Monday, April 28, 2008

Candidates Answer MH Questions

Survey Answers on Mental Health Questions By The Associated Press Posted:
Apr. 25, 2008
Here are three questions posed by The Associated Press to the eight major-party candidates for governor on the topic of mental health, followed by their unabridged responses. The responses were edited for AP style:

1. In 2001, lawmakers began to overhaul the state's mental health treatment system by shifting more patients from institutional care to community-based treatment by private doctors and services. The reforms have stalled and are widely regarded by critics and advocates of the mentally ill as a failure. As governor, what will you do in your first two years in office to improve the state's mental health care system?

2. Do you support a law - as proposed by a campus safety task force led by Attorney General Roy Cooper - to bar handgun sales to people who have been involuntarily committed to mental hospitals?

When reading The News & Observer's series on mental health I was struck by Professor Joseph Morrissey's summary of the problem: "Solving these systemic problems will require the capacity to analyze proposed solutions, check out their costs and benefits in advance, monitor policy and program implementation, and assess outcomes on an ongoing basis. No multibillion-dollar enterprise in corporate America operates without this type of intelligence function."
As the only candidate for governor that has run two state agencies, I am very familiar with the challenges of operating vast bureaucracies with silo-funding streams and have experience in breaking down those barriers to change and improvement. I will bring a decade of public managerial experience to bear on our mental health system.
First, I will finish any of the outstanding initiatives Secretary Benton began, but remain incomplete, in order to ensure a smooth transition. This includes gaining approval from Centers for Medicaid and Medicare Services to end the blended payment rates. My budget will include funding for an internal inspection team to ensure we do not forfeit millions in Medicaid/Medicare payments because our hospitals are not in compliance with federal rules. And I will ensure we are filling key positions related to our mental health system with the most highly qualified individuals by offering sufficient salaries to attract them.
Concurrently, I will begin my own improvements starting in our institutions. I will develop an interagency team that will be dispatched immediately to investigate all deaths that occur in our mental hospitals. The team will include investigative personnel from the Department of Crime Control and Public Safety and will be required to file timely reports with the hospital, the DHHS Secretary, the medical examiner/pathologists, and the family. It will also be forwarded to the district attorney if there is any suspicion of wrong doing by anyone in the facility.
Second, to increase the quality of care our patients are receiving in state hospitals, we will seek to institute a career ladder of sorts for the medical and patient technicians working directly with patients in our hospitals. To advance on the ladder and earn a higher salary, the staff will achieve more advanced levels of certification. We will ask the community colleges, universities, and medical hospitals to design continuing education courses that will be offered during the work day. Much like we have done in our schools and in child care, we will raise the wages of our employees by raising the quality of care they provide.
Because more than 20 percent of the patients admitted to our mental hospitals last year were dependent on alcohol or drugs and because our psychiatric hospitals admitted more drug addicts than schizophrenics last year, I will commit more resources to substance abuse treatment programs.
As governor I will seek to further our knowledge base on mental health issues and develop improvements by working with our research institutions to convene regular task forces of experts to study these complex mental health issues and develop workable solutions on an ongoing basis. Currently, Secretary Benton has a number of working groups meeting regularly to develop solutions, but I want to institutionalize the dialogue and grow the state's knowledge base on mental health issues.
From those groups we will 1) seek to create meaningful, clear objective criteria for the local management entities, 2) design effective clinical and fiscal competencies with incentives for those exceeding the criteria and penalties for those who fail, 3) develop standard protocols for mental health care to ensure consistency of treatment between providers, 4) develop a system of statewide case management through health care community networks, or a "medical home" system and 5) develop a funding mechanism to ensure our low wealth counties have the resources they need to attract high quality providers so all patients can have access to high quality care.

1. We must first define the exact problem and then work towards real solutions. Hoping will not work we need real definitions of problems and then together set real goals and milestones to implement the fixes. This is a complex issue and one that requires strong leadership to define and fix. We also need to separate those that need help; citizens with mental illnesses, disabilities and those with substance abuse need different programs, we must do away with a one size fits all approach.
2. Handgun sales: I don't like a law that is so broad so I would have to see the actual legislation to see if I would or would not support it.

We need to get serious about the goal of quality health care for all North Carolinians - and that must include mental health care.
My background in health care tells me that it makes no sense to separate mental from physical health care. The best research confirms that many patients have mixed mental and physical health issues. Thus I am proud that my plans for expanding health care coverage to all children and more low-wage working parents have been praised by such leading advocates as Adam Searing of the North Carolina Health Access Coalition for containing "the most significant changes in health care access in North Carolina in, quite literally, decades." To read more, go to
As North Carolina's next governor, I also want to establish the national model for an integrated approach to behavioral and primary health services for patients with mental health, development disability, and substance abuse problems. It will be one of my top goals to break down the barriers to the coordination of mental and physical health care.
North Carolina's Medicaid program has recently moved to the forefront in emphasizing the importance of a "medical home" for the primary care of adults and children. Our Community Care of North Carolina has developed a very cost-effective and quality-driven model of statewide case management through health care community networks. We need to extend this kind of collaboration and community network to the delivery of mental health services.
In my view, the concept of a medical home should play a major role in helping to revitalize our badly tattered mental health system within and outside of Medicaid. Patients with severe mental illness need the security of a medical home as well as strong inpatient professional service. We should also strive to define a basic level of mental health services to which needy patients should have access.
Recent events have made us all too painfully aware of what can happen to those who fall through the gaping holes in our mental health care system. While in the long-term my focus is on closing those holes, it would be irresponsible not to take what steps we can in the short-term to avert tragedy. The Campus Safety Task Force led by Attorney General Cooper has proposed a law to bar handgun sales to people involuntarily committed to mental hospitals. We should take such a sensible step in the interests of the safety of our students and of our communities.
I know that improving our mental health system is easier said than done. Yet we cannot stop until we have a system where the local and state levels work in a coordinated fashion to assure access to appropriate services for all North Carolinians. We will need to adopt a disciplined approach with lots of two-way learning between government officials and the mental health community.
That will require sound leadership and coordination throughout state government. We need stability, a shared vision, and a focus on quality outcomes for all those who depend on our mental health, developmental disability, and substance abuse services. I will be the kind of dedicated, hands-on governor who can provide this needed leadership on health care generally and mental health in particular.


. The first step I will take is to bring all interested parties involved to the table to discuss the failure of our current system as well as any successes. We have some of our nation's premier experts on mental health in our state, yet we have failed to use them. Our mental health professionals understand what needs to be done, we need a governor who will listen to them. I would immediately increase funding for our mental hospitals and for other programs that offer treatment to those who are considered high risk or critical.
After the initial steps, I will work with our mental health professionals and experts to devise a plan that will meet the needs of our mentally ill citizens. We will begin with pilot programs so that we can quickly identify any problems. Once I am satisfied that we have a workable system that will fully meet our needs, I will then launch the new mental health system statewide.
2. Yes. ---

1. It is no secret that North Carolina has people who suffer some form of mental illness and need state help. It is also no secret that the last eight years have seen escalating waste, fraud, institutional ineptitude, bureaucratic bungling, and now, finger pointing as to who is to blame for this sorry state of affairs. Responsibility for mental health care falls under the broad mandate of the governor and his secretary of Health and Human Services. Now the governor is trying to "pass the buck" to the Legislature, which approved privatizing many mental health care services without, apparently, having appropriate service levels defined and without having clear guidelines of responsibility and supervision in place. Such lapses could explain other puzzling proposals as the one recently where HHS planned to close two mental health hospitals without having enough beds in place to replace them.
Parceling out treatments to private sector facilities located closer to the patients themselves makes sense. The existing plan needs considerable redrafting in terms of quality, costs, patient care, oversight, and state follow up but can be salvaged. The new governor first needs to take responsibility for fixing the problem and actually begin fixing it ... putting policies and procedures in place to make sure the patients who are depending on the state for help get the help they need. Those actions will be my starting point for mental health reform. The governor's office is responsible and accountable for mental health in North Carolina. If the legislature is making that job harder, the governor needs to let us know and then he needs to step up to the plate and do his job.
2. Yes. ---

1. We must have leadership, the right concept of care, the appropriate resources, and a rigorous oversight process. Administration officials have admitted that they have been aware of the problems in mental health, yet have taken no action to fix them. The next governor must be ready to take on the challenge of addressing our broken mental health care system from the first day in office. Among the reforms needed, we must determine where privatization is a viable business model, implement a fair and efficient reimbursement process that pays for actual care, fully fund the Mental Health Trust Fund, and ensure that the state has a secure, long term supply of mental health care providers. Please visit my web site at for my full proposal.
2. Yes. ---

. Apparently, lawmakers may not have the best answers or solutions. I will replace some agency directors with knowledgeable and efficient people in their proper fields, removing ones placed by favoritism or the buddy-buddy system. Who are these inefficient agency directors? To find out, I go down the ladder in each department to the working people. The following statement from an individual who is a worker within the mental health system. "The state passed the buck to private providers. Now the private providers are collecting money for services that they are not necessarily providing. Also, they appear as they don't care about the individual. All they are worried about is collecting the money. The dollar has become what's important. Also there are approximately 800 private providers now that are fighting to offer services. Another issue that concerns me is that we have had individuals that have worked on their own for years, now all of a sudden they need a one on one worker. What this means is the facility draws down huge dollars for this individual to have a baby sitter for several hours a day."
2. Definitely, yes on this question unless a unique situation reveals it to show otherwise. ---

1. It is important that we move forward with reform that creates a structure of clarity, certainty, and confidence, providing appropriate leadership and a plan that more clearly identifies the roles and responsibilities of the State, the Local Management Entities (LME's), and the care providers. To accomplish this we must:
- place clear responsibility on the state for providing care for the long-term and more difficult chronic cases of mental illness and disabilities that cannot be appropriately served in the community and require the expertise and services provided through our state psychiatric hospitals and facilities for the developmentally disabled.
- develop the community capacity for short-term acute psychiatric care by working with our LME's, community hospitals, and other providers to establish and reinforce our abilities to serve consumers in crisis, providing a hub around which to build community services while reducing dependency on the State's psychiatric hospitals.
- develop the community capacity to provide individuals with mental illness, developmental disabilities, and substance abuse with appropriate ongoing assistance and services necessary to provide the greatest opportunity to live a productive and quality life.
Building a strong system of community based mental health services is not going to happen as a result of increased and constantly changing state rules and regulations coupled with poorly developed and sometimes inadequate provider reimbursement policies. Building community access and choice is going to require leadership focused on understanding the needs and identifying and addressing the barriers to success. This requires a willingness and devotion to working closely with our community hospitals and other care providers, the LME's and local governments, consumers, families, and advocates to find solutions.
2. Yes.

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