N.C. health officials outline plan to improve mental-health system - Winston-Salem News Journal

Wednesday, May 31, 2006

Agenda calls for more pay for psychiatrists, money for training

By David Ingram

JOURNAL RALEIGH BUREAU

RALEIGH

Faced with a shortage of psychiatrists across North Carolina, health officials said yesterday that they want to pay psychiatrists 33 percent more for some treatments for patients eligible for Medicaid.

The change would affect about 300 psychiatrists and cost the state between $1.5 million and $3 million, officials said. They said they see the money as an investment, possibly resulting in fewer visits to emergency rooms and savings in other areas.

Officials also said they plan to redirect mo-ney to encourage training more psychiatrists.

"We simply don't have enough psychiatrists, especially child psychiatrists, to meet our needs," said Dr. Allen Dobson, the assistant secretary for healthy policy and medical assistance in the N.C. Department of Health and Hu-man Services.

The changes were part of a five-page "Action Agenda" released yesterday by Carmen Hooker Odom, the secretary of health and human services, and her staff. The agenda outlines plans for improving the state's mental-health system, which began moving toward privatized, local care in 2001.

A survey by the N.C. Psychiatric Association, a trade organization, found a 13.5 percent drop from 2003 to 2005 in the number of full-time-equi-valent psychiatrists working for the state mental-health system.

Robin Huffman, the executive director of the group, said that a higher Medicaid reimbursement rate might help bring psychiatrists back to the system.

Huffman said, however, that many psychiatrists have other objections about how the system is run.

"We want to make sure the mo-ney goes to making sure patients are being taken care of, and that it's not going to administration," she said.

Among the other recommendations in the Action Agenda are increased access to prescription medication for the poor, increased monitoring of medical providers' accreditation and the possible consolidation of some mental-health services into few-er buildings.

Odom and the Department of Health and Human Services have been heavily criticized for their roles in the transition of the mental-health system.

A legislative oversight committee has recommended chang-es of its own, and they are winding their way through the General Assembly along with about $104 million in proposed new spending for next year. Mental-health advocates have asked for at least $156 million.

Rep. Verla Insko, D-Orange, a co-chairwoman of the oversight committee, said she welcomes Odom's proposed agenda.

"This is consistent with what the oversight committee has been working for," Insko said. "We would prefer that the executive branch take the lead."

o David Ingram can be reached in Raleigh at (919) 833-9916 or at dingram@wsjournal-.com

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Mental health gets budget help - Winston-Salem Journal

$104 million not enough, some say

By David Ingram

JOURNAL RALEIGH BUREAU

Advocates for the mentally ill were cautiously optimistic yesterday after budget-writers in the N.C. Senate proposed $104 million in new spending for mental health.

The money would go toward day-to-day services, crisis services, housing and other resources for the mentally ill. It's about $15 million more than what Gov. Mike Easley recommended two weeks ago but about $52 million less than what advocates say the system needs.

"It's in general a good step, a good step in the right direction," said David Richard, the executive director of the Arc of North Carolina, an advocacy group for mentally ill people.

"This will be the biggest one-time recommendation ever for mental health, but knowing the needs ... we have to fight the perception that it's enough," Richard added. "It's not going to fix the system at the level that we need it fixed."

The spending is intended to help repair a mental-health system that has received heavy criticism since 2001, when the state began to privatize many mental-health services and to emphasize local care.

A series of articles in the Winston-Salem Journal in December explored how efforts to transform the system have faltered because of poor planning and a lack of money.

Senators have scheduled votes on their budget plan for today and Thursday, after which the House is expected to recommend its own plan. A final budget for state government's next fiscal year is expected to emerge in late June.

Senate leader Marc Basnight, D-Dare, said he would like to see more money for the mental-health system. But, he said, it was competing with many other priorities for the $2.2 billion available for new spending and for tax cuts next year.

A mental-health oversight panel has recommended $156 million in new spending.

"Every study committee recommends more money," Basnight said yesterday. "Every city will ask for more money. Every county will ask for more money. Every university will ask for more money.

"But I think we did pretty good for mental health."

Carmen Hooker Odom, the secretary of health and human services, said that the Senate's recommendations are reasonable.

"It follows along very closely with what the governor proposed," Odom said.

Unlike Easley's plan, the Senate budget recommends earmarking 5 percent of the state's alcohol tax for the Mental Health Trust Fund, which has been raided in recent years when the state faced billion-dollar budget deficits. The earmark would be the first dedicated revenue stream for the trust fund.

"The Mental Health Trust Fund is something that has great potential to build infrastructure throughout the state, and it hasn't been used to its potential," Richard said.

The Senate also recommended the replacement of two of the state's mental hospitals using certificates of participation, a type of bond that does not require voter approval. The plan would authorize $145.5 million to replace Cherry Hospital, followed in two years by $162.8 million to replace Broughton Hospital in Morganton.

State officials say that the hospitals are outdated, but Easley did not recommend replacing them. The new hospitals are the most expensive building projects in the Senate's recommendations.

Among the items that the Senate did not fully finance is money for crisis or emergency services.

The mental-health oversight committee recommended $10.5 million in startup money, but Senate budget-writers included only half of that. They did include full funding, at $9 million, for on-going emergency services.

People near Winston-Salem have limited options during a mental-health emergency, said Betty Taylor, the chief executive of CenterPoint Human Services, the mental-health program that covers Davie, Forsyth and Stokes counties.

CenterPoint's treatment center on Highland Avenue is open only during the day, so patients must go to a hospital emergency room after hours.

"Which of course puts increased pressure on our hospitals," Taylor said, "and it means that people do not always get the services that they need."

Rep. Verla Insko, D-Orange, is a co-chairwoman of the mental-health oversight committee. She said yesterday that she hopes to increase spending on mental health during House negotiations.

"The goal of reform was to service people in the community," Insko said, "and it looks like we're going in the exact opposite direction."

David Ingram can be reached in Raleigh at (919) 833-9916 or at dingram@wsjournal.com Read more!

Where do kids fit in this equation? - Greensboro News-Record

By Lorraine Ahearn:

It would have been nice.

At the Guilford Center on North Eugene, one of the county's full-service mental health centers, they've put in new carpet, bright pastel walls, and a kids' play area in the Child and Family Services waiting room. The long-planned work is almost done.

But as if to show how abruptly the state's mental health “reform” is about to pull the rug out from under the most vulnerable children -- this time almost literally -- parents who watched the progress of the spring renovations were already on notice that most of the services offered inside are being discontinued.

With the center being ordered, along with others across the state, to gut its staff by June 30 in favor of “divestiture” to HMO-type providers, thousands of families are scrambling to find new psychiatrists, therapists and caseworkers for children suffering from mental illness.

School bus driver Rudy Kennedy, for example, received a letter March 3 giving him two weeks to find new services for his daughter. The 14-year-old is bipolar, and her violent, psychotic episodes finally forced the family to place her in a group home. When Kennedy last met with a casework manager at the Bellemeade building and saw workmen pulling up the old carpet, it was a cruel joke.

“Why don't we fix up the ship before we sink it?” said Kennedy, who moved here in 2004 after Hurricane Charley destroyed his Florida home.

“We finally had everything in place for my daughter. Our caseworker has been absolutely wonderful. She pulled rabbits out of hats for us. And now she's being fired. That's stupid.”

At a chapter meeting Monday night of the National Alliance on Mental Illness, veteran child psychiatrist Barbara Smith was peppered with questions from parents confused by the virtual dismantling of the public mental health system. Other than to offer medication management and crisis services, the Guilford Center, like other regional centers statewide, will no longer exist after next month.

“I was stunned. I just cannot believe it,” Smith, a staff psychiatrist at Moses Cone Hospital, said of the changes, which the state announced in March would take effect June 30, six months sooner than planned. “Where are all these people going? They can't just close mental health without an alternative.”

In a March letter to families, Guilford Center officials said they were “excited” about the change: “We believe this new service is more flexible and that it should meet your child's needs better” than before.

The center's director of nursing, Paula Snipes, said her agency would still be a “safety net,” and that clinicians would help what she called “consumers” to find new providers.

But families and doctors said this week it is difficult to find therapists, caseworkers and psychiatrists who take the kind of insurance many children carry: Medicaid.

Advocates say it's no accident that business-school words such as “divestiture” and “consumer” have crept into conversation about public health.

“It's all boiling down to dollars and cents,” said Jean Allen, who founded the outreach program Tristan's Quest, named for her son who died while being restrained at Charter Hospital in 1998. “Where does that leave kids? Sometimes I think they've been left out of the equation.”

For Smith, who grew up bipolar in the '50s before the therapeutic knowledge available today, it's a painful predicament: An age of possibility for the mentally ill -- if they have money.

How, then, to calculate the cost of not treating children early on for disorders such as bipolar disorder, post-traumatic stress or depression? Should someone have taken an adding machine and totaled up all the misery before scrapping our mental health centers?

It would have been nice.

Next week: A gathering storm.

Contact Lorraine Ahearn at 373-7334 or lahearn@news-record.com
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New crisis stabilization center will open next year

by Leslie Boyd, LBOYD@CITIZEN-TIMES.COM

published May 22, 2006 12:15 am


ASHEVILLE - The last time Jamey Wallace had a mental health crisis, he spent hours in the emergency room before being transported to Broughton in Morganton, the closest state psychiatric hospital.

By early next year, Wallace and others who need emergency psychiatric care should have a place to go for stabilization in Asheville, a 16-bed unit where patients can stay from 23 hours to 15 days.

“Jamey's doing well right now,” said his mother, Kathy Wallace. “But there are no guarantees, and it would be wonderful to have a place where he can go that's close to home.”

Buncombe County will open the crisis stabilization center using money from the sale of buildings formerly used by Blue Ridge AreaProgram. Under mental health reform, Blue Ridge divested all its services and real estate, and the money went to the counties to be used for mental health services.

The new center will be on Biltmore Avenue, where the Neil Dobbins Center now provides substance abuse detoxification beds. Those beds will move to Black Mountain. It will be operated by ARP Phoenix, a division of Sisters of Mercy.

“It's important for the community that these beds be there,” said Don Reeves, vice president of Sisters of Mercy. “Having to take somebody to Broughton is a waste of community resources if it can be prevented.”

Reeves said the first two crisis care beds should open in the next month.

Crisis stabilization is an important part of mental health care, but has been lacking in this region since Charter Health closed in 2000. Patients who start to lose control can avoid hospitalization with the proper intervention. Some can be helped with a mobile crisis unit, but if counselors can't bring a situation under control, they need a place to take patients, said Dan Zorn, whose company, Families

Together, provides mobile crisis care for children and is adding adult mobile crisis care in the coming months.

“Without crisis care, people get worse,” said Diane Bauknight, whose daughter has been institutionalized for two years.

She blames the severity of her daughter's illness on the lack of crisis care.

Wallace agrees that transport to a crisis care center in town is far less traumatic than being handcuffed and taken to Morganton by police - the usual method of transport.

Mandy Stone, director of the Buncombe County Department of Social Services and a member of the board of Western Highlands Network, said the new center will cost between $500,000 and $750,000 to build and will operate at a loss of about $400,000 a year because it will have to treat people who have no insurance coverage.

The center also will connect patients to medical care, Stone said.

“You can't provide mental health care and ignore people's other health care needs,” she said. “We're working to link it all together.”

Contact Leslie Boyd at 828-232-2922 or via e-mail at lboyd@ashevill.gannett.com.
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County notes: Commissioners back mental health consolidation talks - Greenville Daily Reflector

By Amanda Karr, The Daily Reflector
Saturday, May 20, 2006

Pitt County's mental health agency might disband and become part of a regional organization.

Pitt County commissioners Thursday signed a resolution supporting the county joining eight other counties in a single agency.

The larger agency would organize and monitor mental health, developmental disability and substance abuse services. Local private providers would continue to provide the individual services.

There has been a statewide push for mental health agencies to regionalize since the agencies began transitioning several years ago from providing services to an administrative role. Many counties did partnerships that met the state's recommendation of organizations serving 200,000 people and five counties. Others, like Pitt, did not.

Impending funding cuts, however, are prompting agencies to reconsider.
Officials with Roanoke-Chowan Human Services Center and Neuse Center have met informally with Pitt County officials to discuss combining forces. With the nod from county commissioners and last month's approval by the Pitt Mental Health Advisory Board, those discussions will now become more formal, Pitt County Manager Scott Elliott said.

The Roanoke-Chowan agency serves Bertie, Gates, Hertford and Northampton counties. The Neuse Center serves Craven, Jones and Pamlico counties. Including those living in Pitt County, about 370,000 people would be served by such a regional entity.

Commissioners voted 8-1, with Mark Owens dissenting, to look into creating the entity before July 2007.

Meanwhile, Pitt Mental Health is scheduled to cut about half of the department's positions in the coming fiscal year.

Existing employees also are continuing to work on solidifying the agency's financial situation.

The county's mental health budget deficit has dropped from $3.6 million to $1 million because the state has reimbursed the county for payments to private service providers.

Melonie Bryan, deputy county manager for finance, said the chance the agency will make it back into the black looks much more positive. In earlier interviews, Bryan said she was worried the agency could still be down at the end of the fiscal year. Read more!

Prison officials seek long-awaited funding for new hospital - Associated Press

By MIKE BAKER,, Associated Press Writer

Karan Dillow's patients may be criminals, but the director of nursing at the state's Central Prison hospital believes they deserve respect in death like anyone else.

And so, when a prison storage room was too humid to hold a body three years ago, she kept the remains of a dead inmate in her air-conditioned office, patiently working at her desk while waiting for a transport team to arrive and take the body to the morgue.

“I had to do what was necessary,” Dillow said. “They still deserve dignity.”

Today, she longingly glances at plans drawn up eight years ago for a new Central Prison hospital - one with a morgue. Lawmakers knew then the facility that opened in 1965 was in need of repair and renovation. But nothing has happened since, and the hospital ward at the aging prison has devolved into what Dillow considers “third-world” conditions.

“We can't bury our heads in the sand any longer,” she said.

This year, the Department of Correction is seeking money - $152 million - to build a new hospital at Central Prison, which opened in 1884 and houses the state's death row and execution chamber. The current 86-bed hospital and 144-cell mental health wing serves the needs of 30,000 prisoners statewide.

The new hospital would have 120 beds, an operating room, a morgue and the ammenities of a community hospital, along with 200 cells for inmates with mental health needs.

But not long removed from a budget crunch, lawmakers face a backlog of requests and a new hospital prison is just one project in Gov. Mike Easley's proposal to spend $764 million on construction.

Easley wants to pay for the largest projects - the prison hospital and a $101 million replacement of the state's public health laboratory - with a kind of public debt that doesn't require voter approval. The cost of both projects is enough to make a few legislators wary.

“We need to be cautious, to be good stewards of our money,” said Sen. Linda Garrou, D-Forsyth, co-chair of the Senate Appropriations Committee.

Rep. Joe Kiser, R-Lincoln, who sponsored a bill passed Tuesday to funnel $15 million to the Department of Correction to shore up its health care budget, said a full makeover of the hospital would “save the state a tremendous amount of money” in the long run.

The problems at the hospital are numerous. There is no central heat or air conditioning. A leaking roof compounds a problem on the third floor, where bathtubs drip into a second floor patient care room. The building's elevator, used to transport sick and injured inmates, works sporadically. The now-defunct operating room has been replaced with a $1 million-per-year mobile trailer, where general surgeries are performed.

“It is really more of an infirmary than a hospital,” said Dr. Paula Smith, the state prison system's chief of health services.

For more pressing medical issues, about 30 prisoners leave the prison each day for hospitals in the Raleigh area, trips that officials said are a big part of why prison medical costs have jumped from $143 million in 2004 to a projected $192 million this year.

Inmates know how to take advantage of the hospital's problems. In the past, prisoners have shoved batteries or bed springs down their throats. One forced wired headphones into his rectum, while another threaded a mangled wire through his urethra to his bladder.

Each bodily gamble paid off with a trip to an outside hospital - a new venue with fresh faces and good food. And another chance to escape.

“It's dangerous,” said Gerald Branker, the prison's deputy warden. “Any time you move an inmate outside the confines of the prison, you don't know what you're getting in to.”

Correction Department officials fear it will take an escape or a hostage situation to force lawmakers to act. They also fret about facing a lawsuit challenging the hospital's decrepit conditions.

“I hate to say it, but we almost look forward to a lawsuit,” Dillow said. “Maybe something would finally happen.”

Revisions to criminal laws, such as one pending before lawmakers that would impose harsher penalties on sex offenders, have landed more inmates behind bars for longer sentences. In the next eight years, the state's prison population served by the hospital is expected to rise 20 percent, putting additional pressure on the aging facility.

As those inmates age, they turn “parts of our prison facilities into rest homes,” said Boyd Bennett, the state's prisons director.

Meanwhile, few nurses have applied to work at the hospital. A facility with a 20-year-old discontinued X-ray machine and a dialysis room the size of two parking spaces, stuffed with eight patients and their respective machines, isn't much of an attraction.

“The people that we do have are doing an excellent job with the resources that they have,” Smith said. “But it would benefit the entire state if we just had the basic standards that you'd find in a community level hospital.”
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Addressing the psychiatric health of U.S. Presidents - Pittsburgh Post-Gazette

May 18, 2006 08:02 PM EST

James Madison, John Quincy Adams and Franklin Pierce all suffered from major depressive disorders. Theodore Roosevelt was bipolar. So, too, was Lyndon Johnson. Woodrow Wilson suffered from a generalized anxiety disorder. If only we knew then what we think we know now.

It turns out that about half the presidents between George Washington and Richard M. Nixon suffered from some sort of psychiatric disorder. This is different from saying that you have to have a mental disorder to be president, which is an amateur's irreverent observation, though perhaps open to clinical testing. The cases mentioned above were diagnosed by three members of the Department of Psychiatry at the Duke University Medical Center in North Carolina, and they're not being playful. They've conducted the first psychiatric inventory of the presidency, and it's a serious study.

The sheer volume of psychiatric disorders resident in the historical presidency is, at first blush, staggering. Most of us have given very little thought to the mental health of, say, Rutherford B. Hayes (major depressive disorder) or James Garfield (depression, again). But to realize that 10 presidents suffered from depression is to concentrate the mind on why it often seems so difficult for presidents to concentrate the mind.

In truth, there is a very important message in the three psychiatrists' report, published this winter in the Journal of Nervous and Mental Disease. This study tells us that presidents are more vulnerable and less perfect than we sometimes think. It tells us that people with mental illness can be highly functional and highly successful. And, because the presidents suffer rates of mental illness roughly comparable to the general public, it reminds us that mental illness, especially depression, is more widespread than we sometimes acknowledge.

“These are ordinary people in some ways,” says Marvin S. Swartz, one of the Duke psychiatrists. “They are not immune to mental illness.”

This report may become irresistible fodder for political scientists of the Jay Leno and Jon Stewart schools, but if interpreted soberly it may be one of the most potent political tools the mental-health lobby has ever acquired. That lobby can now enlist Thomas Jefferson (social phobia, non-generalized), Abraham Lincoln (major depressive disorder, recurrent, with psychotic features) and Dwight D. Eisenhower (major depressive disorder) among those who suffered from mental illness. (Winston Churchill was an honorary American -- a status conferred by Congress in 1963, the first time such a designation was made -- and he, too, suffered from depression.)

Activists advocating programs for alcoholics can take heart, too. Ulysses S. Grant is probably the most famous alcoholic in American history, but not the only alcoholic president. Franklin Pierce suffered from alcohol dependence, and Nixon from alcohol abuse.

Presidents may not rule from the grave, but psychiatrists can still give rulings on men in the grave. In this case, the Duke investigators examined biographies, histories, medical studies and journals to find suggestions of psychiatric disorders. Then they applied this information against a strict rubric to evaluate whether they could reasonably conclude that an individual president suffered from mental problems.

Some presidents emerged perfectly healthy, mentally speaking, although as political analysts and not practitioners of psychiatric analysis we can say with confidence that there was nothing rational about how one of them, James Buchanan, let the country slip into civil war, or how another, John F. Kennedy, let himself slip into bed and compromising relationships with dozens of women while he was presiding over tense Cold War years.

On the other hand, Andrew Jackson was fiercely, almost maniacally, competitive, but completely healthy. I have long wondered whether William McKinley suffered from mental disorders, but his behavior might best be described as abiding devotion to a wife who herself suffered from debilitating headaches and seizures. He gets a clean bill of health from the Duke psychiatrists.

Some of the presidents, to be sure, came to office with a proclivity to mental disorder, only to find that the stress of office pushed them into illness. But some -- Calvin Coolidge, Franklin Pierce -- developed mental disorders after their sons died tragically, Coolidge's from a bizarre toe infection after a blister developed during a tennis game, Pierce's from a terrible train accident. “Neither president was able to commit himself effectively to the task of leadership following such tragic loss,” the psychiatrists write. “(T)raumatic bereavement may have left each one poorly equipped to discharge the demanding responsibilities of office.”

In many cases, presidents overcame mental disorders or mined their strengths of character to emerge as national leaders despite mental problems. “To contemporaries well acquainted with Madison, Hayes, Grant and Wilson,” the psychiatrists write, “it must have appeared that, as young men, these individuals were doing very little with their lives, with Grant, in particular, unable to hold down even the most simple employment on account of alcohol problems.”

The Duke team did not examine the presidents after Nixon, but it is reasonable to guess that they would have found that Gerald R. Ford and George H.W. Bush were exceedingly healthy psychologically. We know that Ronald Reagan suffered from Alzheimer's late in life and perhaps even in the White House. George W. Bush has admitted freely that he abused alcohol in the years leading up to his 40th birthday. Bill Clinton exhibited colorful personal behavior before and during his presidency, but let's leave it to the next study for a professional diagnosis.

All this is intriguing, but perhaps only as presidential prurience. But it is important information for two reasons quite apart from the tantalizing notion that William Howard Taft had a breathing-related sleep disorder or that Coolidge suffered from social phobia. (In the latter case, one reading of the man's biography should be sufficient to convince even the most casual observer.)

The important implications of this study: There is no evidence that mental illness led to national catastrophe. (Indeed, it was a man with severe mental disorders who saved the nation during its gravest challenge, the Civil War.) And the prominence of mental illness in our most prominent citizens can only serve to diminish the stigma of psychological problems. In that regard, some of our presidents are serving their country long after having left office.


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An unhealthy lack of psychiatrists - Fayetteville News

By Rochelle Williams

Staff writer
Anna Finch refused to give her autistic son, Nicholas, antidepressants when he was a young boy.

But when he turned 11, in 2000, his inability to cope with changes to his routine — where his toys were arranged in his bedroom, what foods he was willing to eat — triggered anxiety attacks and bouts of violent anger that scared Finch and drained her entire family.

At the same time, new research indicated that autism was most likely caused by a chemical imbalance that could be neutralized with drugs.

Finch and her husband decided to consult a child psychiatrist. It took them a year and a half to find one who was accepting new clients.

Lack of access to psychiatrists is becoming an all too common problem in Fayetteville, in North Carolina and around the country.

The state’s supply of psychiatrists shrinks each year as need for the services grows, according to a recent report released by The Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, the Department of Psychiatry and Behavioral Sciences at the Duke University School of Medicine, and the N.C. Area Health Education Centers.

About one in three adults experiences a mental disorder each year, and 15 percent of children have behavioral disorders such as attention deficit problems, anxiety or depression. However, the number of psychiatrists has not increased in the past 10 years to meet population growth. North Carolina has 1.05 psychiatrists for every 10,000 people and ranks 20th in the nation.

The need for child psychiatrists is even greater and has reached a critical stage, according to the report. The number of child psychiatrists in the state has declined 24 percent in the past decade.

In Fayetteville, there are four child psychiatrists compared with thousands of children who need help, said Dr. Pinckney McIlwain, medical director of psychiatric services at Cape Fear Valley Health System.

McIlwain said shrinking reimbursements from private and federal insurance programs is one of the biggest reasons for the decline in the number of psychiatrists who graduate each year. He said psychiatrists are the second lowest paid medical specialists. Pediatricians get paid the least.

The shortage means more work for county mental-health center employees, emergency-department doctors, and general practitioners.

And while psychologists, social workers and other therapists can counsel people, only psychiatrists and other medical doctors can prescribe medication.

On Wednesday, six mentally ill teenagers showed up at the Cape Fear Valley Medical Center emergency department.

McIlwain said one of them was a young girl in distress, who was brought in by her parents.

“They have been trying to get her an appointment with a psychiatrist,” McIlwain said. The earliest anyone can see her is January 2007.”

Dr. John Lesica, a child psychiatrist at the county mental health center, said the shortage of psychiatrists is one of the biggest problems facing the health care industry today.

About a third of the patients treated for mental illness at the county center are children. The center treated 1,397 mentally ill children In 2005, said the center’s spokeswoman Sharon Yates.

Finch, who is the president of the Autism Society of Cumberland County, eventually found a child psychiatrist in Chapel Hill. She says her family lucked out.

After a few months of trial and error, her son’s psychiatrist found an anti-depressant that has alleviated many of Nicholas’s behavioral problems.

“When you are dealing with this type of issue you want to work with a psychiatrist who has a lot of experience under their belt, someone who is familiar with the medications, Finch said.”

But most people have to settle for whoever they can get. If they can get anyone at all.”

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Benefit bump could cost disabled people Medicaid - Raleigh News & Observer

Thomas Goldsmith, Staff Writer

It's not just older North Carolinians who stand to lose thousands in Medicaid benefits because of a small increase in Social Security payments.

Children and adults with disabilities who get help from Medicaid could lose services or pay annual deductibles of nearly $7,000 -- because their Social Security checks rose less than $400 a year.

"In the case of my daughter -- and probably many other developmentally disabled -- it will mean a drastic cut in support services," said Virginia Jones, 80, a Durham resident. Jones' daughter, Janet, 39, qualifies for the federal insurance program because she has mental retardation.

This year, the government gave the largest Social Security cost-of-living increase in 15 years. But that extra income pushed hundreds and perhaps thousands of seniors and people with disabilities over the Medicaid eligibility limit.

Exactly how many is not known. Marjorie Morris, chief of the state's Medicaid Eligibility Unit, said the state does not track the number of people who lose Medicaid coverage because of a Social Security cost-of-living adjustment.

Asked what people were advised to do when faced with the cutoff, she said she didn't know.

"I think that's up to each individual situation," Morris said.

More uninsured

U.S. Rep. Brad Miller of Raleigh predicted that people who lose Medicaid coverage will put more financial pressure on health-care providers.

"Many people can't afford the deductibles, and they will be adding to the rolls of the uninsured," Miller said. People will use emergency rooms and hospitals that are already stressed, he said.

Miller said Tuesday that he was trying to find a solution. After hearing from constituents, he said, he is contacting the Atlanta office of the federal Centers for Medicare and Medicaid Services, which runs the programs.

Donna Cross, technical director of the Division of Medicaid and Children's Health in Atlanta, did not return messages left at her office Tuesday.

In Janet Jones' case, the loss of Medicaid means she could be bumped from her group home and lose her slot at Life Experiences Inc. in Cary, where she works weekdays. The agency helps people with disabilities gain independence by teaching job and social skills.

"She's very appropriate for this type of setting," said Mary Madenspacher, executive director of Life Experiences. "She needs prompting, supervision and monitoring to stay on task, but with that support and help, she is capable of doing the task she is assigned."

Virginia Jones said she kept Janet at home as long as she could but arranged for the group home after her husband died and she was diagnosed with cancer.

"The world is looking pretty grim from every angle," said Jones, who this week tried to reach state and local officials about her daughter's situation.

Attorney Doug Sea of Charlotte-based Legal Services of the Southern Piedmont said his health-rights advocacy group asked state health and human services officials to do something about the impending cutoffs in March.

In an e-mail response to Sea, Mark Benson, chief operating officer of the Division of Medical Assistance, wrote that leaving the Social Security increase out of the picture when deciding people's eligibility for Medicaid "would only serve to manipulate/circumvent the income thresholds established by the General Assembly."

"We've actually heard from clients in our area and other parts of the state," Sea said. "Next, we'll be talking to legislators. [State officials] certainly knew about it."

'Off the cliff'

But a solution is uncertain in a year when legislators have a large budget surplus but face many demands for money.

State Sen. Bill Purcell, co-chairman of the committee on appropriations on health and human services, said he's aware of the situation and would like to see money for it included in the state budget during the current legislative session.

However, he said, the committee, with $165 million to work with, already has received "legitimate" requests for more than $560 million in funding.

That's an unwelcome prospect for parents of children with developmental disabilities such as autism or mental retardation. Medicaid support pays for the Community Alternatives Program, which often allows children to stay at home instead of at an institution.

The loss of Medicaid could mean that some families will be liable for a $581 monthly deductible -- nearly $7,000 annually.

"That's a perennial problem for programs with these sharp cutoffs that assist people with health care or child care," said Adam Searing, director of the N.C. Health Access Coalition. "If you have a strict income level, people fall off the cliff." Read more!

An unhealthy lack of psychiatrists - Fayetteville News

By Rochelle Williams

Staff writer
Anna Finch refused to give her autistic son, Nicholas, antidepressants when he was a young boy.

But when he turned 11, in 2000, his inability to cope with changes to his routine — where his toys were arranged in his bedroom, what foods he was willing to eat — triggered anxiety attacks and bouts of violent anger that scared Finch and drained her entire family.

At the same time, new research indicated that autism was most likely caused by a chemical imbalance that could be neutralized with drugs.

Finch and her husband decided to consult a child psychiatrist. It took them a year and a half to find one who was accepting new clients.��

Lack of access to psychiatrists is becoming an all too common problem in Fayetteville, in North Carolina and around the country.

The state’s supply of psychiatrists shrinks each year as need for the services grows, according to a recent report released by The Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, the Department of Psychiatry and Behavioral Sciences at the Duke University School of Medicine, and the N.C. Area Health Education Centers.

About one in three adults experiences a mental disorder each year, and 15 percent of children have behavioral disorders such as attention deficit problems, anxiety or depression. However, the number of psychiatrists has not increased in the past 10 years to meet population growth. North Carolina has 1.05 psychiatrists for every 10,000 people and ranks 20th in the nation.

The need for child psychiatrists is even greater and has reached a critical stage, according to the report. The number of child psychiatrists in the state has declined 24 percent in the past decade.

In Fayetteville, there are four child psychiatrists compared with thousands of children who need help, said Dr. Pinckney McIlwain, medical director of psychiatric services at Cape Fear Valley Health System.

McIlwain said shrinking reimbursements from private and federal insurance programs is one of the biggest reasons for the decline in the number of psychiatrists who graduate each year. He said psychiatrists are the second lowest paid medical specialists. Pediatricians get paid the least.

The shortage means more work for county mental-health center employees, emergency-department doctors, and general practitioners.

And while psychologists, social workers and other therapists can counsel people, only psychiatrists and other medical doctors can prescribe medication.

On Wednesday, six mentally ill teenagers showed up at the Cape Fear Valley Medical Center emergency department.

McIlwain said one of them was a young girl in distress, who was brought in by her parents.

“They have been trying to get her an appointment with a psychiatrist,” McIlwain said. The earliest anyone can see her is January 2007.”

Dr. John Lesica, a child psychiatrist at the county mental health center, said the shortage of psychiatrists is one of the biggest problems facing the health care industry today.

About a third of the patients treated for mental illness at the county center are children. The center treated 1,397 mentally ill children In 2005, said the center’s spokeswoman Sharon Yates.

Finch, who is the president of the Autism Society of Cumberland County, eventually found a child psychiatrist in Chapel Hill. She says her family lucked out.

After a few months of trial and error, her son’s psychiatrist found an anti-depressant that has alleviated many of Nicholas’s behavioral problems.

“When you are dealing with this type of issue you want to work with a psychiatrist who has a lot of experience under their belt, someone who is familiar with the medications, Finch said.”

But most people have to settle for whoever they can get. If they can get anyone at all.” Read more!

Troubled state of mind - Raleigh News and Observer

If you look past the facts, the figures and the endless torrents of jargon and acronyms, mental health reform in North Carolina boils down, very simply, to people.


Consider the case of Ann-Marie Dooley, a Greensboro mother whose 10-year-old autistic son has received treatment at the Guilford Center since he was 3.

"I trust them," Dooley says of the staff at the center, which offers centralized counseling and treatment for 16,000 clients a year. "They are an excellent provider."

Now that relationship is about to end. Dooley, who also is vice chairwoman of the Guilford Center's Consumer and Family Advisory Committee, is not sure what the future holds.

Five years ago, North Carolina decided to reinvent its mental health system, shifting the emphasis from state institutions to community-based programs. In theory, the new model will recast local treatment agencies such as the Guilford Center as HMO-like entities that instead will administer patient care through private providers. But in practice, the drastic makeover has prematurely snatched the government safety net from thousands of patients without providing an adequate replacement.

There is nowhere for many patients to live once they're turned out of state facilities. There are bureaucratic tangles. There are not enough private practitioners to handle the local demand for treatment, especially Medicare, Medicaid and indigent patients.

And there clearly is not enough money.

In Guilford County, the existing services are being removed much faster than they are being replaced. By December, the Guilford Center must lay off 135 employees, or nearly half of its work force.

Fortunately, the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities and Substance Abuse is proposing $155 million in funding to help fill the gaps in local treatment. Meanwhile, Gov. Mike Easley has included in his proposed budget $89 million for mental health reform.

Dr. Martha K. Sharpless, chairwoman of the nonprofit Greensboro Mental Health Association, says she prefers the Oversight Committee's spending plan, though even it may not be enough. Sharpless also has grave misgivings about the reform itself. "We should call a moratorium," she says. "We should screechingly halt and look at what we've done."

Sen. Kay Hagan, a Greensboro Democrat who supports at least $100 million in mental health reform funding, says a moratorium "for a short period of time" might be a good idea. For instance, what if, upon closer examination, the state decided all those Guilford Center staff cuts weren't necessary? she says.

At the very least, lawmakers need to provide adequate resources.

Overshadowed by the under-planned and, perhaps, overreaching reform initiative are continuing strides in treatment. More and more patients are able to lead productive lives -- when the system works.

Better late than never, that message may be getting through. Now lawmakers owe it to local communities, including Guilford County, to fix what the state has broken.
Read more!

State plans to build grandly - Raleigh News and Observer

Cherry, Broughton, Mental Health Hospital at Central Prison among projects considered

Published: May 13, 2006 12:30 AM
Modified: May 13, 2006 04:59 AM

J. Andrew Curliss, Staff Writer
State government is getting ready for a building boom, paid mostly with cash, on a scale not seen in two decades.

While the state has pumped millions of borrowed dollars into university buildings in recent years, budgets were tight elsewhere, and spending on new construction slowed.

But the state’s economic outlook has brightened, and leaders in Raleigh find themselves with a $2 billion budget surplus for the coming fiscal year.

Gov. Mike Easley this week proposed to spend much of that money on pay raises for teachers and state employees, education programs, mental health care and a small cut in the state sales tax.

Easley also said some of the money should be used for construction. The new plans are ambitious and stand to benefit Raleigh more than anywhere else.

There’s a $61 million engineering complex at N.C. State University and $10 million toward a new wing of the Museum of Natural Sciences downtown.

A $20 million parking deck would go up nearby.

In West Raleigh, the state would spend $40 million expanding the N.C. Museum of Art and $50 million toward a new office building for the Department of Environment and Natural Resources.

Easley wants to buy cranes for the state port at Wilmington and build a children’s center at the zoo in Asheboro. There’s money for a nursing school at UNC-Wilmington and a $2 million forestry office in the mountains.

Easley’s plan is just the beginning of the debate. Easley, House Speaker Jim Black and Senate leader Marc Basnight, all Demo-crats, indicated the building proposal will get plenty of attention before the legislature approves a final budget this summer.

“There’ll be a lot of debate on all of that -- it’s still very early,” Basnight said.

“Debate about it?” Black asked. “Oh, yes. Oh, yes.”

Some say the state should save at least some of the money.

“I just worry that we’re going to use it all up and not have anything left when the cycle turns downward,” said Sen. Phil Berger of Eden, the Senate Republican leader.

Easley has proposed using $324 million of the $2 billion surplus to replenish the state’s rainy-day account, which now stands at $313 million. He also wants $50 million set aside for emergencies. The governor would spend more than $300 million on building projects in the coming fiscal year.

He would also borrow for a few projects: a $101 million public health lab in West Raleigh and $152 million to pay for a 120-bed medical center and a 200-cell mental health center at Central Prison.

The prison facilities will help with security and save on costs such as putting inmates in medical facilities away from the prison, Easley said.

In addition, Easley would use $200 million for repairs and renovations, a 60 percent increase from a year ago.

Those figures are substantial by any measure, but more so when compared with what the state has spent on construction in recent years.

During a budget crisis in 2001-02 and 2002-03, the state spent about $30 million each year on capital projects, mostly for water systems and infrastructure. The state set aside nothing for repairs.

With little new construction, the needs kept piling up, state officials said.

“In the main, capital spending has been basically nonexistent since ‘01,” said Jim Lora, the assistant state budget officer for capital projects. “We’re only beginning to recover.”

The spending is possible because of increases in tax collections.

More suggestions

Already, legislators have heard from a number of interests that didn’t make the cut with Easley.

Some are pushing a plan to buy vacant land to preserve it from development. Others want the state to build affordable housing or water and sewer projects.

One item getting notice is a request from the Department of Health and Human Services to replace outdated state psychiatric hospitals in Morganton and Goldsboro.

DHHS Secretary Carmen Hooker Odom met with legislative leaders this week, pitching the need for money.

Some lawmakers have toured the hospitals and called the conditions terrible.

“It’s awful,” said Sen. John Kerr, a Democrat whose Wayne County district includes Cherry Hospital. He stretched his arms out. “You have four women in a room about this size. No one would want their relative in that,” he said. The price tag to replace both hospitals: $300 million.

“We believe our psychiatric hospitals are in a dire situation,” Hooker Odom said. Read more!

State plans to build grandly. Raleigh, others would get millions - Raleight News ‡ Observer

New hospitals for Central Prison, Broughton, Cherry mentioned

Published: May 13, 2006 12:30 AM
Modified: May 13, 2006 04:59 AM

J. Andrew Curliss, Staff Writer

State government is getting ready for a building boom, paid mostly with cash, on a scale not seen in two decades.

While the state has pumped millions of borrowed dollars into university buildings in recent years, budgets were tight elsewhere, and spending on new construction slowed.

But the state’s economic outlook has brightened, and leaders in Raleigh find themselves with a $2 billion budget surplus for the coming fiscal year.

Gov. Mike Easley this week proposed to spend much of that money on pay raises for teachers and state employees, education programs, mental health care and a small cut in the state sales tax.

Easley also said some of the money should be used for construction. The new plans are ambitious and stand to benefit Raleigh more than anywhere else.

There’s a $61 million engineering complex at N.C. State University and $10 million toward a new wing of the Museum of Natural Sciences downtown.

A $20 million parking deck would go up nearby.

In West Raleigh, the state would spend $40 million expanding the N.C. Museum of Art and $50 million toward a new office building for the Department of Environment and Natural Resources.

Easley wants to buy cranes for the state port at Wilmington and build a children’s center at the zoo in Asheboro. There’s money for a nursing school at UNC-Wilmington and a $2 million forestry office in the mountains.

Easley’s plan is just the beginning of the debate. Easley, House Speaker Jim Black and Senate leader Marc Basnight, all Demo-crats, indicated the building proposal will get plenty of attention before the legislature approves a final budget this summer.

“There’ll be a lot of debate on all of that -- it’s still very early,” Basnight said.

“Debate about it?” Black asked. “Oh, yes. Oh, yes.”

Some say the state should save at least some of the money.

“I just worry that we’re going to use it all up and not have anything left when the cycle turns downward,” said Sen. Phil Berger of Eden, the Senate Republican leader.

Easley has proposed using $324 million of the $2 billion surplus to replenish the state’s rainy-day account, which now stands at $313 million. He also wants $50 million set aside for emergencies. The governor would spend more than $300 million on building projects in the coming fiscal year.

He would also borrow for a few projects: a $101 million public health lab in West Raleigh and $152 million to pay for a 120-bed medical center and a 200-cell mental health center at Central Prison.

The prison facilities will help with security and save on costs such as putting inmates in medical facilities away from the prison, Easley said.

In addition, Easley would use $200 million for repairs and renovations, a 60 percent increase from a year ago.

Those figures are substantial by any measure, but more so when compared with what the state has spent on construction in recent years.

During a budget crisis in 2001-02 and 2002-03, the state spent about $30 million each year on capital projects, mostly for water systems and infrastructure. The state set aside nothing for repairs.

With little new construction, the needs kept piling up, state officials said.

“In the main, capital spending has been basically nonexistent since ‘01,” said Jim Lora, the assistant state budget officer for capital projects. “We’re only beginning to recover.”

The spending is possible because of increases in tax collections.

More suggestions

Already, legislators have heard from a number of interests that didn’t make the cut with Easley.

Some are pushing a plan to buy vacant land to preserve it from development. Others want the state to build affordable housing or water and sewer projects.

One item getting notice is a request from the Department of Health and Human Services to replace outdated state psychiatric hospitals in Morganton and Goldsboro.

DHHS Secretary Carmen Hooker Odom met with legislative leaders this week, pitching the need for money.

Some lawmakers have toured the hospitals and called the conditions terrible.

“It’s awful,” said Sen. John Kerr, a Democrat whose Wayne County district includes Cherry Hospital. He stretched his arms out. “You have four women in a room about this size. No one would want their relative in that,” he said. The price tag to replace both hospitals: $300 million.

“We believe our psychiatric hospitals are in a dire situation,” Hooker Odom said.�� Read more!

State plans to build grandly; Raleigh, others would get millions - Raleigh News & Observer

200-cell mental health center at Central Prison, new hospital in Morganton, Goldsboro considered

Published: May 13, 2006 12:30 AM
Modified: May 13, 2006 04:59 AM
J. Andrew Curliss, Staff Writer

State government is getting ready for a building boom, paid mostly with cash, on a scale not seen in two decades.��

While the state has pumped millions of borrowed dollars into university buildings in recent years, budgets were tight elsewhere, and spending on new construction slowed.

But the state’s economic outlook has brightened, and leaders in Raleigh find themselves with a $2 billion budget surplus for the coming fiscal year.

Gov. Mike Easley this week proposed to spend much of that money on pay raises for teachers and state employees, education programs, mental health care and a small cut in the state sales tax.

Easley also said some of the money should be used for construction. The new plans are ambitious and stand to benefit Raleigh more than anywhere else.

There’s a $61 million engineering complex at N.C. State University and $10 million toward a new wing of the Museum of Natural Sciences downtown.

A $20 million parking deck would go up nearby.

In West Raleigh, the state would spend $40 million expanding the N.C. Museum of Art and $50 million toward a new office building for the Department of Environment and Natural Resources.

Easley wants to buy cranes for the state port at Wilmington and build a children’s center at the zoo in Asheboro. There’s money for a nursing school at UNC-Wilmington and a $2 million forestry office in the mountains.

Easley’s plan is just the beginning of the debate. Easley, House Speaker Jim Black and Senate leader Marc Basnight, all Demo-crats, indicated the building proposal will get plenty of attention before the legislature approves a final budget this summer.

“There’ll be a lot of debate on all of that -- it’s still very early,” Basnight said.

“Debate about it?” Black asked. “Oh, yes. Oh, yes.”

Some say the state should save at least some of the money.

“I just worry that we’re going to use it all up and not have anything left when the cycle turns downward,” said Sen. Phil Berger of Eden, the Senate Republican leader.

Easley has proposed using $324 million of the $2 billion surplus to replenish the state’s rainy-day account, which now stands at $313 million. He also wants $50 million set aside for emergencies. The governor would spend more than $300 million on building projects in the coming fiscal year.

He would also borrow for a few projects: a $101 million public health lab in West Raleigh and $152 million to pay for a 120-bed medical center and a 200-cell mental health center at Central Prison.

The prison facilities will help with security and save on costs such as putting inmates in medical facilities away from the prison, Easley said.

In addition, Easley would use $200 million for repairs and renovations, a 60 percent increase from a year ago.

Those figures are substantial by any measure, but more so when compared with what the state has spent on construction in recent years.

During a budget crisis in 2001-02 and 2002-03, the state spent about $30 million each year on capital projects, mostly for water systems and infrastructure. The state set aside nothing for repairs.

With little new construction, the needs kept piling up, state officials said.

“In the main, capital spending has been basically nonexistent since ‘01,” said Jim Lora, the assistant state budget officer for capital projects. “We’re only beginning to recover.”

The spending is possible because of increases in tax collections.

More suggestions

Already, legislators have heard from a number of interests that didn’t make the cut with Easley.

Some are pushing a plan to buy vacant land to preserve it from development. Others want the state to build affordable housing or water and sewer projects.

One item getting notice is a request from the Department of Health and Human Services to replace outdated state psychiatric hospitals in Morganton and Goldsboro.

DHHS Secretary Carmen Hooker Odom met with legislative leaders this week, pitching the need for money.

Some lawmakers have toured the hospitals and called the conditions terrible.

“It’s awful,” said Sen. John Kerr, a Democrat whose Wayne County district includes Cherry Hospital. He stretched his arms out. “You have four women in a room about this size. No one would want their relative in that,” he said. The price tag to replace both hospitals: $300 million.

“We believe our psychiatric hospitals are in a dire situation,” Hooker Odom said. Read more!

Paxil Raises Suicide Risk For Young Adults - Medical News Today

GlaxoSmithkline, the makers of the antidepressant, Paxil, have warned that the drug may raise the risk of suicide attempts in people under 30. Glaxo has sent a letter to doctors stating this.

According to a clinical trial, of 3,455 people taking Paxil 11 tried to kill themselves. Among the placebo group of 1,978 people, 1 tried to commit suicide. The majority of suicide attempts were made by patients under 30. One of the Paxil patients who attempted suicide succeeded.

Mary Anne Rhyne, who works for Glaxo, said the company is advising doctors to monitor all patients to make sure their symptoms don't worsen while they are taking Paxil.

The FDA says doctors and patients should follow current advice. The agency is still analysing the results of the trial.

A spokesman for the FDA said it is important that patients on Paxil do not suddenly stop taking their medication without first consulting with their doctors.

Written by: Christian Nordqvist
Editor: Medical News Today Read more!

Antidepressant May Raise Suicide Risk – The New York Times

By BENEDICT CAREY and GARDINER HARRIS
Published: May 12, 2006

After analyzing data from clinical trials, GlaxoSmithKline has sent letters to doctors warning that its antidepressant drug Paxil appears to increase the risk of suicide attempts in some young adults.

The company said it had changed the labeling on the drug to reflect the finding of the study, which analyzed clinical trial data involving some 15,000 people. The study found that reported suicide attempts were rare but significantly more common in adults who took the drug for depression than in those who received placebo pills.

The Glaxo researchers reported only one suicide in the trials, a number so small it says nothing about the drug's risk, experts said.

In October 2004, the Food and Drug Administration ordered drug companies to place a strong warning on antidepressant labels after studies suggested that some drugs increased suicidal thinking or behavior in children and adolescents. But the Glaxo study — the first by a drug company to find a link between antidepressants and suicidal behavior in adults, experts say — is likely to persuade some skeptics that the risk is real and not confined to minors.

The studies of children and adolescents found mainly evidence of suicidal thinking and agitation. There were no completed suicides reported.

In a statement issued this week, the F.D.A. said that though it was still evaluating the data, "we are recommending that consumers and prescribers follow current advice to carefully observe adults being treated with antidepressants for worsening of depression and for increased suicidal thinking and behavior." The statement said, "It is essential that patients taking Paxil do not suddenly stop taking their medication."

Last year, the agency asked psychiatric drug makers to review all their data on side effects in adults after a prolonged international debate over whether antidepressant drugs increase the risk of suicide in some children. Other companies have not yet reported their findings.

"This is the first analysis to show a relationship between suicide attempts and one of the antidepressants" since the F.D.A. required the warning label for children and adolescents, said Kelly Posner, an assistant professor in the department of child psychiatry at Columbia, who has helped the agency interpret bad reactions to antidepressants.

Dr. Posner said the Glaxo findings should be treated with caution, because the antidepressant trials done to date were not designed to evaluate suicide risk.

"It's not clear that the drug caused the behavior," she said.

Glaxo sent out the warnings voluntarily, and its data still show that the drug's benefits outweigh the risks for people with depression, said Mary Anne Rhyne, a company spokeswoman.

"We are now advising doctors to monitor all patients to make sure their symptoms don't worsen" in the full course of treatment, Ms. Rhyne said.

Previous research has suggested that the risk of suicidal thinking or behavior was highest in the first few weeks of treatment, or when people went off the medication. One large review of antidepressant trials, published last year in BMJ, a British medical journal, found that people taking Paxil and similar drugs like Prozac reported suicide attempts more often.

But experts have debated the interpretation and value of these findings. In the Glaxo analysis, the researchers analyzed trials that included 8,958 people who took Paxil and 5,953 who received placebo pills. The study participants ranged in age from 18 to 64 years old and were taking the medication for depression or other disorders, like panic attacks and obsessive compulsive disorder.

The analysis found that 11 of 3,455 people who were taking Paxil for depression reported an attempted suicide, compared with 1 in 1,978 taking placebo in the trials. Most were among adults ages 18 to 30, the company said.

Over all, the analysis found no increased risk of suicidal behavior in adults over 30.

"The new findings are not going to change my practice a lot, but I say, yes, they provide a reason to do even more careful monitoring of people on the medication," said Dr. George Simpson, a professor in psychiatry and behavioral sciences at the Keck School of Medicine at the University of Southern California.

Dr. Simpson said the warning underscored the need for more careful tracking of side effects once drugs went on the market.

"The current system of postmarketing surveillance is lousy," he said. Read more!

State leaves few options for helping mentally ill - Wilminton Star-News

By S.I. Cantrell

I’d rather stay here with all the madmen,
Than perish with the sad men roaming free.
– David Bowie, 1972

These days, the rock singer’s mental patient no longer has the option of staying in a mental institution, even if he feels unready for life outside the walls.

Most patients enter in a period of crisis and are released in a few days, when they no longer pose a danger to themselves or others.

Local homeless shelter operators have been grumbling about Goldsboro’s Cherry Hospital sending people to Wilmington with little more than pills and a list of shelter addresses.

Tuesday morning, Janet Johnson, director of the state mental facility’s social work program, and Doug Dexter, social work supervisor of the adult admission unit, spoke to the Tri-County Homeless Interagency Council.

Their message? Shelters are pretty much it, but Cherry will try to work more closely with them.

“When the time for discharge comes, people want to go home,” Dexter said. Trouble is, if their family won’t take them, home means a homeless shelter.

Of 133 patients Cherry discharged to New Hanover County from January to April, they said, 24 went to homeless shelters, 78 to private residences like family homes, 12 into rest homes or nursing homes, seven into group homes and six into “halfway homes,” which included First Fruit Ministries’ transitional housing for homeless women. The rest went to hotels or other destinations.

Shelter operators say they aren’t prepared to offer services to the mentally ill.
Dexter said Cherry communicates with the destination shelters before release.

Shelter operators have told me that doesn’t always happen. Of the 41 people discharged in January to New Hanover, all but three were from this county, Johnson said. Two were from Brunswick County and one from Duplin.

Mental health reform was supposed to mean money for new facilities in communities like ours. We’ve seen some open, but not enough.

This year, Southeastern won permission to use some of the 12 beds in its detoxification unit for overnight crisis services. People can stay up to 15 days.

Southeastern’s Tammy Knight suggested the new unit could take some of the more severely affected patients discharged from Cherry, a sort of “step-down” level. But there aren’t enough beds to take everyone Cherry releases.

The National Alliance on Mental Illness in North Carolina held its annual breakfast for legislators on Wednesday. As usual, no legislators showed up.

While there, I talked to Southeastern’s director, Art Constantini. He said he’d like to see small group homes created to take Cherry’s discharged patients. They could offer relatively normal settings augmented with supportive services.

Such solutions take money and time. NAMI says much of the savings from closing two state mental hospitals is going to pay for the one that will replace them. That’s unacceptable.

The lawmakers who launched this reform need to repair it.

Film & a forum: I’ll be among the panelists discussing tonight’s showing of Out of the Shadow, Susan Smiley’s film about her mother’s schizophrenia. I saw an advance copy. It’s a powerful movie.

We see what it’s like to grow up in a home where Mom’s behavior swings erratically from suburban-normal to hostile and dangerous, how she’s shuffled from place to place and the toll it’s taken on her two daughters.

The film and forum are at 7 p.m. tonight in the Warwick Center Ballroom at the University of North Carolina Wilmington. It’s presented by NAMI Wilmington, the Cape Fear Chapter of the Mental Health Association of North Carolina, and Jannsen, a pharmaceutical company specializing in mental health.

It’s free and you’re invited.

Contact Si Cantwell at 343-2364 or si.cantwell@StarNewsOnline.com. Read more!

Easely Budget: $90 Million For Mental Health - Associated Press

By GARY D. ROBERTSON
Associated Press Writer

The General Assembly opened its session Tuesday ready to spend up to $2 billion in extra money and determined to better monitor the ethics and campaign contributions of lobbyists and legislators.

Legislative leaders and Gov. Mike Easley already have plenty of ideas about how to use the additional cash, proposing larger raises for state employees and teachers, improved mental health services and repairing aging government buildings. Lawmakers are also considering cutting taxes.

The House and Senate each convened about noon with the bang of gavels. Although both chambers adjourned within an hour, lawmakers said they were going to get as much done as possible during the so-called “short session.”

“We’re going to deal with a lot of issues,” House Speaker Jim Black, D-Mecklenburg, said while backed by dozens of Democratic colleagues at a news conference before the session started. “We’re going to hit the ground running today. We’re not going to have time for folks to throw bombs and deal with things that are not productive for the people of North Carolina.”

Republicans, the minority in both the House and Senate, want to eliminate a temporary half-cent sales tax increase that has been on the books since 2001. Anti-gas-tax forces scheduled a rally near Easley’s office and the Legislative Building for Tuesday afternoon.

Before the session started, Easley unveiled his proposed changes to the $17.4 billion budget the General Assembly approved last summer for the fiscal year beginning July 1. The $18.9 billion proposal suggests giving teachers 8 percent raises, cutting the sales tax by a quarter-penny and setting aside $90 million to accelerate mental health reform.

Budget-writers had to regroup last week after learning that April tax revenues surged thanks to real estate sales, a strong job market and continued robust sales tax growth. The projected surplus of nearly $1.1 billion is the highest recorded since lawmakers began adjusting state budgets annually in the early 1970s.

More money is expected to be returned from state agencies that didn’t spend their allotted money this year and tax revenues are expected to exceed expectations in the coming year, pushing the total expected surplus to about $2 billion.

The House and Senate also are expected to use this session weighing whether to change lobbying, ethics and campaign finance rules.

Part of their interest stems from a series of legal troubles that have surrounded Black since the General Assembly ended its last session in October.

The State Board of Elections has asked local prosecutors to consider filing misdemeanor charges against Black or his campaign for the handling of incomplete contribution checks from Black’s fellow optometrists. Separate state and federal investigations of possible lobbying and campaign finance wrongdoing tied to the speaker’s campaign are also ongoing.

A House committee formed by Black has recommended several bills, including one that would prohibit lobbyists from making campaign contributions to legislators and statewide elected leaders.

Legislators also are expected to consider this year whether to raise the minimum wage from $5.15 an hour and alter eminent domain laws. In his budget proposal, Easley recommended increasing the minimum wage to $6.

Bills filed in the House on Monday would raise all teacher and state employee salaries by 7 percent; another would set a statewide referendum November on whether to borrow $1 billion with water and sewer bonds. Easley’s proposal would give state employees other than teachers only a 4 percent raise.

The Senate was to meet Tuesday for the first time in its newly renovated chambers - the first overhaul since the Legislative Building was completed in 1963. The $2 million renovation covered the familiar masonry blocks and metal shadow screen behind the dais with drywall. There are also new cherry desks, leather chairs, carpeting and a new Senate seal.

Three new lawmakers - Rep. Tim Spear, D-Washington, and Sens. Pete Bland, D-Craven; and William Miller, R-Forsyth - took their seats for the first time Tuesday. Read more!

Los Angeles County OKs Mental Health Reform Plan

County supports $186 million plan

BY TROY ANDERSON, Staff Writer

In its first plan for how to spend revenue from a voter-approved state income tax on millionaires, the Board of Supervisors on Tuesday approved a $186 million plan to overhaul Los Angeles County’s mental health system.

More than 18,000 adults and children are expected to receive expanded mental health services beginning this fiscal year, and officials say the extra money will help get thousands of mentally ill transients off the streets. ��

“This is very huge,” said Marvin Southard, director of the county’s Department of Mental Health. “This is really revolutionary.

“This is the first step in what will be a major change in the way the mental health system operates. It will be a first step in making it more customer-friendly, providing what people need rather than narrow mental health services.”

The plan helps restore some of the services cut since the early 1990s, when budget woes forced the state to close psychiatric hospitals and the county to close several of its mental-health clinics.

The newly approved plan calls for hiring 260 mental health workers and building a psychiatric urgent-care facility at Olive View-UCLA Medical Center in Sylmar.

“What we are trying to do is create a psychiatric urgent care facility where people who are in a psychiatric crisis, but probably won’t get admitted to the emergency room, can go to get stabilized,” Southard said.

“Rather than have them wait in the ER, which isn’t necessarily a good place to be if they are in a mental health crisis, (this would) create an alternative place for them.”

Money for the plan comes from Proposition 63, passed by voters statewide in 2004 to help fund services for people with severe mental illness through a 1 percent tax on incomes of more than $1 million.

Southard said the initial round of funding will go to agencies that help the homeless on Skid Row and throughout the county, and includes $11.6 million for a trust fund to develop permanent housing for people with psychiatric disabilities.

That money will augment $100 million the supervisors recently designated and




the $50 million Los Angeles Mayor Antonio Villaraigosa has promised to help house the homeless.

Southard also said some of the $2.8 billion targeted for housing in a $37 billion state bond package set to appear on the November ballot could be used for homeless housing.

“The most important thing, from our perspective, is creating avenues for people to get off the streets,” said Orlando Ward, spokesman for the Midnight Mission on Skid Row.

“We know from the physical exposure of people on the streets, particularly those suffering from untreated mental illness, we know their situation will not get better unless we find treatment for them.”

The funds will also be used to start and expand programs for people with schizophrenia, bipolar disorder, major depression and other serious conditions.

County programs are expected to include around-the-clock counseling and support, rent subsidies, resources for finding permanent, affordable housing, treatment for alcohol and drug problems, and drop-in centers.

It also will include counseling for teens leaving foster care, counseling for families with children who have severe emotional disorders, and transitional support for formerly homeless people.

The funds will also be used to set up more than a dozen transitional resource centers throughout the county, including in North Hills, Pasadena and Long Beach.

The facilities will help foster youth who have run away from the system or who have been emancipated at age 18 get housing, education and mental health services.
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Los Angeles County Mental Health Reform Gets OK -

County supports $186 million plan

BY TROY ANDERSON, Staff Writer

In its first plan for how to spend revenue from a voter-approved state income tax on millionaires, the Board of Supervisors on Tuesday approved a $186 million plan to overhaul Los Angeles County’s mental health system.

More than 18,000 adults and children are expected to receive expanded mental health services beginning this fiscal year, and officials say the extra money will help get thousands of mentally ill transients off the streets. ��

“This is very huge,” said Marvin Southard, director of the county’s Department of Mental Health. “This is really revolutionary.

“This is the first step in what will be a major change in the way the mental health system operates. It will be a first step in making it more customer-friendly, providing what people need rather than narrow mental health services.”

The plan helps restore some of the services cut since the early 1990s, when budget woes forced the state to close psychiatric hospitals and the county to close several of its mental-health clinics.

The newly approved plan calls for hiring 260 mental health workers and building a psychiatric urgent-care facility at Olive View-UCLA Medical Center in Sylmar.

“What we are trying to do is create a psychiatric urgent care facility where people who are in a psychiatric crisis, but probably won’t get admitted to the emergency room, can go to get stabilized,” Southard said.

“Rather than have them wait in the ER, which isn’t necessarily a good place to be if they are in a mental health crisis, (this would) create an alternative place for them.”

Money for the plan comes from Proposition 63, passed by voters statewide in 2004 to help fund services for people with severe mental illness through a 1 percent tax on incomes of more than $1 million.

Southard said the initial round of funding will go to agencies that help the homeless on Skid Row and throughout the county, and includes $11.6 million for a trust fund to develop permanent housing for people with psychiatric disabilities.

That money will augment $100 million the supervisors recently designated and




the $50 million Los Angeles Mayor Antonio Villaraigosa has promised to help house the homeless.

Southard also said some of the $2.8 billion targeted for housing in a $37 billion state bond package set to appear on the November ballot could be used for homeless housing.

“The most important thing, from our perspective, is creating avenues for people to get off the streets,” said Orlando Ward, spokesman for the Midnight Mission on Skid Row.

“We know from the physical exposure of people on the streets, particularly those suffering from untreated mental illness, we know their situation will not get better unless we find treatment for them.”

The funds will also be used to start and expand programs for people with schizophrenia, bipolar disorder, major depression and other serious conditions.

County programs are expected to include around-the-clock counseling and support, rent subsidies, resources for finding permanent, affordable housing, treatment for alcohol and drug problems, and drop-in centers.

It also will include counseling for teens leaving foster care, counseling for families with children who have severe emotional disorders, and transitional support for formerly homeless people.

The funds will also be used to set up more than a dozen transitional resource centers throughout the county, including in North Hills, Pasadena and Long Beach.

The facilities will help foster youth who have run away from the system or who have been emancipated at age 18 get housing, education and mental health services.
Read more!

Katrina’s young victims reminders of the need to take good care of all children - Asheville Citizen-Times

By Kerra L. Bolton
Pure Politics
May 9, 2006 12:15 am

Hakeem is one of the forgotten children of Hurricane Katrina.

Like many 6-year-olds, he loves to enact imaginary battles with action figures. He proudly recites the alphabet and can count to 110.

But the bright smile that illuminates his face disappears at times when he struggles with bedwetting and nosebleeds.

Hakeem’s story is one of many featured in the Children Defense Fund’s report: “Katrina’s Children: A Call to Conscience and Action.”

It highlights the illnesses experienced by thousands of children who are expected to develop post-traumatic stress disorder.

Marion Wright Edelman, president of the Children’s Defense Fund, traveled to New Orleans on Monday with a group of prominent Hollywood and New York women. The delegation included Reese Witherspoon, Jennifer Garner, Cicely Tyson, Regina King and Deborah Santana.

I was invited to cover the event but was unable to go.

“Over seven long months after children in our nation’s poorest states suffered horrifying flood devastation, tens of thousands of them have been left to wrestle with their profound losses without adequate mental health and health supports,” Edelman said.

About 27 percent of the first 1,000 children screened by the Louisiana State University Health Sciences Center displayed symptoms of trauma such as nightmares, flashbacks, heightened anxiety and bedwetting, CNN reported.

Hakeem, for example, constantly watches his grandmother, Valerie, for signs she will abandon him.

His mother deserted him during the storm. She relocated to another state and changed her phone number to an unlisted one when the family contacted her about reclaiming Hakeem, according to the Defense Fund’s report.

There are parallels between Hakeem’s story and those of countless children in North Carolina who go without adequate mental health services.

State lawmakers are considering earmarking $100 million this year to boost mental health services. But that isn’t enough. At least $172.5 million is needed to bring the current level of services to all who are eligible and seek help.

The state’s lack of psychiatric services has crested critical levels. North Carolina ranks 43rd in the nation in its per capita spending on mental health services, according to a report card issued by the National Alliance on Mental Illness.

Another report by the N.C. Psychiatric Association found it would cost an additional $285.5 million to bring the state’s per capita spending on mental services to 88.8 percent of the national average.

Legislative leaders will unveil today, the first day of the short session, a list of priorities that will include increasing teacher pay, ethics and government reform, and possibly tax cuts. But when children like Hakeem can’t count on adults to protect and provide for them, our priorities are as tattered as the trailer park shanty-town in which Hakeem lives.

This is the opinion of Kerra L. Bolton. She can be reached at (919) 821-4749 or kbolton@citizen-times.com.

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At last, good news on mental health - Asheville Citizen-Times Editorial

Some really good news on the mental health front came last week when a mobile mental health crisis services unit began operating in Buncombe County. It's about time for the unit - and for some good news about a system that's been in chaos for several years.

The mobile unit goes to patients who are having a mental health crisis and attempts to stabilize them. It already operates in Henderson and Transylvania counties and by the end of the summer it will operate in eight counties, according to Western Highlands Network, which oversees the local mental health network.

A $100,000 grant from the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services pays for the unit.

Those who have mental illness have been without adequate crisis intervention services since Charter Hospital closed in 2000. That's a long time, during which patients in crisis have found themselves in sometimes dangerous confrontations with law enforcement officers, dumped in hospital emergency rooms ill-equipped to care for them, and confined to residential facilities, sometimes far from their families. Mental health advocates in the region have lobbied for crisis intervention services since Charter closed. The mobile crisis services unit is part of the answer to their prayers. Besides operating around the clock, the unit is equipped to transport someone who cannot be stabilized at home to a facility, such as Broughton, prepared to handle mental health patients in crisis.

That should help free law enforcement officers to deal with criminals instead of spending hours escorting and transporting mentally ill patients. It should also reduce the times when they are placed in potentially dangerous situations they are trained to handle primarily through use of force, which could have a very bad outcome for the patient.

But the mobile unit is only part of the answer. Arthur Carder Jr., CEO of Western Highlands, called it a good first step.

The next critical step is a facility where patients whose crisis can't be resolved at home can be taken for a couple of days to be stabilized.

In many instances, patients placed in such a facility near their homes and loved ones can be stabilized and ready to return to their normal life within a few days. That ultimately saves the money required for longer stays in institutions far from home. And it permits family members to remain involved in their loved one's care and rehabilitation.

It is, as Diane Bauknight wrote in a letter to state lawmakers and other officials, a necessary component for a crisis care continuum. Bauknight is a member of the advocacy group WNC Families CAN and the mother of a child with a mental illness.

It's heartening to see that some progress toward better care for those who suffer from mental illness is being made. But many problems remain. Sen. Martin Nesbitt, D-Buncombe, is co-chairing an oversight committee looking for ways to fix a state mental health services system that crashed and burned as the result of a badly botched and severely under-funded reform. Nesbitt and his committee are expected to request more money for the system during the upcoming short session.

State lawmakers should move swiftly to approve the request in order to see that adequate funds are available to create the community-based services that were supposed to be part of the reform, but have been abysmally slow to materialize.


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Our View: Mental health reorganization isn’t ‘reform’ unless it works. - Fayetteville Observer

There is nothing wrong with appropriate community care for mental health patients. But Michael Watson, head of the eight-county Sandhills mental health unit, isn’t alone in wondering who’s going to provide and pay for all that care.

In fact, Cumberland County staff members voiced similar concerns at a meeting in March, reporting that only 30 providers had been signed.

By June 30, Watson reports, his organization will have moved 2,000 patients off its rolls. That Sandhills will be left with roughly twice that many still awaiting referrals is a serious problem.

If the first wave of 2,000 isn’t being moved to providers who are not merely in the mental-health business, but who can identify the particular needs of individual patients, that’s failure — with greater failure awaiting the second and third waves. If the providers are pros but lack the facilities to meet each patient’s needs, that’s failure, too. And it’s failure if a provider cherry-picks patients to avoid taking on problem patients who, in Watson’s words, “don’t pay for themselves.”

It’s failure if Medicaid, already under siege in Washington, is further squeezed by the state, prompting providers to turn their backs on suffering people.

Finally, it will be hard to declare reform a success if more patients than before end up “falling through the cracks in the system” — a phrase tossed about dismissively by those higher up the bureaucratic food chain, but used with bitter distaste by those who will be watching when the casualties fall.

The directors are not anti-reform. But they know that, in Watson’s words, “It’s an extraordinary amount of change happening very quickly.” They know that the state is burning bridges. (Sandhills’ budget will be cut in half next year.) And they know that their specific, rubber-meets-the-road concerns draw only broad assurances that everything’s going to work out fine (except, of course, for those who fall through the cracks in the system, tut-tut).

Dick Oliver, who evaluates local agencies, offered some good advice. If Watson thinks reform is coming too fast, he said, he should tell the state Division of Mental Health and plead for more time. His strong implication is that the state will grant any reasonable request. Maybe a procession of directors pleading for more time would shift the state’s focus from the gleaming superstructure to the unfinished foundation. Read more!

New service the first of many steps - Hendersonville Times-News

Mental illness doesn't keep regular office hours. Crises can happen at any time, day or night.

That's why getting mobile crisis intervention teams up and running is so important to the state's mental health care system. The teams are available 24 hours a day, seven days a week to respond to families experiencing a mental health or substance abuse crisis.

New Vistas-Mountain Laurel, which provides mental heath services in eight mountain counties, has launched mobile crisis teams in Henderson and Buncombe counties.

"That has not been something readily available in the past," said Barry Beavers, the director of Mountain Laurel Community Services. "In the past, a lot of community members, parents, clients have been upset that our help services ended at 5 p.m. even when Mountain Laurel extended office hours. Crises happen at three in the morning."

Money for the teams comes from a $100,000 state grant that Mountain Laurel received through Western Highlands, which manages mental health care for Henderson, Buncombe, Mitchell, Madison, Polk, Rutherford, Transylvania and Yancey counties. Western Highlands expects to have teams in the other six counties by mid-summer.

"Consumers, family members, advocates, board members and many others have consistently identified crisis services as a major gap in services," said Arthur D. Carder Jr., the Western Highlands CEO. "While this is not a solution to all the concerns, it is a step in the right direction."

Beavers said Mountain Laurel was selected to implement the service because it launched a similar program last year that has shown success.

The program was formed after a mental health reform mandated by the Legislature in 2001 caused the mentally ill to begin flooding local homeless shelters, overwhelming emergency rooms and burdening local law enforcement. Mountain Laurel launched a crisis assistance team in Henderson County to help ease the burden. The agency recently received a $71,000 grant to extend the program to Transylvania County.

The intervention team concept is a good one. A team of mental health professionals goes to the person's home or the location of the crisis. There the team evaluates the person's needs, defuses the situation if possible and figures out what the next step should be.

In some cases, if the person can't be helped on the spot, the crisis team may refer him or her to an out-of-home facility. In other cases, the team can refer people to a local provider for follow-up, which would allow them to remain at home.

Research shows that people have a better chance of long-term mental stability or sobriety if they are in familiar surroundings such as their home, school or work instead of being separated from family and friends at a facility far from home.

"Our goal is to enable consumers in crisis to remain at home whenever possible," said Don E. Herring, director of the Western Highlands Access and Emergency Services.

That's a good goal to shoot for and one that the mobile crisis intervention teams make more realistic.

But as important as the teams are, they are only one small step. More services are needed so that the mountains can offer comprehensive mental health care. For example, the mountains need a permanent facility where people in crisis can seek help and remain until they are stable.

What other services and facilities the mountains get will depend on how much money the Legislature makes available. The Legislative Oversight Committee on Mental Health, Developmental Disabilities and Substance Abuse Services is drafting a bill that would earmark an extra $160 million for solving the state's mental health care mess.

Mental health consumers, their families and the public ought to keep a close eye on this bill and insist that their legislators support it.

Getting the crisis teams going is progress, but the Legislature still has a long way to go before it fixes the system that it "reformed" five years ago. Read more!

Durham Center receives injunction - Durham Herald-Sun

BY GREGORY PHILLIPS
The Herald-Sun_gphillips@heraldsun.com
419-6636
May 3, 2006 : 7:34 pm ET

DURHAM -- A judge granted a preliminary injunction to the Durham Center that is the first court victory for local mental health providers against North Carolina's statewide reform plan to shift managed care to private companies.

The state Department of Health and Human Services announced in March that a private provider would start managing care for all Medicaid patients statewide as of June 1. On Tuesday, Administrative Law Judge Sammie Chess Jr. blocked that initiative from taking effect in Durham pending a full hearing the week of July 24.

The judge's ruling, the first of its kind in the ongoing dispute, also suspends the state's plan to have a neighboring authority handle all after-hours screening of Durham mental health cases beginning July 1.

The Durham Center is responsible for managing mental health, developmental disabilities and substance abuse services in the county. The state's directives would cost 15-20 of the center's 55 or so employees and $1.4 million in funding.

"This is the best news we've had in a long time," Durham Center Director Ellen Holliman said of the injunction. Durham's state legislators also told county commissioners Tuesday they'd fight to preserve funding for the Durham Center.

Private contractors don't save taxpayer money because they generally authorize more care than patients actually need, according to Durham Center officials. Losing that power to prescribe care and the ability to screen cases locally makes care less personal and not geared toward the patients' best interests.

During five years of mental health reform, local mental health authorities have moved toward service management rather than direct care, which is now handled mostly by private providers. The Durham Center embraced reform. For the most part it was labeled a model system by the state for its efforts to reduce local admissions at state hospitals.

But local officials got indignant when Health and Human Services announced in March that Value Options, a private provider, would handle authorization of all mental health care for Medicaid patients in the state starting June 1. Another blow was the simultaneous order that, beginning July 1, the neighboring Five Counties authority would handle all screening, triage and referral of mental health cases in Durham after 5 p.m. and on weekends.

A week after those announcements, County Attorney Chuck Kitchen filed a petition for a contested case hearing with the Office of Administrative Hearings to void the state's plan. The petition claims the state is violating its own statutes, breaching a contract with The Durham Center to oversee care and denying the center due process rights. That July hearing will result in a recommendation to Health and Human Services, which it can ignore. If the state ignores a ruling in The Durham Center's favor, the case can be appealed to Superior Court.

Health and Human Services spokesman Mark Van Sciver declined to comment on the specifics of the case, but said the state plans to have Value Options start authorizing care for other counties on schedule.

"We are not backing off," Van Sciver said. "Everything is proceeding."

Kitchen also declined to discuss how the state argued against the injunction in a closed hearing Tuesday.

"I don't want to comment on arguments because the case is still pending," Kitchen said.

A preliminary budget supplied to the Durham Center last month included a 28 percent budget cut from the state due to the impending removal of services. But Kitchen said the preliminary injunction also requires the state to continue funding The Durham Center to authorize care for Medicaid patients and conduct after-hours screening pending the hearing.

The center currently contracts with a private provider to screen cases. Holliman said bringing that service back in-house was one way the center might try to avoid losing staff if the state prevails.

The center's budget is up for discussion at a public meeting of its Board of Directors at 4 p.m. Thursday at 501 Willard St. downtown.


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