debate over what insurance plans should cover.

The study, published today in the New England Journal of Medicine, examined seven federal health plans in the years after 1999, when President Bill Clinton ordered companies in the Federal Employees Health Benefits Program to provide coverage for mental health and substance abuse that is comparable to that for other health conditions.

Researchers found that, contrary to the predictions of some policymakers and analysts, the use and cost of such services did not increase, compared with the experience of private health plans with less generous mental health benefits -- provided that new benefits were offered under managed-care plans. The changes did, however, mean lower out-of-pocket expenses for people who used the services under the federal plans.

"These results are important, because it means that it is affordable for all of us who have health insurance to have better protection in the event that we might need to use mental health or substance abuse services," said Howard H. Goldman, the lead researcher and professor of psychiatry at the University of Maryland School of Medicine.

The findings provide ammunition for advocates of mental health "parity" in the long-running battle in Congress and state legislatures over whether health insurance companies should be required to offer mental health coverage that is equivalent to the coverage they offer for physical diseases such as cancer or diabetes.

Such expanded coverage is ardently supported by mental health professionals and patients' groups, who say it would eliminate long-standing discrimination against people who are mentally ill. Just as passionately, leading business groups almost unanimously oppose such a requirement, saying it would increase insurance premiums and force some employers to scale back coverage for physical diseases or drop health benefits altogether.

In general, mental health and substance abuse coverage has come with higher out-of-pocket costs to patients and greater restrictions on office visits and days in the hospital.

Ralph Ibson, a vice president with the nonprofit National Mental Health Association, said the study shows that requiring mental health parity in employer-provided insurance plans is a good idea that will not break the bank.

"This study, which is certainly enormous and robust, very decisively puts to rest some of the major myths that opponents have brought to this debate, the principal myth being that to enact and implement parity is to increase health-care costs," Ibson said.

Edwina Rogers, vice president for health policy at the ERISA Industry Committee, an association of major employers, said a single study does not settle the argument and that costs are still a concern.

"The data can be massaged on either side of this particular debate," Rogers said. "There is a big push in the mental health community to kind of force the government to say they have this right to sort of a steady stream of benefits, to mandate it. What they are asking for is just not appropriate."

Rogers said many large employers already offer generous mental health coverage.

Goldman and other researchers, working under contract to the federal government, looked at seven FEHB plans from 1999 to 2002, comparing them to similar plans in the private sector that did not offer enhanced mental health and substance abuse coverage. More than 300,000 people were continuously enrolled in each set of plans.

The research team found that the rates of spending on, and use of, mental health and substance abuse services rose in both groups over the study period, but no more so in the federal group than in the other one. At the same time, enrollees in five of the seven federal plans saw average reductions in out-of-pocket spending ranging from $14 to $87 a year. The plans were managed-care plans.

"Managed care has figured out how to direct care and prioritize things within budgets," said Richard G. Frank, a professor of health economics at Harvard Medical School. "What our results suggest is that if you are going to do parity and you are concerned about cost growth, then parity is a good idea if it's done along with managed care." Read more!

Parity: Simple fairness at a fair price - Wilmington Star Editorial

Another study has found that people and their employers can easily afford health insurance that offers the same coverage for mental illnesses as for others. It costs little or no more.

There’s no longer any excuse for allowing employer-provided health insurance to discriminate against people who suffer from psychological afflictions.

The federal government and the state of North Carolina already offer “parity” for mental health coverage in the insurance offered to their employees.

The new study, led by a Harvard researcher and published in The New England Journal of Medicine, compared the cost of federal insurance that has parity with private insurance plans that lack it. The bottom line: If equal coverage for mental illness raised the cost at all, it was “probably less than half a percentage point.”

Other studies have found pretty much the same thing. Several years ago, a top federal personnel official said better coverage cost the average employee 23 cents a week.

The state of North Carolina found that health insurance costs actually dropped after coverage improved for mental illness – presumably because employees were getting help in time to avoid more lengthy, difficult and costly treatment.

When the General Assembly was debating requiring parity for private insurance in 1998, the accounting firm Coopers & Lybrand estimated that it would raise premiums by $1.34 a month.

Despite that, and despite the state’s own successful experience, the General Assembly is yet to eliminate unfair and unfounded discrimination against the treatment of mental illness.

Maybe next year. Read more!