By PAM BELLUCK
PORTLAND, Me. — When Maine became the first state in years to enact a law intended to provide universal health care, one of its goals was to cover the estimated 130,000 residents who had no insurance by 2009, starting with 31,000 of them by the end of 2005, the program’s first year.
So far, it has not come close to that goal. Only 18,800 people have signed up for the state’s coverage and many of them already had insurance.
“I think when we first started, in terms of making estimates, we really were kind of groping in the dark,” said Gov. John E. Baldacci, who this month proposed a host of adjustments.
The story of Maine’s health program — which tries to control hospital costs, improve the quality of health care and offer subsidized insurance to low-income people — harbors lessons for the country, as covering the uninsured takes center stage. States, including California, Massachusetts and Pennsylvania, have unveiled programs of their own, seeking to balance the needs and interests of individuals, employers, insurers and health care providers.
But as Maine tries to reform its reforms, it faces some particular challenges: It has large rural, poor and elderly populations with significant health needs. It has many mom-and-pop businesses and part-time or seasonal workers, and few employers large enough to voluntarily offer employees insurance. And most insurers here no longer find it profitable to sell individual coverage, leaving one carrier, Anthem Blue Cross Blue Shield, with a majority of the market, a landscape that some economists said could make it harder to provide broad choices and competitive prices.
Some parts of the state’s current program — named Dirigo after the state motto, which means “I lead” in Latin — are seen as promising. These include the creation of a state watchdog group to promote better health care, and an effort to control costs by asking hospitals to rein in price increases and spending, although experts and advocates said those cuts needed to be greater.
But a financing formula dependent on sizable payments from private insurers has angered businesses and is being challenged in court.
And while some people have benefited from the subsidized insurance, which provides unusually comprehensive coverage, others have found it too expensive. And premiums have increased, not become more affordable, because some of those who signed up needed significant medical care, and there are not enough enrollees, especially healthy people unlikely to use many benefits.
“It was broad-based reform that just never got off the ground,” said Laura Tobler, a health policy analyst with the National Conference of State Legislatures. “The way that they funded the program became controversial. And getting insurance was voluntary and it wasn’t that cheap.”
Governor Baldacci said in an interview that when the Legislature enacted the Dirigo Health Reform Act in 2003, it gave him less money and more compromises than he had wanted. He said his administration had now learned more about what works and what does not.
His new proposals include requiring people to have insurance and employers to offer it and penalizing them financially if they do not; making the subsidized insurance plan, DirigoChoice, more affordable for small businesses; creating a separate insurance pool for high-risk patients; instituting more Medicaid cost controls; and having the state administer DirigoChoice, which is now sold by Anthem Blue Cross.
“We’ve got a reform package that takes Dirigo to the next level,” Mr. Baldacci said. “It takes the training wheels off.”
The proposed overhaul seems to include something each of Maine’s constituencies can embrace and something each opposes, so there is no guarantee which changes will be adopted by the Legislature.
“It’s very hard politically to deal with the underlying costs of the system,” said Andrew Coburn, director of the Institute for Health Policy at the Muskie School of Public Service in Portland. “And Maine is just not wealthy enough to cobble together enough resources to fully cover the uninsured.”
The state’s current program, which has added 5,000 people to Medicaid and enrolled 13,800 people in DirigoChoice, has made progress. Even though the enrollment goal has not been met, the insurance plan has grown faster than any in Maine’s history, the governor said. And although about 60 percent of its enrollees were previously insured, some were paying what state officials deemed was too high a percentage of their income, said Trish Riley, director of the Governor’s Office of Health Policy and Finance.
The DirigoChoice benefits are impressive, said Hilary K. Schneider, policy director for Consumers for Affordable Health Care, a Maine advocacy group. The program completely covers preventive care, subsidizes premiums and deductibles, and unlike most insurance plans, covers treatment for mental illness and does not exclude people for pre-existing medical conditions.
Such coverage has caused critics to say DirigoChoice would be more affordable if it scaled back benefits.
“It’s a Cadillac policy, and we ought to be trying to fund a Ford Escort policy,” said Jim McGregor, executive vice president of the Maine Merchants Association.
One of DirigoChoice’s success stories, Jacquie Murphy, 63, of Westbrook, said, “It absolutely saved my life.” Ms. Murphy said she has fibromyalgia, chronic fatigue syndrome, back problems, an autoimmune disease and memory problems from a childhood brain injury. She said that a few years ago, when she left an abusive marriage and gave up her husband’s coverage, the fear of being unable to afford insurance that would accept someone with her illnesses “caused me to become clinically depressed.”
With DirigoChoice, which costs her just over $100 a month with the state paying a subsidy of about $250, she now has a walker, sees orthopedic surgeons for shoulder and ankle fractures, and takes medication for memory, cholesterol and thyroid problems. The relief of being insured lifted her depression, she said, and now, in her home with its Asian-themed pebbled backyard, she works as a career and life coach.
For others, like Leah Deragon, 34, DirigoChoice is too costly. Ms. Deragon, who runs a Portland nonprofit center that helps low-income families with new babies, said that although she and her husband, an engineering student, qualified for a subsidy, they could not afford the roughly $300 out-of-pocket cost each month. She remains uninsured, forgoing annual checkups and using student loan money when she needed dental work.
“For us it was very frustrating,” said Ms. Deragon, who shops at Goodwill and lives in her mother’s home in Gorham to save money. “We earned, I think, $16,000 last year. We can’t do $200 or $300 a month and still put gas in our car. Come the end of the month, we would be forced to hitchhike.”
And there is John Henderson, 42, of Auburn, who enrolled in DirigoChoice in 2006 for about $90 a month while working at an L. L. Bean warehouse, a job he kept to 20 hours a week so his income would qualify him for such a low rate.
But he dropped the plan this year when rates increased by 13.4 percent on average. Mr. Henderson, who has diabetes and is currently jobless, said he had stopped once-regular doctor’s appointments and some medications that “I have just no hope of affording.”
Ms. Schneider’s group is suing the state insurance commissioner for approving the rate increase.
An Anthem spokesman, Mark Ishkanian, said the increase was necessary because medical claims of DirigoChoice customers were “substantially higher” than anticipated, about double those of non-Dirigo plans. One reason for the higher expense was “pent-up demand” by enrollees who had been deferring visits to doctors while they were uninsured, Mr. Ishkanian said. Another was the richness of the coverage, which enrollees used for treating long-held conditions or mental illness, he said.
Ms. Riley said the state was surprised that more than half of DirigoChoice enrollees qualified for the highest subsidy, 80 percent, which meant the program has been more expensive for the state.
She said Maine also expected more small businesses to enroll in DirigoChoice. But many businesses found that the program requirements of enrolling 75 percent of a firm’s employees and paying 60 percent of the cost were too expensive.
“If they weren’t able to afford insurance before, they’re unlikely to be able to afford Dirigo,” said Kristine Ossenfort, senior governmental affairs specialist of the Maine State Chamber of Commerce.
Some health care advocates have accused Anthem of not marketing DirigoChoice enough to prospective customers, which Anthem denies.
Especially controversial was Maine’s financing formula for its program, which assumed that there would be savings because an increase in insured people would mean less charity care from hospitals, and that the cost-cutting measures would mean lower costs to insurers.
The state said it would charge insurers for those savings, rather than let insurers take the savings as profit. But when the state tried to charge insurers $43.7 million in 2005 and $34.3 million in 2006, the insurance industry and the chamber of commerce sued, saying the insurers owed much less.
A judge ruled for the state, but the case is being appealed. The governor’s new proposal would phase out this financing structure and impose lower-cost surcharges instead.
Among the state program’s biggest fans is Joan M. Donahue, 40, who was uninsured when she started a home care agency in Warren three years ago. She now has DirigoChoice for herself and her 17-year-old son, and three employees are enrolled. She also has two employees who cannot afford it and have not enrolled.
“I will absolutely stick with Dirigo,” said Ms. Donahue, who does not qualify for the subsidy. “This program needs healthy people who don’t get subsidized so it can prosper.”
The Dirigo program has already made one change that could attract people like Malvina Gregory, 31, a Spanish interpreter in Portland, who could not afford the subsidized insurance but may reconsider. Ms. Gregory was originally put off because it demanded full payment up front, and rebated the subsidy later; she went instead to a Portland program giving nearly free care, but is now afraid her income “will bump me over the limit” for that program.
DirigoChoice will now allow individuals to pay only their part up front. “The concept of Dirigo, I think, is phenomenal,” Ms. Gregory said. “I hope they are able to lower the premiums. There are a lot of folks like me that are in that bind.” Read more!
Monday, April 30, 2007
By PAM BELLUCK
Posted by david at 7:18 AM Permalink
Published April 30
By ANEMONA HARTOCOLLIS
He was a media columnist for Women’s Wear Daily who built a reputation on his writing about the counterculture of the 1960s and ’70s. He got attention for his odd dress, a self-consciously nerdy, retro look that reminded some people of Austin Powers. His prose was dense, sarcastic, with intellectual overtones.
Now the writer, Peter Braunstein, 43, is about to go on trial, charged with a bizarre crime against a woman who worked in his own newsroom. Prosecutors say he dressed as a firefighter, staged a fire to get into her Chelsea apartment, tied her to a bed, drugged her with chloroform and sexually molested her for 13 hours.
As the trial opens today in State Supreme Court in Manhattan, jurors will be asked to decide whether he was a sadistic man preying on an unsuspecting woman or whether his actions were the result of mental illness.
The defense has conceded that he committed the crime, and is working on a risky defense that will combine traditional psychiatric testimony with the burgeoning field of “neurolaw,” which holds that there is a biological basis for behavior. Prosecutors have said that steps Mr. Braunstein took before the attack show his intent.
Mr. Braunstein’s lawyer, Robert Gottlieb, has said he would show color images of his client’s brain, called positron emission tomography, or PET, scans, that he said show that Mr. Braunstein had undiagnosed and, until his arrest, untreated paranoid schizophrenia that drove him to behave as he did.
During jury selection last week, and in his court papers, Mr. Gottlieb said he planned to argue that Mr. Braunstein was so psychologically impaired that he could not form the intent to commit a crime. He has hinted that Mr. Braunstein’s attack on the woman was part of an elaborate fantasy over which he had little conscious control.
In similar cases, lawyers have argued that their clients were in a dissociated state, much like sleepwalking. A version of this defense, said Rachel Barkow, a law professor at New York University, would be: “You know killing is wrong, but it turns out you think you’re in the middle of a video game. Because of a paranoid delusional state, you thought it was all a fantasy.”
A more classic lack of intention defense, said Stephen J. Morse, a professor of law and psychiatry at the University of Pennsylvania, would be that someone out hunting in the dark shot a person thinking he was shooting a tree.
Dr. Morse compared Mr. Braunstein’s argument to that in Clark v. Arizona, in which the defendant, a paranoid schizophrenic, was convicted of killing an Arizona police officer. There, too, intent was one of the issues, he said. The defendant claimed that he thought aliens — some impersonating government agents — were trying to kill him. “If he really believed that this was a space alien, he did not intend to kill a human being knowing it was a police officer,” Dr. Morse explained. (The United States Supreme Court affirmed the murder conviction in 2006.)
But the challenge of mounting such a defense, Dr. Morse said, is that “even abnormal brains produce intention.” Dr. Morse said that for a defendant to claim he was in an automatic state like sleepwalking for 13 hours would be unusual. “Virtually always, when people claim they committed a crime in an automatic state, that automatic state was relatively transient,” he said.
At first glance, Mr. Braunstein seems an unlikely candidate for a high profile trial. He had a fairly ordinary upbringing in Kew Gardens, Queens. The strangest part of his past, according to court papers, may be the family secret he unearthed when he was 27. He found out that his cousin was also his half-brother, the son of his father’s previous marriage to his aunt.
But because of his connection to New York’s fashion and media worlds, his story has been picked up not only by the crime-hungry tabloids, but by Vanity Fair and New York magazine.
As if working off a script, Mr. Braunstein staged the crime on Oct. 31, 2005, Halloween night, the prosecutors said. In an echo of a scene from his failed 2004 play, “Andy and Edie,” about Andy Warhol and Edie Sedgwick, it appeared he had videotaped his attack, although court papers say the tape was blank. He left a Manolo Blahnik shoe — the ultimate symbol of the fashion industry that had cast him out a few years before — on the bed, the police said.
Mr. Braunstein spent six weeks as a fugitive before being captured at the University of Memphis, where an employee recognized him from the television program “America’s Most Wanted.”
His downward spiral began in 2002, according to court papers filed by the defense, when he was fired from Women’s Wear Daily, in a dispute over free tickets to a Vogue event, and accelerated after he broke up with his girlfriend, Jane Larkworthy, the beauty editor at W magazine. “Without the stabilizing factor of a regular job, Mr. Braunstein rapidly began to unravel psychologically,” Barbara R. Kirwin, a clinical psychologist hired by the defense, said in a written report. He became suicidal and felt like a “person who exists with no social identity,” she said.
But the fashion press, Dr. Kirwin added, was the wrong job for Mr. Braunstein from the beginning.
“Working in the highly competitive, glitzy and sexually charged atmosphere of a celebrity-driven fashion periodical was an extremely toxic and unsuitable environment for a socially compromised and marginally compensated schizotype like Mr. Braunstein,” Dr. Kirwin wrote.
“It was,” she added, “in fact the proverbial recipe for disaster.”
The expert who conducted Mr. Braunstein’s PET scans, Monte S. Buchsbaum, a professor of psychiatry at Mount Sinai School of Medicine, has worked with other high-profile defendants, including Vincent Gigante, the Mafia leader. Mr. Gigante was known for wandering Greenwich Village in a bathrobe and slippers, and prosecutors accused him of faking mental illness to avoid prosecution. Dr. Buchsbaum testified in 1997 that brain images showed Mr. Gigante suffered from dementia.
In 2003, Mr. Gigante pleaded guilty to obstruction of justice, admitting he tried to outsmart the legal system by pretending he was mentally ill. Dr. Buchsbaum said in an interview last week that he stands by his diagnosis of Mr. Gigante, who died in 2005, and that he considered the guilty plea to be a legal maneuver.
In Mr. Braunstein’s case, while the defense is putting forward an insanity defense, prosecutors have a more prosaic theory of what happened. Maxine Rosenthal, the lead prosecutor, argued in pretrial hearings that Mr. Braunstein was bitter over his breakup with Ms. Larkworthy and enraged at the fashion world for rejecting him.
He could not attack Ms. Larkworthy, the prosecutor said, because she had taken out an order of protection against him, after accusing him of harassing and stalking her. So he lashed out at his co-worker, the prosecutor said, because she was an unwary surrogate for those who had betrayed and humiliated him.
The intentional element, the prosecutors said, can be seen in Mr. Braunstein’s ordering of the firefighter’s costume, chloroform and other supplies. He also called his probation officer in the stalking case to postpone an appointment scheduled for Oct. 31, the day of the attack.
In the end, said Stephen Gillers, a law professor at New York University, Mr. Braunstein will have to show why he should not be held accountable by society. “Gottlieb can point to his very pretty color photograph of Braunstein’s brain,” Mr. Gillers said. “But that’s not going to be enough. He’s got to satisfy the moral conscience of the jury, which is going to take this very seriously.” Read more!
Posted by david at 7:15 AM Permalink
Sunday, April 29, 2007
State officials made a step in the right direction when they backed off a 30 percent reduction in rates for a popular mental health care program.
Thursday the state announced it would roll back the cut to about 16 percent for community support services that keep people out of hospitals, on medications and at their jobs. We'll just have to wait and see whether the change is enough to keep an already shaky mental health care system from collapsing.
Originally, Department of Health and Human Services Secretary Carmen Hooker Odom had announced that the state was slashing the reimbursement rate for community support services from $60.96 an hour to $40 an hour. The cut was effective April 1, but later was made effective April 5. Now the rate will be set at $51.28, a reduction of $9.68 an hour.
While that's better than a reduction of almost $21 an hour, the 16 percent cut is still a heavy hit on a mental health care system that is still reeling from an ill-conceived and poorly executed reform that the Legislature mandated in 2001.
"We feel that this is a fair rate that covers the actual cost of the services," Hooker Odom said.
Complaints from providers that the 30 percent reduction would drive them out of business prompted the department to reconsider the cut. Providers such as Appalachian Counseling, which provides community support services to about 250 of its 5,500 clients in Henderson, Transylvania, Polk and Buncombe counties, reacted cautiously to the news.
"It is much better than the $40 rate," said Meg Foley, the chief operating officer for Appalachian Counseling. "I think some providers will have to restructure, but they may be able to continue services, which is a lot better than the alternative."
Hooker Odom said the original reduction was based on an audit of 167 providers who were billing for services provided by high school graduates. She said the rate was meant to pay for services provided by a mix of staff including professionals with master's degrees.
Jane Ferguson, the CEO of Appalachian Counseling, wrote in a guest column Thursday that the agencies that were billing incorrectly represented only about 16 percent of the state's more than 1,000 providers.
"Those providers could have been put on a corrective action plan or probation or both," she wrote, echoing exactly what we said in this space April 13.
Instead, the state chose to punish everybody for the sins of the few. Although this week's new rate may ease the pain some, it still punishes the entire system instead of just the wrong-doers.
As Ferguson said, community support services are the glue that holds the mental health care system together.
"Without it, many other services -- such as mobile crisis response, intensive in-home services, intensive outpatient services for substance abuse and psycho-social rehabilitation -- do not quite work," she said.
Hooker Odom said the new rate reflects the actual cost of providing the services. For the sake of the mental health care system and the people it is supposed to serve, we hope she got it right this time. Read more!
Posted by david at 6:42 AM Permalink
By LEE HANCOCK / The Dallas Morning News
Hundreds of boarding homes across Dallas warehouse the elderly, the disabled and the mentally ill in privatized bedlam. They are what the head of the region's mental health system flatly calls "mental health slums."
City officials believe at least 350 unlicensed, unregulated board and care homes house 2,500 people across Dallas – probably more.
"Pretty much, you can open up a boarding home anywhere you want to, stuff as many people in there as you can, keep them at 85 degrees or worse in the summer and 50 degrees in the winter. You can nearly feed them dog food and get away with it," said one veteran caseworker in North Texas' privatized mental health system.
"So many of the residents are clearly psychotic. We have clients who think they're God," the worker said. "Who's going to believe them when they say they're being mistreated or ripped off?"
Dallas' problems aren't unique, but official inaction here has made them worse.
The city and the state haven't closed troubled homes, and state regulators have shown little enthusiasm for pursuing unlicensed ones. County prosecutors have refused to take homes to court for violating state laws. The Social Security Administration has allowed home operators to control residents' disability checks, and that has led to abuse.
Dallas County pays hundreds of thousands of dollars a year to put people in some of these unlicensed facilities. And officials say it's all the county can afford as it tries to help the indigent and homeless.
There is little money for treatment – let alone housing programs – in a state ranked 49th in funding mental health programs, advocates say. So mentally ill people suffer and taxpayers get the tab for constant police and fire calls, jail stints and emergency treatment at Parkland and other hospitals.
Officials, mental health care providers and advocates acknowledge they've come to view the homes as a grim necessity. They share the belief that living in a bad one is better than living under a bridge.
That's akin to child-abuse investigators saying, "Oh, they only beat and starved the child but didn't kill it," said Texas A&M Regents professor Catherine Hawes, a national expert in long-term care regulation.
"It is a failure of government at every level – a failure of the mental health system that is so committed to moving people to 'the least restrictive environment' that it will tolerate them becoming homeless or living in conditions the Humane Society would not accept for a dog," she said.
"It is a failure of the regulatory system to ensure that all places housing vulnerable adults be licensed and meet minimum standards," she said. "It is a monumental failure of the judicial system not to protect these vulnerable adults. And it is a failure of our society that we allow this to occur."
The city formed a boarding home task force last fall. "The problem is a lot bigger than we first imagined. ... Every time we look, it seems to grow," said assistant city manager Charles Daniels, head of the task force.
The task force will brief the City Council on Wednesday on plans for better protecting neighborhoods and boarding home residents. "I know a lot of people do look at them as throwaway people. It is hard to get people to care," Mr. Daniels said. "But these are residents of the city of Dallas. The city has an obligation to protect them."
The names of Dallas' board and care homes evoke hope and stability and family for people who have lost all of those things. Their residents are ex-cons, substance abusers, the chronically mentally ill, the mentally retarded and the elderly poor. Some are comfortable. Others are faded apartments, dilapidated nursing homes or flophouses indistinguishable from crack houses.
Some operators are good people trying to help the disadvantaged. But others are predators – as many as half of those in business, some officials and advocates say. Some drive luxury cars, while their residents trade $623 monthly Social Security disability checks for Dickensian squalor and a diet of bologna sandwiches, Ramen noodles and food-pantry handouts. Some have run unlicensed homes for years despite court orders and promises to quit.
Michelle Cotten may be a typical resident – 55, bipolar and unable to work or live on her own since her 20s. She said trying a care home seemed attractive when her mental health caseworker offered her a home list. Her mother, Ouida Banks, 92, said the caseworker didn't mention until later that the first home Ms. Cotten chose had long been known as a problem.
Ms. Cotten was in and out of three homes. The first was a place where she once went without heat in the winter and sometimes didn't eat until midnight – that's when someone brought food. No one ever told her or her mother that her second care home was being pursued by the state for operating illegally. Her last care home was a bug-ridden place where she fell asleep each night staring at a gaping hole in the ceiling. An air-conditioning duct had fallen through it, onto her bed's previous occupant, she said. "She had to go to the hospital," she said.
Another resident turned tricks when she wasn't feeling too ill from HIV, she said. The back stairs were so rickety that Ms. Cotten fell walking down them to smoke. She broke her back. "You might think you want my life," she said, "but you'd get tired of it."
"These group homes, they kind of dwell on mentally ill people," added her mother, a retired Dallas County court employee. "They can treat 'em any kind of way."
Nowhere else to turn
The dependence of so many mentally ill residents on boarding homes is rooted in changes in the mental health system. With new medications and deinstitutionalization in the 1970s, Texas began moving the severely mentally ill from state hospitals to outpatient care. Terrell State Hospital has since shrunk from more 2,500 beds to 316. The average stay is now about three weeks.
The region's mental health programs also have undergone a sea change since the '90s, shifting to a managed-care program. Although many advocates and officials say community treatment has improved, state funding hasn't kept up with demand. Funding for the few supportive housing programs for the chronically mentally ill has also been cut.
Caseworkers and advocates say profoundly disturbed, heavily medicated patients are often discharged from mental hospitals when they're barely stable. Many have no homes or families to return to. Caseworkers have to find someplace to put them and turn in desperation to unlicensed board and care homes.
"Everybody gets in a high-pressure situation," said Myrl Humphrey, a vice president at ABC Behavioral Health, a mental health care provider in the North Texas system. "We've got to get them out of there [the state hospital]. That's how they end up dumping them in those places."
The region's largest mental health care provider, Metrocare Services, maintains a boarding-house list with about 90 Dallas homes – only 12 of which are licensed.
Dr. James Baker, Metrocare's executive director, said his staffers aren't supposed to recommend unlicensed homes but know most clients can't afford any that are. So caseworkers hand the boarding-home list to clients and "follow them where they choose."
That's a sidestep around state law. Mental health care providers jeopardize state contracts and funding if they refer clients to illegal, unlicensed homes.
Dr. Baker said decent housing is crucial to treatment, and not spending money on that and other services for the mentally ill means more expensive emergency treatment and jail costs. "You get to the point that you decide you're going to do the best you can with what you've been given," he said. "And what we're given isn't adequate."
Mentally ill offenders in the justice system are also steered to unlicensed homes. "It's epidemic level," said Margaret Johnson, a court-appointed lawyer for special-needs offenders. She cited a recent case as typical: A bipolar client was paroled to a dingy, two-bedroom boarding home with eight other residents. He fled and ended up back in jail after being hit with a pipe for complaining about other residents smoking crack.
Regional mental health chief Ed Miles said mental health, justice and social agencies have pointed fingers and tried to shift costs instead of tackling the issue together. "You have agencies arguing about who is responsible and who can back it up with funding," he said. "There's been, really, a dramatic lack of coordination."
Making things worse is boarding-home residents' poverty. Many survive on $623 monthly Social Security disability checks. Even that pittance makes them targets for abuse.
"Boarding homes will go to homeless shelters and round people up," said Erroll Willis, a Veterans Affairs staffer who works with veterans who can't manage their own finances. "The boarding homes have people handing out cards, saying, 'If you need assistance getting your [disability check], we'll do it.' "
Social Security allows disability recipients who can't manage finances to have monthly checks sent to a person they designate as "representative payee." Boarding home operators often demand to be named residents' payee, and mental health advocates say that's not always unreasonable. Many residents will blow any money they get on drugs and alcohol.
Unlicensed Dallas homes that take the poorest, most troubled residents charge $500 to $600 a month, promising allowances from what's left from disability checks. In contrast, a recent survey found the average monthly charge for licensed assisted living in Dallas was about $2,500.
Some owners profit by crowding in disability recipients and feeding them poorly, advocates and officials say.
Ms. Banks, the retired Dallas County worker, said that happened to her daughter, Michelle Cotten.
One unlicensed Dallas home that Ms. Cotten chose from her mental-health provider's list hired teenagers and eventually quit buying food or utilities. They said the operator abandoned her daughter and others, and Ms. Banks called police. In a March 2005 report, Dallas police described finding Ms. Cotten and two other confused residents in a home emptied of furniture.
Ms. Banks said another home operator recruited her daughter and, as soon as she moved in, made her file papers replacing Ms. Banks as her daughter's representative payee. Ms. Banks said she got her daughter out, but spent months getting the boarding-home owner removed as payee. She said she never recovered several of her daughter's disability checks.
"I do try to screen places," Ms. Banks said. "There's a lot of things the state or somebody really needs to know about."
States are supposed to report substandard homes to the Social Security Administration, so they can be screened when disability recipients request payees. States also have had to certify annually since 1976 that no federal disability recipients are in substandard board and care homes. Critics have long said those requirements lack teeth.
Despite frequent complaints from disability recipients, Dallas officials and advocates say, they seldom hear of payees punished for mishandling money. Police also get reports but say they can do little.
"We get complaints all the time from the residents who are out panhandling. They say they're hungry. They talk about not being fed enough – that's constant," said Southwest patrol division Lt. Kimberly Stratman. "People in these homes are potential victims – not criminals."
Social Security's Dallas regional office referred questions to media representatives who did not return calls over more than a month.
Home inspections falling
Regulation of board and care homes in Dallas falls through city and state cracks. Texas law requires facilities to get assisted-living licenses if they help clients with bathing and eating or if they dispense medication and house four or more residents unrelated to the owner.
While the number of nursing homes in Texas – and the number of people in them – has fallen over the last nine years, the number of licensed assisted-living facilities has soared. For every state licensed home, regulators recently estimated, there may be two unlicensed ones.
As the industry has grown, Texas regulatory efforts have shrunk. State reports indicate that inspections of licensed assisted-living facilities and unlicensed homes have dropped 14 percent between fiscal 2002 and fiscal 2006. The state has rarely used its regulatory powers to close licensed homes or put in outside supervision. And policing of unlicensed homes has dipped since regulation moved in 2004 to the Department of Aging and Disability Services.
In Dallas County, DADS' unlicensed home inspections fell 30 percent between fiscal 2002 and 2006. In the fiscal year ending last September, DADS surveyors made 42 visits to 33 unlicensed assisted-living homes. They found in 18 of those visits that homes violated state law.
The Dallas County district attorney's office also has declined to take DADS case referrals for at least eight years, a district attorney's office spokesman said. In contrast, Harris County's district attorney regularly gets court orders fining or closing bad homes. Houston's DADS officials are also more likely to fine homes and go after unlicensed ones than their Dallas counterparts.
Cecilia Fedorov, a DADS spokeswoman, cautioned against comparisons between cities because regulatory decisions are made "case by case." She added that DADS inspectors have no legal authority to go looking for unlicensed homes unless they get complaints.
When investigators do go to unlicensed care homes, records indicate, they focus on whether the operators are doling out medications. When operators and staff say they don't, and there's no blatant evidence otherwise, cases are closed. If investigators do find violations, records indicate the agency often opts to send a warning letter.
When inspectors identify violators, licensed or unlicensed, the agency must consider "our jurisdiction, what we have the ability to do, and the circumstances surrounding each individual case," Ms. Fedorov said.
"While our role is enforcement, we must weigh the overall environment – to include a lack of affordable housing, limited resources for MHMR [mental health and mental retardation programs], the availability of appropriate licensed placements," she said.
The agency will close a facility only if it can find licensed homes that will accept the residents involved and charge what they can afford. Otherwise, she said, "we would be effectively putting those residents on the street or placing them in another facility which could be unlicensed."
A recent internal memo prepared by DADS on the issue of expanding state regulation of unlicensed homes was more blunt. Though DADS does have authority to close a home without court action if it is endangering residents, the December 2006 memo stated, it would then "be responsible for relocating the residents."
Dr. Hawes of Texas A&M said that, unlike Texas, most states pay supplements for Social Security disability recipients in licensed homes, "so vulnerable, disabled and poor residents will not face this choice of homelessness or housing in an unlicensed facility." Only licensed homes get the supplements, she said, giving homes incentive to get licensed.
She noted that a study she led in the mid-'90s for the federal government found Texas was among five states "with the weakest regulatory systems and the highest number of unlicensed homes." She said she still hears DADS officials voice concerns about the current regulatory system.
Criticism of DADS
People who keep an eye on care homes say DADS doesn't seem interested in getting a grip on unlicensed homes. Licensed industry representatives say that they regularly raise concerns about the homes to agency officials, only to be told they aren't a problem.
State Rep. Jose Menendez, D-San Antonio, said DADS officials have fought his bill requiring licensing and inspection of every facility providing meals, shopping, transportation or other services to three or more unrelated patients. Violators could face criminal fines of $1,000 for a first offense and $500 for additional ones, plus civil penalties. And the fines would go to regulatory efforts.
The state agency initially said the added regulation would cost $42 million in its first two years – a potential bill-killer for fiscal conservatives. Mr. Menendez thought DADS officials agreed that tinkering would drop the price. But DADS then upped its cost estimate to $50 million.
The agency's representatives have warned that DADS might have to regulate convents, motels and fraternity houses. Last week, DADS and Texas Adult Protective Services officials released an 18-point critique, warning that the bill could hurt group homes for the mentally retarded and lead to more elder abuse, neglect and exploitation. Among the downsides noted by the agencies: The bill would make local and state agencies stop referring people to unlicensed homes.
Dr. Hawes, the Texas A&M professor, said most states require licensing for any home housing two or more unrelated individuals – and don't have a problem with over-regulating other businesses.
Mr. Menendez said he is baffled by the agency's full-court press. "My level of frustration is through the roof," he said. "What's the potential cost to the state if we don't do something? What's the potential harm for people in these homes and the people living next to them if we don't try to get this under control?"
In El Paso, a probate judge saw the results of a lack of regulation. The judge, Max Higgs, said he was disturbed by mental-health agency referrals of vulnerable people to filthy, unlicensed homes that fed them rotten food and pocketed their Social Security. He appointed a lawyer to investigate. But the attorney general's office went to an appeals court, argued that the judge lacked jurisdiction and got the hearings halted.
Now retired, Mr. Higgs remains incredulous that the state's priority seems to be "stopping people from knowing how bad the situation really is."
In Dallas, officials with the Veterans Affairs have regularly warned DADS about problem homes and nothing happens, said Gloria Johnson, who oversees the VA's placement of veterans in licensed assisted-living homes. VA representatives visit the 43 North Texas homes in their program at least monthly to ensure all meet VA care requirements.
She recalled one state-licensed operator showing her a filthy Oak Cliff home with inadequate food and linens and a weedy yard last August. The operator was irate when rejected by the VA. Others applying to get VA contacts have admitted feeding residents only oatmeal, bologna and beans. One had a building so shoddy, she said, that VA staffers couldn't believe it passed state inspection.
"There are no consequences for bad care," said Mr. Willis, the VA field examiner who has visited homes all over Dallas since 2000. He said he has reported licensed homes for lack of food or heat and allowing residents to go so long without bathing that anyone walking in their facilities could smell them. All he can do, he said, is encourage veterans to move and refuse to pay homes that don't meet VA standards.
The severity of Dallas' boarding home problems appalled Dr. Miles, director of the North Texas Behavioral Health Authority. Last fall, he made an emotional presentation to his board. He also called DADS. "They read their policy to me," he said. "What it amounts to is there's nobody supervising these places."
He said he saw care-home issues as head of Florida's mental health system. But Florida counties and cities have more regulatory powers, he said. "At least you could call and complain and the problem would be looked at."
Dr. Miles said he'd like Dallas to do more but knows the city is "overwhelmed. It's crazy to me to expect the city to be able to regulate these places alone."
Ordinances not enforced
Dallas does have boarding home ordinances that the city hasn't enforced. The homes are required to get inspections and certificates of occupancy. But some don't bother. When caught, some operators have held off inspectors by claiming to be exempt from city oversight, records show.
City statutes confuse matters by terming the homes everything from group homes to boarding houses, rehab centers and residential hotels. The names determine how the city can restrict them. A U.S. Supreme Court ruling limits regulation of homes with eight or fewer disabled residents; restrictions on those homes must cover all property owners.
Records show homes sometimes go years without repairing violations. Mr. Daniels, the assistant city manager, said inaction has allowed the city's boarding home problem to spread. "It's like fire ants," he said.
The City Council passed a boarding home ordinance in 1998, prompted by state legislation on assisted living. The ordinance requires businesses providing personal care, room and board to four or more people to get state licenses and meet size and safety standards. Violators can face city fines and referrals to state regulators. If asked by state regulators, city attorneys can seek court injunctions and closure orders.
But none of that happened. "There's no valid reason why," said Mr. Daniels.
Complaints about board and care homes in Oak Cliff and East Dallas led to a city task force in 2003. The city's crisis management team gathered home operators, city staff and mental health experts in hopes of getting homes to meet standards voluntarily.
The City Council passed an ordinance requiring boarding homes to register annually and undergo regular inspections, along with multifamily properties such as apartments. Code enforcement began apartment registration and inspections but never got to boarding homes. Soon after, the task force folded.
That panel's chair, city crisis intervention manager Dave Hogan, said other priorities intervened and no one could answer a lingering conundrum: Would enforcement just add to Dallas' homeless problem?
So his staff continued social-work triage, moving residents when they discover horrific conditions and cajoling owners of better places to take people, Mr. Hogan said. "We sometimes find ourselves negotiating and looking the other way."
Another task force
Adam McGough, an assistant city attorney, began exploring the issue in early 2006, prompted by citizen complaints. He found boarding homes with sewage leaks, eight or 10 beds to a room, and beds in closets.
His findings, other complaints and mental-health community concerns prompted City Manager Mary Suhm to start a new task force last fall. The city named a boarding home code inspector in February, and county representatives have joined task force meetings.
The task force will brief the council next week about a new boarding house team including police, code and fire inspectors and social workers. They'll also discuss funding and housing solutions.
Mr. McGough notes that some boarding homes have already done repairs, moved or closed. He and others worry, though, about unintended consequences. After one flophouse hotel agreed late last year to quit housing permanent tenants, he notes, a mentally ill resident told to move set fire to her room.
Bottom line, Mr. Daniels said: The city needs help. "Is there going to be some sort of safety net, or are we going to be the ones having to provide care?" he said. "It's important that we get some additional assistance from the state and the federal government."
Mental health officials say they've seen too many past efforts to be too hopeful. "We're fearful of doing anything, the problem is so huge," said Melodie Shatzer, director of ABC Behavioral Health. "It's going to take money, and it's going to take the collective will of the community."
State commitment is a must, she said. "Until we make a decision that all of these facilities have got to be licensed, monitored regularly and adequately funded, we're going to continue to have this problem."
Posted by david at 6:41 AM Permalink
By Ken Little
Military service many years ago wounded the minds of Richard A. Wilson and Robert Bridges, even though the men fought very different types of battles.
Both remain in conflict against an internal enemy.
For Wilson and Bridges, the U.S. Department of Veterans Affairs Health Administration system is also sometimes the adversary. Both men suffer from post-traumatic stress disorder, a condition diagnosed in thousands of veterans trying to re-enter civilian life, including some returning from combat in Iraq and Afghanistan.
The VA says it is trying to accommodate the needs of all area vets and plans to move into a larger regional clinic in Wilmington by 2010, but for those like Wilson and Bridges who live in outlying areas, a trip to Wilmington or Fayetteville for specialized services can be a major undertaking.
In recent interviews, Wilson and Bridges discussed the life paths they took to get where they are today.
Richard A. Wilson
Wilson, now 68, lives in Bolton in Columbus County, his hometown. As a young man, he dreamed of a joining the military and did so in 1955, at age 17.
As a young black man in the recently integrated Army, Wilson said he encountered many overt acts of racism while training and serving on bases in South Carolina and Texas, and through interactions with civilians.
"I was a young country boy, being a long way from home. I was afraid when these things happened to me, and today those horrible acts still affect me. I have mental stress, headaches, diabetes, congestive heart failure and poor circulation. I didn't know anything about PTSD or anything else," Wilson wrote in an October 2006 letter to the VA.
Wilson was stationed in Hawaii with the 25th Infantry Division from 1956 to 1958. An event one night in June 1957 made a permanent impact.
The night began when Wilson and three friends went into Hilo to get some dinner. They began drinking. As they returned to base later on, the soldiers crossed a railroad bridge. One of them announced he was going for a swim and dived into the river below in full uniform. He quickly tired and went under. Wilson and the other two men did what they could to save their friend, but he drowned.
"Over the years, it traumatized me," Wilson said. "I knew something was wrong with me, but I didn't know where to seek help."
Wilson said he was put on "Kitchen Police" duty the day after his friend's death. He believes his Army days were numbered after the drowning incident. Wilson received an honorable discharge in November 1958, despite efforts to re-enlist. He served three more years in the New York National Guard.
"Over there, I tried to soldier as good as I could. I made rank and I had a lot of different jobs. My plan was to make a career out of the military," Wilson said.
After Army service, Wilson moved to New York City. He began drinking heavily. Troubled years followed. In the late 1970s, he sobered up for good.
"I wasn't able to keep a good job for 10 or 15 years. I couldn't cope with it," he said. "When I got sober, I qualified to manage some of the bigger supermarkets in the state of New York."
While successful in his new career, Wilson remained unsettled by his service experiences. He moved back to Columbus County about 10 years ago, still haunted by his past.
On the night of Nov. 28, 2004, Wilson was working as the assistant manager of the Hills Supermarket in Lake Waccamaw. It was closing time, and he and two teenage employees were getting ready to go home.
They were interrupted by an armed man who burst into the store. Pointing a 9 mm handgun at Wilson, the robber demanded that he accompany him into the office, ordering a young man sweeping the floor to join them.
A 17-year-old cash register clerk stood nearby, paralyzed with fear. When the robber, later identified as Kinny Bethea Jr., began to push the clerk in the direction of the office, Bethea became momentarily distracted. Wilson drew his own handgun and when Bethea turned a corner to enter the office, he was shot dead.
Wilson told police he believed he and his young co-workers were about to be killed. Authorities agreed the shooting was a clear case of self-defense.
Wilson worked about one more year. But he said the shooting vividly brought back many of the conflicts that plagued him since the Army.
"It blew it open. It opened it back up," he said of his post-traumatic stress disorder.
Wilson actively sought VA treatment and currently attends regular mental health counseling sessions at the Wilmington clinic. Persistent attempts to receive disability compensation have been denied. His most recent request to the VA to reconsider its findings about his PTSD was formally answered in January. The letter refers to an evaluation done at the Fayetteville VA Medical Center.
"While this additional treatment report reveals a diagnosis of PTSD was found, there is no verified in-service stressor linked to a diagnosis," it states. "The preponderance of the medical evidence links the diagnosis of PTSD to the involvement in the robbery in which you shot and killed an individual. Because of this, the previous denial of service connection is upheld."
VA officials declined to comment about Wilson's case on grounds of patient confidentiality.
Wilson, who has suffered two heart attacks and has other health conditions, receives medical treatment and assistance with prescription medicine from the VA. He and his wife Elizabeth make regular trips to Wilmington from Bolton, 30 miles away.
"They should have looked more into my case than what they did. I've had a problem for over 50 years," Wilson said. "They didn't deny I had post-traumatic stress. They are saying it didn't come from the Army. I've been through hell, and I've got all the information to prove it."
Robert Bridges, of Surf City, served in the Army from 1967 to 1970. He spent 19 months in Vietnam with an airborne infantry unit.
Bridges, now 59, said he was troubled by his Vietnam experiences from the time he returned home. He sought assistance from the VA, initially without success.
"When I got out of the service, I couldn't get any help there," Bridges said. "I just tried to work and get on the best I could."
Bridges said he was not immediately diagnosed with PTSD. He started drinking regularly, a practice that has persisted over the years.
"I drink to forget. I drink to numb myself. I drink because of my nerves," he said. "When a thunderstorm hits, I dive under the bed because I think it's bombs."
Bridges said he is on 100 percent disability but unable to get VA help for his drinking so he can be treated for his PTSD condition. He would like inpatient treatment but has had trouble getting placed because of lengthy waiting lists for detox center beds, Bridges said.
Bridges spent six days earlier this month in the Facility Based Crisis Center in New Hanover County, formerly known as the Tri-County Center, but was unable to find immediate follow-up placement in a VA hospital. Bridges has tentative arrangements to check into a VA facility in Salisbury, more than four hours away from his home, in mid-May. The treatment program there lasts 35 days, he said.
Frustration still remains for Bridges when he recalls the many times he sought help.
"They tried to send me outside the VA health system. What am I supposed to do?" he asked. "I'm tired of nightmares and I'm tired of flashbacks. You got to be clean and sober for six months, and I've been having a problem with that."
Bridges, who has a progressive eye disease, said it can be difficult making it from his Pender County home to the Wilmington VA clinic or to other VA locations for more specialized treatment. He is sometimes assisted by the Disabled American Veterans organization. He doesn't know how he will get to Salisbury.
"If they send you to Wilmington, you can't get done what needs to be done. Fayetteville is a 2 1/2-hour drive at your own expense," Bridges said. "I think they're doing the best they can. I think the problem is with the cutbacks. They have made everything outpatient. It's a hardship for a lot of veterans to get to where they have to go to get help."
Bridges sees a psychiatrist at the Wilmington VA clinic and said others there have tried to be helpful, but he added the services he really needs are not available locally.
"I fought for my country and my country let me down," Bridges said.
As with Wilson, VA officials would not discuss Bridges' case.
"Any veteran who thinks they have a need for mental health services, we're very confident we can be of help to veterans who are in need of that kind of support," said David Raney, communications officer for the VA Mid-Atlantic Health Care Network that includes North Carolina.
While the VA puts an emphasis on veterans returning from Iraq and other combat postings, "we certainly have not forgotten older veterans," he said. As of last year, an estimated 46,500 veterans lived in New Hanover, Brunswick and Pender counties.
The VA is "extremely proactive" in treating PTSD and substance abuse issues, Raney said.
Expansion plans are in place for the Wilmington clinic, even if it remains the responsibility of patients to get there.
"I get asked that a lot and I have to say we don't tell veterans where to live," Raney said. "Essentially, what we're trying to do with these new community-based outpatient clinics is we're trying to put these clinics typically in the center of where the veterans live. Typically, the idea is that they drive no more than an hour to get the services."
The VA plans to increase its ability to serve more veterans in the Wilmington area "with the construction of a larger clinic with expanded outpatient services," Raney said. The agency is currently looking for land. The new Wilmington clinic is scheduled to open by 2010.
In addition to primary and general mental health care, other services to be offered will include audiology and speech pathology, dental care, an eye clinic, prosthetics, radiology, rehabilitation medicine, a pharmacy and ambulatory surgery.
No outpatient clinic in Brunswick County is planned at least through 2012, Raney said.
Ken Little: 343-2389
Posted by david at 6:32 AM Permalink
America knows all too well the violent potential of some who suffer from mental illness. Less known are those who grapple with the disease in silence, without the medical help they desperately need to be participating and productive members of society.
Treating those with mental illness is not an easy or inexpensive task, and it requires a comprehensive effort utilizing many approaches. And it is vital that this community, state and nation take seriously that pressing need and act with due diligence to see that treatment options are available to all who need them.
Investigators report that 23-year-old student who shot 57 people at Virginia Tech on April 16 exhibited signs of mental illness long before his rampage. Seung-Hui Cho killed 32 students and professors that morning, two years after his interaction with two women led campus officials to have him undergo a psychological evaluation.
This community knows how difficult dealing with mental illness can be, as most recall the 2006 shooting death of a Greenville man who was shot by police following a dangerous high-speed chase. Officers were attempting to execute an involuntary commitment order to Kerry Turner when a stand-off led to the chase and, later, his death.
More often, however, the signs of mental illness are less noticeable and more unspectacular. From personality disorders to depression, signs of instability or imbalance may not be readily apparent to the person suffering or to those around them. It may take careful observation over time, and picking up on signs in order to notice someone in need of assistance. Substance abuse, as well, can be concealed, but requires attention and care.
Sadly, not all who need such help receive it. The Virginia Tech shooter was diagnosed as a danger to himself, but was treated as an outpatient and not required to be monitored. The results of that decision contributed to last week's carnage.
North Carolina launched a significant overhaul of its mental health services more than five years ago, seeking to reduce the number of agencies in the state and to make them more effective. The changes should reduce the overhead cost of administration and streamline bureaucracy. But it remains to be seen if services will suffer in counties that have worked to build strong mental health programs, like Pitt County, when the agency is asked to serve a greater population.
In the aftermath of the Virginia Tech murders, officials and psychiatric experts fear further ostracizing those with mental illness. Instead, Americans should dedicate their effort to making treatment more available and affordable. It should do better to educate the public about mental illness and help Americans recognize symptoms and warning signs, the best way to eliminate the sigma surrounding these disorders and draw more people who need it into treatment.
Last week's events were a terrible tragedy. And it would be shortsighted to avoid confronting this medical issue in the most productive manner in their aftermath. Read more!
Posted by david at 6:31 AM Permalink
By Richard Kunnert
SPECIAL TO THE REGISTER STAR
Over the next several months the state Legislature will respond to proposed changes to the public mental-health system in Illinois by the administration
The core of Gov. Rod Blagojevich’s plan has nothing to do with care; it has to shift the cost of public mental-health care in the state to the federal government. Instead of using a preponderance of Illinois general revenue funds to buy service, the goal is to have Medicaid be the primary funder of service.
Some small amount of general revenue funds would be used to “fill in” where Medicaid services are lacking. This effort would shift from a grant-in-aid system to a fee-for-service system.
There are three fundamental service changes resulting from the governor’s plan to have Medicaid be the primary funder of mental health services in Illinois.
1) Medicaid is a fee-for-service format, 2) the service array is limited to what has been negotiated between state of Illinois and the U.S. Department of Health and Human Services and 3) only those eligible for Medicaid services can be served. Non-eligible people will have very limited access to service.
The consequence for Illinois residents is that fewer people have access to service, the range of services is not sufficiently broad to move people from treatment to recovery, and service delivery will be essentially office based and thus leaving many unserved.
In 1980, the National Institute of Mental Health published the Community Support Program. CSP was reinforced in 1999 when the surgeon general, Dr. David Satcher, released the first Surgeon General’s Report on Mental Illness. The CSP core services received additional research support as to their usefulness in assisting people suffering from mental illness. CSP has been an accepted model of care in Illinois since the ’80s. Now our governor chooses to pull away from a legitimate care model and introduce service instability into communities across the state.
A fee-for-service pay schedule, with few exceptions, only pays when the therapist is talking to a client. Many young people experiencing mental illness for the first time are unlikely to show up in an office. Going out to them has been found to be helpful and clinically productive.
Under Medicaid, time spent traveling out and waiting for people would be nonreimbursable, therefore, it won’t happen. (Grant money using Illinois general revenue funds had been used for case management monies.) The consequence will be more people wandering the city in a confused state. Psychosocial rehabilitation drop-in centers will receive a 90 percent reduction in funds.
Vocational programs are to be transitioned to a supported employment model which is not Medicaid compatible. Drop-in centers and vocational programs are not part of the Medicaid waiver.
The issue is not debating fee-for-service funding; the debate is the effect on the care system when a single funding methodology is used that does nothing to enhance care and is inadequate to support people.
There is another unintended consequence connected to Medicaid only funding. In a grant system, advanced payment to cover agency costs is an option while Medicaid payment is only retrospective. Also, the payment cycle can be anywhere from 60 to 90 days after the service provided.
A great many mental-health service agencies have cash reserves of 30 days or less. Lending agencies are not going to agree to constant indebtedness, therefore numerous bankruptcies are not beyond question. Smaller agencies, particularly those operating in rural communities will experience such a payment-cycle life threatening. Some local agencies could be effected.
Compromise could reduce the ill affects of the governor’s proposal. We ask you to:
Advocate for a continuance of a care model that has the capacity to take people from diagnosis to recovery.
Advocate for a funding system that is capable of producing an enhanced care system for residents.
Advocate for a timely payment mechanism that allows service providers to continue their role in the care system.
Please let the governor and our local legislators know your preferences, particularly Rep. Chuck Jefferson since he is member of the governor’s party.
Richard Kunnert is president of the Mental Health Association of the Rock River Valley.
Posted by david at 6:23 AM Permalink
By STEVE WOODRUFF of the Missoulian
Cliff was the first mentally ill person I ever met. I was a kid working in a produce market where Cliff was a sometimes laborer. Unkempt and unbelievably uncouth, he struck the teenage me as being hilariously outrageous. He was given to profane outbursts about enemies and the government, sentiments he shared freely with me and anyone else who didn't immediately retreat as he noisily approached. He bristled with knives and numchuks and ninja stars, which he'd brandish at the least provocation. I got to know him enough to talk with him a bit. Even as a kid, I could see he was more tragic than threatening.
My first roommate in college, a guy named Bob, was creepy. An upperclassman double-majoring in computer science and electrical engineering, he was brilliant but anti-social. He had a dark personality and seemed perpetually bitter about way too many things. He was especially unlucky in love, and rejection fed a near-pathological anger directed at women. He often mumbled about “getting even” once he was out of college, had a great job and was rolling in money - as if that were going to do the trick. I shared a room with him one very long semester, long enough to conclude he was full of bluster, lonely and rejected, without doubt doomed to unhappiness, but a menace to himself far more than to society.
I've encountered scores of people just like Cliff and Bob in the decades since. Well, not just like them but similar in that they're obviously sharing their heads with demons of one sort or another. A newspaper office, where I've plied my trade, can be a powerful magnet attracting the seriously mentally ill. Maybe that's not so surprising: Many people turn to the newspaper to air their grievances, and some of the unbalanced folks I've dealt with over the years have had an awful lot of grievances, real and imagined. It's a sad fact that a newspaper editor sometimes is the only person to whom a tortured soul can turn.
I've been thinking about all those folks in the wake of the April 16 massacre at Virginia Tech. I worry that mentally ill people everywhere may wind up suffering collateral damage from that awful bloodshed, becoming the focus of even greater suspicion and discrimination than they already are.
As the whole world now knows, 23-year-old Seung-Hui Cho was an angry loner known as a mental case by classmates and faculty at Virginia Tech well before the shooting rampage in which he killed 32 and wounded dozens before killing himself. We in the news business have an almost Pavlovian response to mass murder, which is to call into question America's gun laws. In this case, however, most of the attention focuses not on guns but on Cho's mental problems and the failures of the system that allowed such a psychopath to run loose. That's looking in the right direction, but I worry it will lead to the wrong answers.
Like crossing the street when you see someone who doesn't look or act “normal” on the sidewalk ahead. Or reporting the office introvert to human resources. Or branding depressives or neurotics or compulsives as psychos. Or calling the police to report abnormal people. Or, even more than ever, running not walking away from anyone and everyone who might now be imagined as the next mass murderer.
“We should be asking how weird and anti-social someone has to be before he's identified as a danger to himself and others,” Patty Fisher of the San Jose Mercury News wrote in a column published in the Missoulian last week.
Really? Should we really treat weird and anti-social people like criminals in waiting? Should we blur the lines between weird and dangerous, anti-social and psychotic?
Today I think about my first roommate, a troubled nerd born just a couple of decades before geeks became cool. Whatever his troubles, they could only have been made worse by the constant social rejection he suffered, including my own hasty abandonment of him. He never committed mayhem at college, but I wouldn't be surprised to hear he sometimes fantasized about it. I don't know what became of him. If he's found any happiness in life, it couldn't have been without obtaining mental health treatment.
Every college, almost every office and certainly every town has one or more people just like Bob. What's in store for them now? Will people engage them, befriend them, help them? Or will they avoid them, further isolate them and report them? What will happen to all the weird and antisocial people if we routinely identify them as dangers to themselves and others?
I think, too, about Cliff. If I were a little older, I might never have encountered someone like him in my younger years. That's because we used to “take care” of seriously mentally ill people by placing them in institutions, sometimes for treatment - which could include crude electroshock sessions and lobotomies - but more often just for warehousing. We put them out of sight and out of mind. That began changing in the 1950s and 1960s amid revelations about deplorable conditions in state hospitals. Ken Kesey's 1962 novel “One Flew Over the Cuckoo's Nest” had social as well as literary impact. The 1960s, '70s and '80s were all about “deinstitutionalizing” the mentally ill. Americans suddenly understood that people who hadn't committed any crime didn't belong behind bars.
But what obviously was less well understood is that the “illness” part of mental illness requires effective treatment, inside a hospital or out. Moving from institutionalized care to community-based care was the right thing to do, but doing so made provision of adequate treatment more challenging, not less so. Most communities, including our own, simply don't do enough to care for people suffering mental illnesses.
I suspect my old acquaintance Cliff had been spilled out of some hospital, set free to cope as best he could in an overwhelming world. He wasn't alone. From the mid-1950s to the mid-1990s, the number of people hospitalized for mental illness in America went from more than a half-million to a little more than 55,000, even as the overall population grew by nearly 100 million. Various studies show that close to half of the people with serious mental illness don't even seek treatment, much less get effective treatment.
“Untreated mental illness is America's No. 1 public health crisis, but it is a hidden crisis,” the National Alliance on Mental Illness says on its information-packed Web site. “Treatment works - we know what to do, but we simply have not invested adequately in this treatment.”
Perhaps Cho's shooting spree at Virginia Tech will raise mental health services on the nation's list of priorities. That would be good.
But I still worry about a backlash directed at the mentally ill. “Mental illness” is a broad and imprecise term applicable to about one of every seven people in any given year. The incidence of serious mental disorders is much smaller - affecting maybe one in 17 people. I worry that the stigma of mental illness is magnified by incidents like the Virginia Tech shooting and that the stigma will further isolate the mentally ill and perhaps even deter ill but harmless people from seeking help.
Easily lost in all the discussion of Cho and untreated mental illness these past couple of weeks is the fact that the vast majority of mentally ill people - even among the seriously ill - are not violent. Some are, of course, and the Montana Legislature has been arguing over how much it's worth to treat mentally ill criminals and how best to do it.
In general, though, “The overall contribution of mental disorders to the total level of violence in society is exceptionally small,” according to the U.S. Surgeon General's Report on Mental Health, issued in 1999.
Social-science research cited by the surgeon general shows the likelihood of violence caused by the mentally ill rises when people with serious disorders don't get or don't take prescribed medication. The greatest risk involves people with serious mental disorders who also have substance-abuse problems. The surgeon general's report persuasively argues for more and better treatment and better public understanding of mental illness to reduce the stigma that makes so many people avoid seeking help.
For all the good that does: A lot more people watch CNN and read newspapers than comb through 500-page tomes issued by the surgeon general. I worry the public may make Seung-Hui Cho the new poster child of mental illness. If we let that happen, the list of casualties will grow several orders of magnitude beyond the losses suffered April 16 in Blacksburg, Va.
Steve Woodruff is the Missoulian's opinion page editor Read more!
Posted by david at 6:21 AM Permalink
PRIMETIME | PAM IRISH
Spring is a time many people look forward to. It may be the flower and tree blossoms and the opportunity to enjoy sunny, warm days.
While spring means renewal and new life to most of us, others are experiencing depression.
Dawn Lillard has been a mental health professional in Union County for 25 years. Currently she is with the Geriatric/Adult Mental Health Specialty Team at Piedmont Behavioral Healthcare.
In this first part of a two-part interview, Lillard answers questions about depression and suicide in older adults.
Q. What are some statistics about suicide and older adults?
The age group with the highest suicide rate is white males 80 or older. Women attempt suicide more frequently than men. Men complete their attempt more often than women as they generally choose a more lethal means. Out of 100,000 people, 59 suicides are completed by the group 85 or older and for the general population there are 10.6 suicides per 100,000 people. In older adults, suicide is often a well-thought-out plan.
Q. What impact does depression have on the older adult population?
Of the 35 million adults 65 and older, it is estimated that 7 million are depressed but only 10 percent are being treated.
Q. Why is the percentage being treated so small?
Older adults do not often consider depression an illness. They may believe they are supposed to feel like they do. Even doctors sometimes believe that depression is normal for older adults. It is not normal and is not a part of the aging process. Many older adults may believe, "If I just pull up my boot straps, everything will be OK." Or they may feel a stigma about having a mental health illness and in seeking treatment.
Q. If I suspect an older loved one may be depressed, how may I best approach the subject?
Never ask an older adult "Are you depressed?"
The likely response will be "no." Often this is because there is a belief that depression is a sign of weakness, not an illness.
Symptoms to consider in older adults include a decrease in appetite and weight loss. They are also more likely to report somatic complaints such as back pain. They may complain about feeling "slowed down" and express worries about finances and health issues frequently. Rather than expressing feelings of sadness or hopelessness, the person is more likely to be irritable.
This may be misinterpreted as anger. Depression may become apparent after a major life change such as being widowed, divorced, job loss, substance abuse or failing health. Chronic illness symptoms and certain medications' side effects may mimic symptoms of depression.
The second part of this interview will look at seeking treatment and options available for depressed older adults. For more, call the Piedmont Behavioral Healthcare Access Call Center at 800-939-5911.
Primetime | Pam Irish Read more!
Posted by david at 5:45 AM Permalink
State Rep. Rick Glazier wants to close a loophole that could allow thousands of mentally ill North Carolina residents to buy handguns illegally.
The problem is this: It’s illegal under state and federal law for many mentally ill people to buy guns. But it’s also illegal under privacy laws for the state government to forward names of the mentally ill to a federal database, which law enforcement and gun dealers consult to confirm whether someone is allowed to have a gun.
It has become a significant issue following this month’s massacre at Virginia Tech University, where student Seung-Hui Cho fatally shot 32 people before killing himself.
Cho was able to buy two handguns for the attack despite a 2005 court declaration that he was a danger to himself. The ruling didn’t show up on the background check.
North Carolina judges issue similar mental health orders, but the court system can’t put that information into the federal database.
“We have no authority or directive to report this information to anybody,” said Dick Ellis, spokesman for the N.C. Administrative Office of the Courts, which oversees courthouse operations. “Unless we’re told directly to do so, we don’t give our records over to anybody.”
Glazier said Friday that he is researching the loophole and hopes to write a law to solve it.
If the law were changed, the court information would be stored in the National Instant Criminal Background Check System, which is run by the FBI. It relies on states to forward information such as court orders dealing with mental health.
North Carolina’s mental health filings to the FBI database now fall primarily in two categories, said John Aldridge, special deputy attorney general and leading authority on state firearms law. One is an open court ruling in a criminal case, such as being found not guilty by reason of insanity. The other is a record of being turned down by a sheriff for a pistol-purchase permit or concealed-carry permit.
North Carolina sheriffs are responsible for background checks on applicants for both permits. They can check commitment records on concealed carry permits because applicants waive privacy rights. While they aren’t allowed to check those records for pistol purchases, they might learn of such orders by other means and deny permits.
Sheriffs also decide whether to forward permit denials to the national database. North Carolina sheriffs have forwarded 319 mental-health-related denials since the database began in 1998, Aldridge told The News & Observer of Raleigh.
North Carolina is one of 22 states that report mental health information to the database, though it keeps involuntary commitments confidential.
Virginia has the most mental health-related entries in the database: about 80,000.
Ellis said North Carolina court clerks won’t provide the records unless the legislature grants them the authority to do so.
Glazier, a Fayetteville Democrat and former criminal defense lawyer, said he started researching the issue shortly after the Virginia Tech shootings.
“It’s pretty clear we’ve got reporting capacity issues,” Glazier said.
The issue may face a fight if it moves through the legislature.
F. Paul Valone, president of the gun rights organization Grass Roots North Carolina, said his group opposes removing confidentiality from involuntary commitment orders.
“The intention behind that legislation was to foment additional gun control in North Carolina, and we won’t tolerate that,” Valone said.
Mark Botts, an expert on mental health records and confidentiality at the University of North Carolina at Chapel Hill School of Government, said legislators have written exemptions into the law.
Sealed records relating to mental health treatment are also legally shared for child or elder-abuse investigations. They can be unsealed if considered in the public interest.
Botts said a similar exemption should be made for the gun database after the Virginia Tech shootings.
“I don’t think it has to be that polarizing,” he said.
Besides adjusting the reporting requirements, Glazier wants the legislature to give North Carolina’s 16-campus state university system more money for security.
The state House is preparing the state budget. For now, Glazier said, the system could get an extra $500,000. But he thinks that number will rise once the schools start reporting how they might use the money. Possible uses include police, security equipment and mental health services for the students, he said. Read more!
Posted by david at 5:18 AM Permalink
By Arthur Caplan/Guest columnist
It is not just guns. In all my life I never thought I would write those words after a massacre involving a mass murder with a gun. But a week's worth of intense media coverage of the heinous murders of students and faculty at Virginia Tech and analyses focusing on guns by innumerable experts has left me furious.
I don't think the expert wisdom is even close to understanding what must be done to try and prevent this type of tragedy in the future. It is not just guns. We need to fix a broken, abandoned and pathetic system of mental-health care.
In the same month that Seung-Hui Cho killed and injured scores of people at Virginia Tech, a researcher at the University of Washington was shot to death in her office by a former boyfriend, who then killed himself. Rebecca Griego had gotten a restraining order against Jonathan Rowan. When he showed up at her office he fired five shots into Rebecca. A colleague at the university said it was a "psycho from her past."
In Mandeville, La., a man who had just had a restraining order issued against him by his estranged wife allegedly ambushed her and their three children. Police say James Magee chased his wife's gray Toyota Scion for several blocks, ramming it repeatedly until the car crashed into a tree. As Adrienne Magee tried to get out of the vehicle, James Magee allegedly stepped out of the truck and shot her in the head with a 12-gauge shotgun loaded with buckshot, killing her instantly. He then opened fire on his children as they tried to flee the vehicle, killing his 5-year-old son and striking his 7-year-old daughter in the chest, according to police.
Magee had never gotten any help for previous violent outbursts.
And in Queens, New York, a man killed his mother, a wheelchair-bound man and a home health-care worker before shooting himself dead - just minutes after the mother called 911 pleading for help.
The mother's surviving sister blamed police for failing to protect her sister from the "mentally ill" son. "My sister was scared!" Annetta Taylor screamed. "She thought this might happen!"
Cops outside the house tried to calm her, but she continued. "I blame you!" she said. "She called and nobody would respond!"
The murdered mother, Sonia Taylor, had called police twice Monday during fights with her son Wade Dawkins.
The police had been called to the home eight times since last May. During an incident this past October, Taylor told police her son, a drug abuser with no rap sheet, was throwing things around the house and acting violently.
The police brought him to a local hospital for an evaluation. He was quickly sent back to her house.
All of these killings involved not just guns, all involved killers who might have benefited from mental-health treatment. None got the help they needed.
The Virginia Tech murderer was - to be blunt - totally crazy. He fit the dreary profile all too familiar from the shootings at Columbine High School near Denver and the Nickel Mines School in Amish country near Lancaster, Pa. Cho was an angry outcast, preoccupied with thoughts of violence against those whom he saw as bullying, victimizing or just plain ignoring him.
From the tapes he made of himself, it is obvious that he was in the grip of paranoia. He had profound social withdrawal, suicidal thinking, destructive fantasies and was a known stalker. He scared people. But he fell through the cracks of university bureaucracy and a hodgepodge mental-health system.
Report after report over the past decade have warned that most public mental-health systems have, to quote one, "all but disintegrated." Such systems, whether local, state or federal, are badly fragmented and ill-equipped to address our nation's mental health in a comprehensive manner.
States have been balancing their budgets on the backs of the mentally ill for years. A recent example is North Carolina, where 33 percent cuts in the state budget have been proposed. Advocates for the mentally ill there say that if the cuts hold, it means that in many towns the mental-health system will simply "collapse."
But you don't really need to read the reports or look at the budgets. Look out your window. Most of the homeless people wandering around America's cities are mentally ill. Try to get help for your anorexic daughter, alcoholic brother-in-law, suicidal spouse and see what happens.
See what happens if someone threatens or harasses you repeatedly in terms of a coordinated police and mental-health response.
Serving in Iraq or Afghanistan with post-traumatic stress disorder or another mental illness? Good luck. The military's mental-health system is overwhelmed and understaffed. The services available to our soldiers' families are just as bad.
I don't buy the line that says "guns don't kill people, people kill people." I think there are too many guns with too much firepower that are too readily available. When the damaged and the deranged amongst us go undiagnosed and untreated in a world of guns, then fatalities result. The guns are not going anywhere. Politically, we lack the will to do anything about that problem.
But that is not the whole problem. It is time to start repairing a mental-health system that serves too few, costs too much, protects too little and cannot even find the means to help those who clearly are in desperate need. Maybe after Virginia Tech we can at least find the will to do that much.
Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania. Read more!
Posted by david at 5:15 AM Permalink
By Bill McKelway and Michael Hardy
On Dec. 9, 2005, Leroy R. Hassell Sr., the chief justice of the state Supreme Court, hunkered down during a snowstorm in Richmond with 250 lawyers, mental-health advocates, state officials, sheriffs, caregivers and others to sort through problems with the state's strained mental-health system.
Hassell spoke of concerns he has about the treatment Virginia offers and challenged his listeners to transform the judicial process available "to those Virginians who are least able to care for and help themselves."
Four days later, a suicidal, morose student at Virginia Tech named Seung-Hui Cho became part of the very process that Hassell sought to change. Cho's 22nd birthday was just over a month away.
In a cheerless hearing room at a psychiatric hospital near Radford, Cho was ordered detained and the next day, Dec. 14, was released for outpatient treatment. The release came despite findings by a special justice that he was mentally ill and a danger to himself.
There is no public record of Cho ever receiving help. Nor do court records show whether he complied with unspecified terms of court-ordered treatment; a tape-recording of the hearing is sealed; Virginia Tech officials refuse to discuss whether Cho was referred to their counselors. There is no provision in state law that required a re-evaluation of Cho by the judge who released him.
On April 16, 16 months after Cho's release and Hassell's speech, a commission assembled by the chief justice was still struggling over how to bring more consistency and fairness to Virginia commitment laws and to its system of care for the mentally ill.
And on the Virginia Tech campus that day, Cho erupted from his reclusive shell to shoot to death 27 students and five teachers. He then killed himself, ending a shooting episode unparalleled in U.S. history.
Beyond the grief, the shootings have given a new importance to Hassell's, and now the governor's, promise to assess mental-health laws, even as some lawmakers express reservations about rushing to judgment based on one notorious rampage.
This week, the first changes are expected to be announced by Virginia Gov. Timothy M. Kaine. He promised last week to close loopholes in Virginia weapons laws that allow gun sales to mentally ill people, such as Cho, who have been ruled dangerous but have not been committed to a mental facility. Federal law specifically bars gun sales to mentally ill people.
The loophole, first disclosed by The Times-Dispatch in the days following the shootings, has stunned even the most ardent backers of the Second Amendment. The National Rifle Association, for instance, emphasized it has opposed the sale of guns to the mentally ill for more than three decades.
Mental-health issues and challenges will dominate the proceedings of the independent eight-member commission of experts the governor appointed to review the Tech massacre.
Kaine predicted that its findings could jump-start legislative action to increase funding for mental-health services in Virginia. The state ranks low nationally in providing dollars, especially in community-based settings.
"We can do better on the mental-health side," the governor said.
. . .
An overhaul of Virginia's mental-health laws has been sought for decades, especially in response to the de-institutionalization movement that has shifted care of the mentally ill from sprawling state hospitals to communities.
Virginia, the first state to create a hospital exclusively for the mentally ill in 1769, has been among the slowest to empty them. Virginia still has a higher percentage of institutionalized mental patients than most other states. According to a national association of mental-health professionals, Virginia ranks ninth nationally on in-patient spending and 38th nationally on outpatient spending.
Even so, facilities offering care in local communities are strapped for money and staff, critical emergency care and hospital beds reserved for mental patients are lacking, and funds are focused on the most severely impaired. Virginia law reserves public care in most cases to mentally ill patients who must establish that they are a danger to themselves or others, a high threshold for care shared by only two other states, according to mental-health advocates in Virginia.
"You get help only when it's too late. You can wait weeks for even an appointment," said Hanover County resident Kathy Harkey, who lost her severely depressed adult son to suicide. She had gained access to care for him on some occasions only by lying that he had threatened her.
Mental-health advocates welcomed the focus on mental health in Richmond.
"A state as rich as Virginia needs to increase funding for community-based services," said Bill Farrington, president of the National Alliance on Mental Illness in Virginia.
He blamed the lack of interest on many lawmakers who pay attention to mental health only in times of crisis or scandal.
"In addition, some don't care and don't understand mental-health issues -- interest is low," Farrington said.
The organization gave the commonwealth a D in 2006 for its performance, pointing out that the state ranks 30th nationally in per-capita spending at $68.54. The District of Columbia spends $414 per capita.
The state Department of Mental Health, Mental Retardation and Substance Abuse Services has a budget of $849 million this year. Next year it is to jump to $870 million.
While praising the state's renewed focus, Farrington declared: "The negative is funding. We're always behind the curve." He agreed that there should be monitoring of court-ordered outpatient treatment. "There's no monitoring in the system now."
Del. Clarke N. Hogan, R-Halifax, a budget writer in the House, has been increasingly active in mental-health issues in recent years and is sympathetic to the needs of families and patients.
"There will be a huge push by some quarters saying double the funding," Hogan said. "But while there will be a huge push politically to do something now, it's unlikely that quick, reflexive moves will solve this problem."
It will require an extensive examination of the delivery of services, he said. Despite the demand for immediate action to protect public safety, it's not amenable to a quick fix.
"If you're not very careful, you won't solve the problems," Hogan said. "We'll be looking at the role of community service boards and how good a job community-based care is serving the public."
Hogan said he's pleased that there will be greater focus and debate about the mental-health system. "I think we have made some improvements, and it didn't take a crisis to do that," he said.
. . .
Any zeal for immediate reform must be tempered by court decisions protecting the legal rights of the mentally ill.
"Let's give the governor credit where credit is due for setting up the panel," said Del. William R. Janis, R-Henrico. "Its recommendation will carry a lot of weight."
"But there's a tension here between civil liberties and medical issues," he said. In other words: It requires a balancing of the public's right to security versus the constitutional rights, privacy and treatment needs of the mentally disabled, he said.
Speaking from her Blacksburg home last week, Terry Grimes, who has a mental illness, said the Virginia Tech shootings so close to her home could create further chaos.
"My fear is that there will be an overreaction, a belief that every mentally ill person represents a threat to become some sort of monster," she said. "The move to create new laws mandating treatment and medications could be a disaster. I can't help feeling like the government will be looking over my shoulder every minute, ready to act if I don't follow some court order."
Grimes, who once joked that a psychologist had determined she was "apparently recovered," is a member of the Hassell Commission studying mental-health reform.
She is determined to preserve the civil liberties of the mentally ill in the face of efforts to mandate care on an involuntary, outpatient basis.
"Services need to be people-driven, not rule- or law-driven or judicially ordered," she has written. "Most of all, the tremendous diversity, uniqueness, and potential of individuals with psychiatric challenges need to be recognized and fostered."
Court-ordered medications, for instance, can lead to sleeplessness, weight gains, a loss of sexual desire and a likelihood of diabetes, she said, noting that the patient's voice can be lost in systems of mandated care.
. . .
"Virginia needs to come to a decision about what sort of mental-health care system it wants to have and how to pay for it," said Mary Ann Bergeron, executive director of the Virginia Association of Community Service Boards, the regional agencies that provide most mental-health care in Virginia.
In legislative meetings last fall, Bergeron argued that passing laws increasing demands to provide broader community services to a broader slice of the mentally ill community must be backed with money; longtime mental-health advocate L. William Yelverton told legislators that "without vastly increased funding, outpatient commitment . . . is a charade."
Special justices involved in commitment proceedings said last week that Virginia's laws fail to address some elements of care and that outpatient treatment orders have little teeth.
One justice, who said his position precludes him from being identified, said that the shortage of available community services makes outpatient treatment orders impractical; and there are not sufficient laws on the books to force consumers to adhere to court-ordered outpatient treatment.
"What can I do with a person for violating my order?" he said. "If I can't find that the person is again an imminent threat, all I can do is send him to jail or fine him for contempt."
Such an outcome merely serves to force them into local jails, which are fast becoming the new warehouses for the mentally ill.
The thought was shared by Hassell in his speech calling for reform. He noted that 15 percent of Virginia's prisoners have some form of mental illness.
"The unintended consequence of de-institutionalization has left jail superintendents and sheriffs lamenting their newfound responsibility of housing the mentally ill," he said, "because sheriffs and jail superintendents lack the expertise and resources to do so effectively."
Contact staff writer Bill McKelway at email@example.com or (804) 649-6601.
Contact staff writer Michael Hardy at firstname.lastname@example.org or (804) 649-6810.
Posted by david at 5:13 AM Permalink
Saturday, April 28, 2007
The untold part of mental health reform is that Secretary Carmen Hooker Odom of the Department of Health and Human Services, and officials in the department, continually ignored warnings that glaring problems would doom the system.
As early as 2005, advocates, providers and local mental health leaders identified serious concerns:
1) the possibility that unscrupulous providers would abuse the system by using unqualified individuals to deliver services;
2) the financial burden the new rates would have on North Carolina;
3) the fact that on March 20, 2006, there were not enough services and providers in the community as adequate time had not been given to train staff and properly develop and implement the new services.
Time and again, DHHS officials were encouraged to conduct pilot studies prior to full implementation in order to avoid catastrophic problems. Clearly, the major villains in this saga are Odom and other top-level officials. Cheating providers are minor actors by comparison.
I have requested that the governor assign a neutral third party to investigate the failure of the mental health system and hold those responsible for this failure accountable. Because consumers are losing services, time is of the essence
Frank H. Edwards
President, NAMI Wake County
Raleigh Read more!
Posted by david at 7:54 PM Permalink