Countdown to Election Day- NASW-NC PACE Endorsement List for 2008
Your NASW political action committee (NC PACE) has carefully reviewed the candidates for office in North Carolina’s council of state races (Governor, Lt. Governor, Attorney General, Secretary of State, etc) and races for NC House and Senate. NASW staff has gathered information from candidates via questionnaire and occasionally through interviews. Finally we evaluate candidates through their voting records and through information from sister organizations who have also made endorsements and gathered information on candidates.
You will note that we do not endorse candidates in each House and Senate race, as there are times we choose not to endorse or do not have adequate information to comfortably support a candidate.A reminder that the political action committee is established under state law and as such is separate from NASW. We are non-partisan and endorse based on the performance of candidates relative to the general legislative agenda of NASW-NC.
Sometimes we endorse candidates who are friendly to us on only one or two issues but we know that they do not have significant electoral opposition. The NASW-NC Board appoints all PAC board members.Note that National NASW endorses candidates for federal office (President, US House and Senate).We invite your questions and feedback. naswncadvocacy@naswnc.org
NASW-NC list of endorsed candidates:
Governor: Beverly Perdue
District Court Judge District 18: Angela Foster
Lt. Governor: Walter Dalton
District Court Judge District 18: Polly D. Sizemore
Treasurer: Janet Cowell
District Court Judge District 21: Amy Allred
Secretary of State: Elaine Marshall
District Court Judge District 26: John Totten
Attorney General: Roy Cooper
House Dist 3: Alice Graham Underhill
Commissioner of Insurance: Wayne Goodwin
House Dist 9: Marian McLawhorn
Superintendent of Public Instruction: June Atkinson
House Dist 11: Ronnie Griffin
Supreme Court Associate Justice: Suzanne Reynolds
House Dist 13: Barbara Garrity-Blake
Court of Appeals: James Wynn
House Dist: 17: Bonner Stiller
Court of Appeals: Kristin Ruth
House Dist 23: Joe Tolson
Court of Appeals: Cheri Beasley
House Dist 29: Larry D. Hall
Court of Appeals: Linda Stephens
House Dist 30: Paul Luebke
Court of Appeals: John Arrowood
House Dist 32: Jim Crawford
District Court Judge District 10: Christine Walczyk
House Dist 33: Dan Blue
House Dist 34: Grier Martin
House Dist 106: Martha Alexander
House Dist 35: Jennifer Weiss
House Dist 113: Tom Thomas
House District 37: Ed Ridpath
House Dist 115: Bruce Goforth
House Dist 38: Deborah Ross
House Dist 116: Jane Whilden
House Dist 39: Linda Coleman
House Dist 117: Paul D. Goebel
House Dist 40: Marilyn Avila
House Dist 119: Phil Haire
House Dist 41: Ty Harrell
Senate Dist 2: Jean R. Preston
House Dist 44: Margaret Dickson
Commissioner of Labor: Mary Fant Donnan
House Dist 49: Lucy Allen
Senate Dist 7: Doug Berger
House Dist 52: Betty Mangum
Senate Dist 8: RC Soles
House Dist 53: Joe Tart
Senate Dist 9: Julia Boseman
House Dist 58: Alma Adams
Senate Dist 11: AB Swindell
House Dist 59: Maggie Jeffus
Senate Dist 12: Kay Carroll
House Dist 63: Alice Bordsen
Senate Dist 14: Vernon Malone
House Dist 64: Cary Allred
House Dist 69: Pryor Gibson
Senate Dist 15: Neal Hunt
House Dist 70: Pat Hurley
Senate Dist 16: Josh Stein
House Dist 71: Larry Womble
Senate Dist 18: Bob Atwater
House Dist 77: Lorene T. Coates
Senate Dist 20: Floyd McKissick
House Dist 81: Hugh Holliman
Senate Dist 23: Ellie Kinnaird
House Dist 82: Jeff Barnhart
Senate Dist 24: Tony Foriest
House Dist 86: Walt Church, Sr.
Senate Dist 25: Bill Purcell
House Dist 88: Ray Warren
Senate Dist 27: Don Vaughan
House Dist 90: Jim Harrell
Senate Dist 29: Ronald (Ron) Franklin
House Dist 93: Cullie Tarleton
Senate Dist 34: Andrew Brock
House Dist 100: Tricia Cotham
Senate Dist 36: Fletcher L. Hartsell, Jr.
House Dist 101: Beverly Earle
Senate Dist 37: Daniel G. Clodfelter
House Dist 102: Becky Carney
Senate Dist 38: Charlie Dannelly
Senate Dist 47: Joe Sam Queen
Senate Dist 40: Malcolm Graham
Senate Dist 49: Martin Nesbitt
Senate Dist 43: David Hoyle
Senate Dist 50: John Snow
Senate Dist 45: Steve Goss
Thursday, October 30, 2008
Wednesday, October 29, 2008
The power of change is in your hands.
Text "Early" to 69866 to find your Early Vote location
1-2-3 Voting
Voting in North Carolina is as easy as 1-2-3.
Vote Barack Obama for President and Joe Biden for Vice-President
Vote Straight Democratic Ticket
Flip the ballot over and vote for Democrats in non-partisan races one by one:
Suzanne Reynolds - Supreme Court (Edmonds seat);
Judge Kristin Ruth OR Sam J. Ervin - Court of Appeals (Tyson seat)
Judge John C. Martin - Court of Appeals (Martin seat)
Judge James A. Wynn, Jr. - Court of Appeals (Wynn seat)
Judge John S. Arrowood - Court of Appeals (Arrowood seat)
Judge Cheri L. Beasley - Court of Appeals (McCullough seat)
Judge Linda Stephens - Court of Appeals (Stephens seat)
For a list of more Democratic judicial candidates, visit http://www.ncdemocraticjudges.org/yne Wayne Goodwin for State Insurance Commissioner
1-2-3 Voting
Voting in North Carolina is as easy as 1-2-3.
Vote Barack Obama for President and Joe Biden for Vice-President
Vote Straight Democratic Ticket
Flip the ballot over and vote for Democrats in non-partisan races one by one:
Suzanne Reynolds - Supreme Court (Edmonds seat);
Judge Kristin Ruth OR Sam J. Ervin - Court of Appeals (Tyson seat)
Judge John C. Martin - Court of Appeals (Martin seat)
Judge James A. Wynn, Jr. - Court of Appeals (Wynn seat)
Judge John S. Arrowood - Court of Appeals (Arrowood seat)
Judge Cheri L. Beasley - Court of Appeals (McCullough seat)
Judge Linda Stephens - Court of Appeals (Stephens seat)
For a list of more Democratic judicial candidates, visit http://www.ncdemocraticjudges.org/yne Wayne Goodwin for State Insurance Commissioner
Fit Community Program
October 20, 2008 Bladen Journal RALEIGH
— The N.C. Health and Wellness Trust Fund recently released a request for proposals for a fourth phase of its Fit Community deThere is no fee to apply for the Fit Community designation or grant. For more information about the Fit Community program, or to download a Fit Community application, visit www.fitcommunitync.com. Applications will be accepted until 5 p.m. on February 20, 2009.
— The N.C. Health and Wellness Trust Fund recently released a request for proposals for a fourth phase of its Fit Community deThere is no fee to apply for the Fit Community designation or grant. For more information about the Fit Community program, or to download a Fit Community application, visit www.fitcommunitync.com. Applications will be accepted until 5 p.m. on February 20, 2009.
News from the Polls
Guv Poll
The latest poll from Public Policy Poll puts Democrat Beverly Perdue ahead of
Republican Pat McCrory 47 to 44 percent in the race for governor. Libertarian Mike
Munger had the support of 5 percent of respondents. The poll of 1,036 likely voters,
taken Oct. 25-26, had a margin-of-error of plus or minus 2.8 percent. In the race for
state auditor, the poll put Democrat Beth Wood ahead of incumbent Republican Les
Merritt 44 to 41 percent. Democratic Secretary of State Elaine Marshall led
Republican Jack Sawyer 48 to 39 percent. Republican Commissioner of Agriculture
Steve Troxler led Democrat Ronnie Ansley 46 to 41 percent. A separate poll by the
Democratic polling firm shows Democrat Larry Kissell leading incumbent Republican
Robin Hayes 51 to 46 percent in the race for the 8th District congressional seat.
(THE INSIDER, 10/29/08).
The latest poll from Public Policy Poll puts Democrat Beverly Perdue ahead of
Republican Pat McCrory 47 to 44 percent in the race for governor. Libertarian Mike
Munger had the support of 5 percent of respondents. The poll of 1,036 likely voters,
taken Oct. 25-26, had a margin-of-error of plus or minus 2.8 percent. In the race for
state auditor, the poll put Democrat Beth Wood ahead of incumbent Republican Les
Merritt 44 to 41 percent. Democratic Secretary of State Elaine Marshall led
Republican Jack Sawyer 48 to 39 percent. Republican Commissioner of Agriculture
Steve Troxler led Democrat Ronnie Ansley 46 to 41 percent. A separate poll by the
Democratic polling firm shows Democrat Larry Kissell leading incumbent Republican
Robin Hayes 51 to 46 percent in the race for the 8th District congressional seat.
(THE INSIDER, 10/29/08).
Image v. Substance in the Governor's race
Image v. Substance in the Governor’s race
Will the real Pat McCrory please stand up?
NC Policy Watch with Fitzsimon & Schofield
Check out this link:
http://www.ncpolicywatch.com/cms/2008/10/23/image-v-substance-in-the-governors-race/
Will the real Pat McCrory please stand up?
NC Policy Watch with Fitzsimon & Schofield
Check out this link:
http://www.ncpolicywatch.com/cms/2008/10/23/image-v-substance-in-the-governors-race/
Monday, October 13, 2008
Broughton Loses Accreditation Appeal
http://www2.hickoryrecord.com/content/2008/oct/09/broughton-loses-accreditation-appeal/
Broughton loses accreditation appeal
By Sharon McBrayer
The News Herald
Published: October 9, 2008
Morganton -
The Joint Commission has denied accreditation to Broughton Hospital and the hospital could lose payments from private insurance companies.According to a letter from the Joint Commission on Thursday, it denied accreditation following a December 2007 survey of the hospital.The Joint Commission is a nationally recognized agency that certifies more than 15,000 U.S. health-care facilities and programs."After consideration of all materials and information presented, the committee determined that there was substantial evidence to support the Accreditation Committee's decision and concluded to deny accreditation to Broughton Hospital," Ann Scott Blouin, executive vice president of accreditation and certification operations for the commission, said in the letter.
The decision was effective as of Thursday. The letter didn't give an explanation for the denial of the appeal.That means the hospital will have to reapply for accreditation with the commission, said Tom Mahle, director and CEO of Broughton.Losing its accreditation means the hospital will lose money from private insurances that require commission accreditation, Mahle said.Mahle wouldn't way on Thursday how much the hospital stands to lose in private insurance payments, only saying, "We evaluating it."
In August, Broughton's then Interim Director Art Robarge estimated the hospital could lose between $400,000 to $500,000 a year in payments from private insurance companies if it lost Joint Commission accreditation.The loss of accreditation doesn't, however, jeopardize Medicaid or Medicare, Mahle said.Broughton lost its Medicaid and Medicare funding in August 2007 following two deaths at the hospital. It regained its Medicaid and Medicare funding in July.Mahle said the hospital will work with the commission to establish some guidelines for applying for accreditation."And we're going to do that as quickly as we can," Mahle said.
Mahle said he's not sure how long the process will take but plans to talk to Joint Commission officials about it.The loss of accreditation won't mean a loss of employees, Mahle said.Mahle believes the hospital has made a lot of changes since the survey in December 2007, and that's why the Centers for Medicare & Medicaid Services reinstated its funding."We're really looking forward to reapplying as quickly as we can and working with the Joint Commission," Mahle said.
Broughton loses accreditation appeal
By Sharon McBrayer
The News Herald
Published: October 9, 2008
Morganton -
The Joint Commission has denied accreditation to Broughton Hospital and the hospital could lose payments from private insurance companies.According to a letter from the Joint Commission on Thursday, it denied accreditation following a December 2007 survey of the hospital.The Joint Commission is a nationally recognized agency that certifies more than 15,000 U.S. health-care facilities and programs."After consideration of all materials and information presented, the committee determined that there was substantial evidence to support the Accreditation Committee's decision and concluded to deny accreditation to Broughton Hospital," Ann Scott Blouin, executive vice president of accreditation and certification operations for the commission, said in the letter.
The decision was effective as of Thursday. The letter didn't give an explanation for the denial of the appeal.That means the hospital will have to reapply for accreditation with the commission, said Tom Mahle, director and CEO of Broughton.Losing its accreditation means the hospital will lose money from private insurances that require commission accreditation, Mahle said.Mahle wouldn't way on Thursday how much the hospital stands to lose in private insurance payments, only saying, "We evaluating it."
In August, Broughton's then Interim Director Art Robarge estimated the hospital could lose between $400,000 to $500,000 a year in payments from private insurance companies if it lost Joint Commission accreditation.The loss of accreditation doesn't, however, jeopardize Medicaid or Medicare, Mahle said.Broughton lost its Medicaid and Medicare funding in August 2007 following two deaths at the hospital. It regained its Medicaid and Medicare funding in July.Mahle said the hospital will work with the commission to establish some guidelines for applying for accreditation."And we're going to do that as quickly as we can," Mahle said.
Mahle said he's not sure how long the process will take but plans to talk to Joint Commission officials about it.The loss of accreditation won't mean a loss of employees, Mahle said.Mahle believes the hospital has made a lot of changes since the survey in December 2007, and that's why the Centers for Medicare & Medicaid Services reinstated its funding."We're really looking forward to reapplying as quickly as we can and working with the Joint Commission," Mahle said.
Wednesday, October 8, 2008
Breakdown: A Once Effective System Spins Out of Control
By Taylor SiskStaff Writer
This story is the second about mental health care in North Carolina.
As the mental health care system in North Carolina began unraveling, many critics focused on the new private providers, arguing that most of them are in the business foremost for the money. John Mader, who worked as a mental health therapist for 18 years for the OPC Area Program prior to privatization, disagrees. While a vocal critic of the state's reform measures, he says he believes that most providers genuinely want to provide quality services.That said, though, Mader questions whether it's possible to provide comprehensive mental health care services when certain services are profitably compensated for with state and federal funds and others aren't.
You have a situation, Mader continues, where the service provider, whether a for-profit or nonprofit organization, has to report to its board of directors or parent company, whose interest is in seeing to it that the organization is able to stay in business.
The question Mader and many other mental health care advocates ask is: Should such critical services – mental health care services – potentially be victim to internal fiscal concerns?
Mader says: "You don't hear the fire department saying, 'Sorry guys, it's October 31; we've run out of money. Good luck over the next two months.'"
"Can you imagine doing away with the local STD clinic, privatizing it?" asks Nicholas Stratas, a psychiatrist in private practice in Raleigh and former state deputy commissioner of mental health. "Can you imagine the well-baby program being privatized? I can't. The neonatal program being privatized? I can't. So what the hell are we doing here?"
As part of reform legislation passed in 2001, state government began privatizing mental health care services. Area programs such as OPC that in the past had provided services were now ordered to divest of those services and to contract them out to private providers. The area programs, now called Local Management Entities (LMEs), were tasked to oversee those providers. Under the reform, more services would now be provided in communities and, in theory, the state institutions would be less crowded and better positioned to treat the more critically ill.
Most everyone now agrees these reform efforts have miserably failed. Private providers are going out of business; the mentally ill, most particularly those un- or underinsured, are falling through the cracks; and our state institutions are in crisis.
Finding a solution, Stratas believes, will require once again taking what he calls a systems approach."Mental illness is a fragmenting problem and our system needs to be unified," he says. "We can not treat a fragmenting problem with fragmented services. Piecemeal won't get it."
'Making hay'
At one time, North Carolina had what was considered to be a model mental health care system. Stratas – still active in psychiatry and actively advocating for the mentally ill – was one of the architects of that system.
Stratas came to North Carolina in 1960, recruited by a progressive-minded cadre of mental health care experts, led by Eugene Hargrove, a co-chair of the UNC department of psychiatry who became the first head of the state Department of Mental Health, created in 1963.
Hargrove's vision was to train mental health care professionals within the state to run the system and Stratas was selected as the statewide director of professional education and training.
These were "exciting days; really exciting days," Stratas recalls. "It was all new. It was like a blank blackboard; there was nothing except the state hospitals." Licensing standards for personnel within those institutions were upgraded and Charles Vernon, the newly appointed director of community programs, and Stratas began traveling the state, to all 100 counties, meeting with local officials.
About this time, the federal government got interested in improving public state mental health institutions and initiated two types of grants: Hospital Improvement Program grants and In-service Training Program funds.
Vernon and Stratas met with every county commission in the state, held town meetings and generally laid the groundwork for local involvement in mental health care.
They also had solid support in the Legislature, led by John Umstead.
In 1963, the Kennedy administration pushed through the Community Mental Health Act, and, says Stratas, who at the time had been named deputy commissioner of mental health, "man, we made hay with that."
Local mental health facilities were built across the state. Programs were set up to provide inpatient, outpatient and 24-hour emergency care. Consultation and education was provided to schools, courts and sister agencies that due to the nature of their work needed guidance with mental health issues. The importance of providing continuity of care through the transition from an institution to outpatient services and among essential community-based services was stressed.
In sum, a systems approach to mental health care.
At the same time, the system became racially integrated. Cherry Hospital and the O'Berry Center for those with developmental disabilities (then referred to as the mentally retarded), both in Goldsboro, had previously been the only institutions in the state open to blacks.
Meanwhile, admissions to the state institutions were declining through the '60s and '70s.
In addition, says Stratas, there was a research and a data processing department. If a county official wanted to know where the county stood in terms of, for example, outpatients seen, Stratas says, "You could get that data within 24 hours."
That kind of accounting, says Stratas, is a thing of the past: "Nowadays, I can't get that data if I'm waiting for two or three months. They're not even keeping coordinated, unified data anymore. It's criminal."
'Benign neglect'
Stratas points to the Bob Scott administration of 1969-73 as the beginning of the deterioration of the mental health care system in North Carolina.
"Scott decided there were too damn many state agencies, and I agreed with him," Stratas says. Scott set about reorganizing state government and Stratas was one of two physicians on an advisory commission to plot that reorganization.
The state Department of Mental Health had been created to provide visibility and access to the governor and the Legislature.
"We had total free access, and we encouraged free access to our staffs," Stratas says. The reasoning was: "If legislators want to talk to you, talk to them. We need all the help we can get; we don't need secrecy."
The department now became a division within the Department of Human Resources, which eventually became the Department of Health and Human Services (DHHS).
At the time, Stratas agreed with the rationale of moving mental health care into one department to include all human services. But Scott was succeeded by Jim Holshouser, the first Republican governor of North Carolina since 1901, and, says Stratas, communications between state mental health care administrators and the governor and the Legislature deteriorated.
Jim Hunt was next in office. Hunt's approach to mental health care, Stratas affirms, was one of "benign neglect."
While Scott had appointed a doctor, Lennox Baker, to head the newly created DHHS, the Holshouser administration began a trend of appointing nonmedical directors – the beginning of what Stratas calls the de-medicalization of the state office, which would subsequently happen at the local level as well.
Meanwhile, Stratas says, the area programs became quasi-governmental agencies with autonomous boards. Stratas says communications between the programs and the state institutions began eroding; liaison teams were discontinued.
By the mid- to late '90s, programs were falling on hard days financially due to both state and federal cutbacks; they were letting people go and were cutting back services.
"So the Legislature started talking about reform," says Stratas; "they decided the whole system was sick."
Cutting corners
In a unified, systems approach to mental health care, liaison teams are deployed so that when a patient gets admitted to Dorothea Dix, for example, the area program in the patient's community knows about it and can immediately begin to plan for the discharge of that patient.
Under our current system, that doesn't generally happen.
Marilyn Ghezzi, who for some 20 years worked as a therapist for OPC, says that throughout her tenure the liaison between the institutions and the area programs wasn't great, but that prior to privatization at least the process was relatively straightforward.
"It used to be that a social worker from Umstead would call us when one of our patients was being discharged," Ghezzi says. "Now, with so many different providers, there's uncertainty about who to call."
And, she adds, with patients being let out after such short stays due to overcrowding, "it's hard to handle so many."
Then, once out, services for the more seriously mentally ill are limited.
In a privatized health care system, says John Mader, "compromises have to be made."As private providers have continued to struggle to make ends meet, they're inadequately prepared to deal with those more seriously ill and, in most cases, are unable to provide 24-hour emergency care.
"And when you cut those two things out," Stratas says, "everybody goes to the hospitals" – an ugly cycle.
This story is the second about mental health care in North Carolina.
As the mental health care system in North Carolina began unraveling, many critics focused on the new private providers, arguing that most of them are in the business foremost for the money. John Mader, who worked as a mental health therapist for 18 years for the OPC Area Program prior to privatization, disagrees. While a vocal critic of the state's reform measures, he says he believes that most providers genuinely want to provide quality services.That said, though, Mader questions whether it's possible to provide comprehensive mental health care services when certain services are profitably compensated for with state and federal funds and others aren't.
You have a situation, Mader continues, where the service provider, whether a for-profit or nonprofit organization, has to report to its board of directors or parent company, whose interest is in seeing to it that the organization is able to stay in business.
The question Mader and many other mental health care advocates ask is: Should such critical services – mental health care services – potentially be victim to internal fiscal concerns?
Mader says: "You don't hear the fire department saying, 'Sorry guys, it's October 31; we've run out of money. Good luck over the next two months.'"
"Can you imagine doing away with the local STD clinic, privatizing it?" asks Nicholas Stratas, a psychiatrist in private practice in Raleigh and former state deputy commissioner of mental health. "Can you imagine the well-baby program being privatized? I can't. The neonatal program being privatized? I can't. So what the hell are we doing here?"
As part of reform legislation passed in 2001, state government began privatizing mental health care services. Area programs such as OPC that in the past had provided services were now ordered to divest of those services and to contract them out to private providers. The area programs, now called Local Management Entities (LMEs), were tasked to oversee those providers. Under the reform, more services would now be provided in communities and, in theory, the state institutions would be less crowded and better positioned to treat the more critically ill.
Most everyone now agrees these reform efforts have miserably failed. Private providers are going out of business; the mentally ill, most particularly those un- or underinsured, are falling through the cracks; and our state institutions are in crisis.
Finding a solution, Stratas believes, will require once again taking what he calls a systems approach."Mental illness is a fragmenting problem and our system needs to be unified," he says. "We can not treat a fragmenting problem with fragmented services. Piecemeal won't get it."
'Making hay'
At one time, North Carolina had what was considered to be a model mental health care system. Stratas – still active in psychiatry and actively advocating for the mentally ill – was one of the architects of that system.
Stratas came to North Carolina in 1960, recruited by a progressive-minded cadre of mental health care experts, led by Eugene Hargrove, a co-chair of the UNC department of psychiatry who became the first head of the state Department of Mental Health, created in 1963.
Hargrove's vision was to train mental health care professionals within the state to run the system and Stratas was selected as the statewide director of professional education and training.
These were "exciting days; really exciting days," Stratas recalls. "It was all new. It was like a blank blackboard; there was nothing except the state hospitals." Licensing standards for personnel within those institutions were upgraded and Charles Vernon, the newly appointed director of community programs, and Stratas began traveling the state, to all 100 counties, meeting with local officials.
About this time, the federal government got interested in improving public state mental health institutions and initiated two types of grants: Hospital Improvement Program grants and In-service Training Program funds.
Vernon and Stratas met with every county commission in the state, held town meetings and generally laid the groundwork for local involvement in mental health care.
They also had solid support in the Legislature, led by John Umstead.
In 1963, the Kennedy administration pushed through the Community Mental Health Act, and, says Stratas, who at the time had been named deputy commissioner of mental health, "man, we made hay with that."
Local mental health facilities were built across the state. Programs were set up to provide inpatient, outpatient and 24-hour emergency care. Consultation and education was provided to schools, courts and sister agencies that due to the nature of their work needed guidance with mental health issues. The importance of providing continuity of care through the transition from an institution to outpatient services and among essential community-based services was stressed.
In sum, a systems approach to mental health care.
At the same time, the system became racially integrated. Cherry Hospital and the O'Berry Center for those with developmental disabilities (then referred to as the mentally retarded), both in Goldsboro, had previously been the only institutions in the state open to blacks.
Meanwhile, admissions to the state institutions were declining through the '60s and '70s.
In addition, says Stratas, there was a research and a data processing department. If a county official wanted to know where the county stood in terms of, for example, outpatients seen, Stratas says, "You could get that data within 24 hours."
That kind of accounting, says Stratas, is a thing of the past: "Nowadays, I can't get that data if I'm waiting for two or three months. They're not even keeping coordinated, unified data anymore. It's criminal."
'Benign neglect'
Stratas points to the Bob Scott administration of 1969-73 as the beginning of the deterioration of the mental health care system in North Carolina.
"Scott decided there were too damn many state agencies, and I agreed with him," Stratas says. Scott set about reorganizing state government and Stratas was one of two physicians on an advisory commission to plot that reorganization.
The state Department of Mental Health had been created to provide visibility and access to the governor and the Legislature.
"We had total free access, and we encouraged free access to our staffs," Stratas says. The reasoning was: "If legislators want to talk to you, talk to them. We need all the help we can get; we don't need secrecy."
The department now became a division within the Department of Human Resources, which eventually became the Department of Health and Human Services (DHHS).
At the time, Stratas agreed with the rationale of moving mental health care into one department to include all human services. But Scott was succeeded by Jim Holshouser, the first Republican governor of North Carolina since 1901, and, says Stratas, communications between state mental health care administrators and the governor and the Legislature deteriorated.
Jim Hunt was next in office. Hunt's approach to mental health care, Stratas affirms, was one of "benign neglect."
While Scott had appointed a doctor, Lennox Baker, to head the newly created DHHS, the Holshouser administration began a trend of appointing nonmedical directors – the beginning of what Stratas calls the de-medicalization of the state office, which would subsequently happen at the local level as well.
Meanwhile, Stratas says, the area programs became quasi-governmental agencies with autonomous boards. Stratas says communications between the programs and the state institutions began eroding; liaison teams were discontinued.
By the mid- to late '90s, programs were falling on hard days financially due to both state and federal cutbacks; they were letting people go and were cutting back services.
"So the Legislature started talking about reform," says Stratas; "they decided the whole system was sick."
Cutting corners
In a unified, systems approach to mental health care, liaison teams are deployed so that when a patient gets admitted to Dorothea Dix, for example, the area program in the patient's community knows about it and can immediately begin to plan for the discharge of that patient.
Under our current system, that doesn't generally happen.
Marilyn Ghezzi, who for some 20 years worked as a therapist for OPC, says that throughout her tenure the liaison between the institutions and the area programs wasn't great, but that prior to privatization at least the process was relatively straightforward.
"It used to be that a social worker from Umstead would call us when one of our patients was being discharged," Ghezzi says. "Now, with so many different providers, there's uncertainty about who to call."
And, she adds, with patients being let out after such short stays due to overcrowding, "it's hard to handle so many."
Then, once out, services for the more seriously mentally ill are limited.
In a privatized health care system, says John Mader, "compromises have to be made."As private providers have continued to struggle to make ends meet, they're inadequately prepared to deal with those more seriously ill and, in most cases, are unable to provide 24-hour emergency care.
"And when you cut those two things out," Stratas says, "everybody goes to the hospitals" – an ugly cycle.
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