Thursday, November 10, 2011

NAMI Report:"State Mental Health Cuts: The Continuing Crisis"

NAMI North Carolina
Press Release
November 10, 2011
NAMI Report:"State Mental Health Cuts: The Continuing Crisis"

Contact: Jennifer Rothman, 919.788.0801 / 800.451.9681,

NAMI Report Shows NC Avoided Deep Cuts to Mental Health Funding
NAMI North Carolina Calls on State Leaders & Congressional Delegation to Protect Mental Health from Further Spending Cuts, Including 'Super Committee' Deficit Reduction

RALEIGH, N.C. (Nov. 10, 2011) - The National Alliance on Mental Illness (NAMI) North Carolina today announced that North Carolina ranks 24th among all states in terms of mental health care budget cuts made between fiscal years 2009 and 2012, according to a national report issued today by NAMI. In light of this new report, NAMI North Carolina urges the General Assembly and members of Congress to continue protecting North Carolinians living with mental illness from additional spending cuts, which will only exacerbate challenges to the mental health system.

"North Carolina's mental health system is at a crossroads," said NAMI North Carolina Executive Director Deby Dihoff. "While state leaders in North Carolina have worked hard to minimize cuts to mental health, the budget battles are far from over. We know that any further cuts will endanger our state hospitals and our community mental health system, which have both undergone tremendous turmoil and upheaval in recent years. We need a time of stability for the managed care approach to take hold and strengthen our system."

"North Carolinians need to contact members of Congress and state legislators to ask that mental health care be strengthened in the upcoming budget and protected from any cuts aimed at deficit reduction," continued Dihoff. "North Carolina's mental health care system is already at a breaking point, and if the congressional 'Super Committee' recommends further Medicaid or Medicare cuts this month, additional pressures will come into play. We can't balance the budget by compromising health care for our state's most vulnerable citizens."

According to the new NAMI report, "State Mental Health Cuts: The Continuing Crisis," North Carolina cut $7.3 million from state mental health care between fiscal years 2009 and 2012-a decrease of 1.2 percent. While the state made serious cuts to mental health spending, $48.2 million between fiscal years 2011 and 2012, the numbers don't tell the whole story. $45 million of those cuts were directed to the Local Management Entities, which were directed to take these one-time cuts largely out of their fund balances. Leaders in North Carolina made an effort to ensure that these cuts did not, in large part, affect service delivery. But North Carolina would like to join the majority of states, which increased their funding to mental health in the period from 2011-2012.

According to the NAMI report, during this same four-year period between fiscal years 2009 and 2012, South Carolina had the highest cuts totaling 39.3 percent of its budget, while North Dakota actually increased its mental health care spending by 48.l percent. See the report for full state-by-state data.

The NAMI report also outlines Medicaid pressures that threaten mental health care nationwide. Following the June 2011 loss of "enhanced" federal Medicaid matching funds that were part of economic stimulus legislation, states have had to fill the shortfall. North Carolina experienced an estimated loss of $343 million in enhanced funding. North Carolina's Medicaid program is now facing a nearly $140 million shortfall.

"We need to protect state and federal Medicaid revenues budgeted for mental health because for every dollar the state puts in, we receive two dollars from the federal government," continued Dihoff. "A recent report by the North Carolina Budget and Tax Center noted that if federal matching dollars are lost, it will cost North Carolina more than 13,000 jobs, and $613 million in labor income. State Medicaid funding means better health care for those with disabilities and a better economy."

NAMI North Carolina has developed a Public Policy Agenda outlining mental health priorities to guide state and federal policymakers as they make budget recommendations and consider funding allocations for mental health. NAMI North Carolina supports priorities that promote sustainable stability for North Carolinians living with mental illness such as additional community hospital beds and housing. To read the NAMI North Carolina Public Policy Agenda, click HERE.

The National Alliance on Mental Illness (NAMI) North Carolina is a grassroots non-profit organization providing support, education and advocacy for people living with mental illnesses and their families and friends. We are governed by a Board of Directors elected by membership and are 501(c)(3) accredited. NAMI NC is a part of NAMI which has over 210,000 members in 1,200 affiliates across the country. For more information, please visit

Thompson: Infant mortality rate threatened

The Daily Reflector
Greenville, NC

In a rare breath of good news, the governor’s office announced last week that North Carolina’s infant mortality rate in 2010 was the lowest in the state’s history. Fewer families endured the indescribable pain of losing a young child, a significant accomplishment for a state with a very poor track record preventing infant deaths. Unfortunately, the budget passed by state legislators last summer will likely undermine progress, particularly for eastern North Carolina and African-American families.
In 1988, North Carolina had the worst infant mortality rate in the country. Prodded by the shame of such a distinction, Republican Gov. Jim Martin and the Democratic state Legislature teamed up to implement a variety of public health programs to improve health outcomes for pregnant women and young children.
North Carolina’s infant mortality rate is now much closer to the middle of the pack in relation to the other 49 states.
The news, however, is not all good. African-American infants are still more than twice as likely to die as white babies, and eastern North Carolina counties suffer from disproportionately high mortality rates. This disparity will likely be exacerbated by the recent decisions of state legislators, who cut not only specific infant mortality prevention programs, but also broader health services for women and children.
Of specific importance to Greenville is the East Carolina University High-Risk Clinic, which serves as a regional hub for the treatment and support of high-risk pregnancies. In 2011, the Legislature chose not to renew the grant for the clinic.The elimination of state funding has led to the closure of two outreach clinics, the loss of key staff including the head nurse, and the doubling of wait times for patients. Since the success of prenatal services depends on providing the right care, at the right time and at the right place, these reductions in capacity and services will have a detrimental impact on infant mortality in the eastern part of the state.
Furthermore, the decision to cut the ECU High-Risk Clinic was penny-wise and pound-foolish. Just one pre-term birth is more expensive than the entire state allocation for the clinic, which was $325,000, a relatively small amount in a $19.7 billion budget. The cost of these preventable pre-term births will largely be shifted to the state’s Medicaid program, which was cut more than $350 million.
The Legislature’s budget decisions become even more troubling when the problem of infant mortality is viewed with an appropriately broad lens. After all, the infant mortality rate is a broad indicator of women’s and children’s health across the state.
In addition to prior pre-term births, diabetes and pre-existing health conditions are some of the major factors that lead to a high infant mortality rate. That’s why deep cuts to our state’s Medicaid program and the elimination of the Health and Wellness Trust Fund will have such a substantial impact on the infant mortality rate, especially in eastern North Carolina where rates of diabetes and obesity are already high.
We can do better. Gov. Martin, a Republican, and the Democratic legislature of 1988 showed that the two political parties can come together and prioritize the health and safety of North Carolina’s children. With the legislature back in session this week and again after Thanksgiving, it’s a perfect time for North Carolina’s current crop of elected officials to follow their example, put children first and fully fund the ECU High-Risk Clinic.

Rob Thompson is executive director of the Covenant with North Carolina’s Children, a coalition advocating policy that benefits children and families in North Carolina.

Sunday, November 6, 2011

Mental health services start fresh

by Kellen Moore

Tuesday was a fresh start for mental health services in Watauga County, as Daymark Recovery Services opened its doors at the sites of the former New River Behavioral HealthCare.

And on day 1, Daymark CEO Billy West had one message for clients and the community: “Bear with us.”

Although hundreds of details large and small were still being finalized even as business started Tuesday, Daymark staff reported a fairly calm transition.

“I think we're able to handle a lot of complicated things very well,” said Murray Hawkinson, site director for Watauga County.

Watauga County commissioners agreed Tuesday morning to lease former New River office space in the Human Services Building on the Poplar Grove Connector Road to Daymark for $5 per square foot per year.

With 13,775 square feet of space being used, Daymark will pay $5,739 per month in rent as well as $5,643 per month in janitorial and operating expenses, County Manager Deron Geouque said.

The rent is far below the fair market value of $10 to $12, but the board agreed to the reduced rate to minimize any disruption of services. The lease runs through June 30, 2012, and will be renegotiated then.

The rate is higher than the $3 per square foot that other members of the New River Service Authority board agreed to offer last week.

Inside the leased space, a skeleton crew was already operating Tuesday.

About half of the newly hired Daymark employees are attending orientation sessions Tuesday and Wednesday, and the other half will attend Thursday and Friday, West said.

The organization is still working to hire more physicians, and West said he did not know the exact number of employees that were in place as of Tuesday but was certain it was enough to keep the offices functioning.

In addition to staffing and space considerations, Daymark has been working to ensure that information technology systems are in place.

Computer systems and data lines are also being installed this week in the offices, West said, and Daymark also has had to purchase a new server to handle the data.

In a perfect transition, those data lines would have been connected and tested a month before the service provider opened, but Daymark didn't have that luxury, West said.

Telephone crisis lines are also continuing to function, although they may still refer to “New River Behavioral Healthcare” in automated messages for a while, West said.

West said all crisis employees have been instructed to continue as they have been until Daymark can address the crisis lines and services.

In Watauga County, 911 dispatchers had been answering New River's crisis lines after hours and connecting callers to the New River staff member on call, but Sheriff Len Hagaman told commissioners Tuesday he would like that system to end.

Commissioners agreed that the sheriff's office should continue answering the lines for the time being and directed Geouque to work with Daymark to find a new agreement.

With so many technology needs, Smoky Mountain Center has agreed to reimburse Daymark up to $370,000 to assist with the technology startup process, Smoky Mountain CEO Brian Ingraham said last week.

Although Daymark is covering the rest of its own significant startup costs at this point, West said he had “no problems” with the amount Smoky Mountain Center has provided to the organization.


While Daymark will provide the bulk of mental health services in the community, Smoky Mountain Center has also selected two other service providers to handle court-referred juvenile services and case management for people with intellectual or developmental disabilities.

True Behavioral Healthcare, based in Gastonia, hired 11 or 12 former New River staff members to start work Tuesday providing intellectual/developmental disability services.

In Boone, those employees are currently in the same space with Daymark employees until office space is arranged, True Behavioral CEO Carla Balestra said.

When IDD programs are up and running, True Behavioral plans to serve about 200 to 250 clients with an array of services, Balestra said.

Youth Villages is a national organization formed in Memphis, Tenn., in 1986 that will provide services to youth offenders and their families referred through the court system.

Sonja Luecke, a spokeswoman for Youth Villages, said the organization plans to begin helping youth by next week and started meeting some juveniles last week to assess their needs. Youth Villages does not yet have office space in Boone, but Smoky Mountain Center and the court are lending office space right now to conduct assessments, she said.

West said he was shocked to learn that Smoky Mountain Center would not select Daymark for the juvenile referral services and disappointed, as those enhanced services typically bring in revenue unlike many other mental health programs.

“What I told my staff was simply this: Am I surprised? Yes. Is this going to be the last thing that happens? No,” West said, adding that he felt there was too much to do to worry long about losing that solid source of revenue.

Luecke said court-involved youth and families can decide whether to follow their therapists to Daymark or use Youth Villages.

With dozens of decisions being made quickly and revenue streams still unknown, West said he is focused on ensuring that Daymark will not meet the same fate as New River.

“At the end of the year, we will have a system that may not be what you had yesterday, but it will be a system that will be sustained, and you will get a professional service for the long haul,” West said.

Durham-Wake Merger Would Create NC's Largest MCO

November 4, 2011

Durham, NC - A proposed merger between the Local Management Entities (LMEs) of Durham County and Wake County would create the state's largest Managed Care Organization (MCO) for public behavioral health and disability services based on population.

The Durham Center was selected by the NC Department of Health and Human Services to operate as an MCO under Medicaid 1915 (b)/(c) waivers effective January 1, 2013, serving Durham, Cumberland and Johnston counties. A merged Durham-Wake LME serving a four-county region including Wake would encompass a population of almost 1,690,000 residents.
A proposed merger agreement has been created and if approved by both parties, the merger would become effective July 1, 2012. The merged LME would begin managed care operations six months later. Durham County Commissioners will discuss the proposal on Monday, November 7 at their 9:00am regular work session.

The merged LME would be comprised of leadership and staff of both organizations with Ellen Holliman, currently Area Director of The Durham Center, serving as CEO. It would also have a new name and branding. Offices would be centrally located with satellite offices in both counties.

LME and other county government leadership from Durham and Wake have been engaged in discussions over the past year about how the two organizations could work together in some capacity. Significant similarities make The Durham Center and the Wake County LME logical partners for merger, with benefits anticipated for citizens, consumers, providers and taxpayers.

These include shared organizational values and missions and proven historical commitments to system of care philosophies and the use of evidence-based practices. The geographical proximity and similar urban compositions of the two counties create potential for pooling resources to address common challenges that can cause behavioral health costs to explode. Leadership and staffs of the two organizations have significant familiarity and existing working relationships with each other. In addition, there is major overlap of provider agencies serving consumers of both counties who frequently cross county lines.

"We are excited about the prospect of teaming with our colleagues in Wake County to help ensure that our citizens as well as those from Cumberland and Johnston counties receive the innovative, high-quality, recovery-focused behavioral health and disability services that result in positive outcomes," said Holliman. "We believe that all of our constituencies will benefit from the strength and viability that will result from the combined expertise and resources of the Durham and Wake LMEs."

For more information, contact Doug Fuller, director of Communications for The Durham Center at 919 560-7206.

Déjà vu in the world of mental health- NC Policy Watch

More than a decade ago, North Carolina’s system for providing services to individuals with mental health needs, developmental disabilities and addictive disease was deeply troubled. Allegations of fraud, mismanagement and conflicted governance signaled poor accountability mechanisms.

In response, the General Assembly directed the state Auditor to investigate the situation. In April 2000, the Auditor issued a report identifying two overarching problems: over-reliance on state institutions and lack of accountability among the local area programs responsible for providing community-based services. The findings also documented North Carolina’s failure to comply with the Americans with Disabilities Act’s “integration mandate.”

The report triggered massive changes to state law designed to reform the service system. The changes included a planned reduction of the number of state hospital beds – closing Dorothea Dix Hospital in Raleigh and replacing the derelict facilities in Goldsboro, Morganton and Butner with new buildings. The semi-autonomous governmental “area programs” created to provide direct services were replaced with county-operated systems or “Local Management Entities” (LMEs), acting under long-term contracts with the State to manage services.

Now fast-forward to 2011 to experience a profound sense of déjà vu. The State still relies on institutional-based care, but now in so-called “adult care homes.” Meanwhile, it has failed to develop adequate community-based services. The system responsible for providing services is again in trouble. Allegations of fraud, mismanagement, and conflicted governance again signal poor accountability mechanisms. To make matters even worse, the latest round of systemic failures are compounded by the State’s severe revenue deficiencies.

Again, the General Assembly has intervened. This time, the legislature has passed a law that mandates the conversion of all “Local Management Entities” into “Managed Care Organizations.” Essentially, the state is demanding radical statewide transformation based on an unproven model used by one very small LME called Piedmont Behavioral Healthcare. The state Department of Health and Human Services is being required to standardize and replicate Piedmont’s practices and processes for providing services across the entire state. This is a bit like the tail wagging the dog.

Unfortunately, this change raises several red flags for other reasons as well. Most notably, Piedmont’s practices include a pattern of violations of individuals’ constitutional due process rights and a disregard of judicial and administrative authority. Indeed, the organization I lead, Disability Rights NC, has filed two federal lawsuits challenging the Piedmont model – one of which (KC v. Cansler) challenges the lack of due process as guaranteed by the 14th Amendment and other federal requirements.

There are other problems with this managed care model.

Under the new law, the same organization (the MCO) is responsible for making requests for services and for approving and/or denying those services. This creates an inherent conflict of interest because it pits the need to save money against the needs and bests interests of the consumer – a problem that Piedmont has already been guilty of in multiple instances.

Yet another controversy surrounds a requirement that the new MCOs contract with Piedmont to obtain its business practices and processes. Remarkably, the contract actually contains a “non-disclosure” clause that would, in effect, keep the processes and practices hidden from the public eye. This is a huge problem because MCOs are not private entities but quasi-public entities serving the public interest with public money. Moreover, they’re linked to county governments subject to the state public records laws.

While the state and Piedmont claim the secrecy provisions are necessary to protect “intellectual property,” as a practical matter, such provisions will allow Piedmont and other newly-created MCOs to operate without real public oversight. This is especially true in light of Piedmont’s expansive view that it can refuse almost every request for information – including those with respect to how resources allocations are made, the standards by which providers are evaluated, and many others. This, of course begs the question: If the Piedmont model works so well, then why the secrecy? Why the lack of due process? And without transparency, how can there be public accountability?

In short, it appears that, once again, state leaders have failed to learn from past mistakes and in so doing continue to fail vulnerable populations. Let’s hope that it doesn’t take another decade for them to correct this latest mistake.

Vicki Smith is the Executive Director of Disability Rights North Carolina.