My 48th birthday was on Monday, Feb. 25th. I work for a non-profit agency that gets most of its funding from the state, so budgets are tight. One year, we weren't able to give cost of living increases, so the board voted to give our birthdays as a personal holiday. What do you choose to do with a personal holiday? Get a manicure, a massage? Maybe some people would. Not me. I chose to haul my butt out of bed early, get stuck in construction, and fight traffic to get to a Forum on Mental Health so that I could listen to most of the candidates for Governor and Lt.Governor talk about the crisis in North Carolina's Mental Health System. As some of you might have realized by now, I am a political geek, but what you might not know is that I've had two family members struggle with mental illness and fall through cracks - one in NJ, and one in NC. So this was a very important day for me.
The speakers were, in this order, Fred Smith [R,Gov.], Pat Smathers, [D,LG], Robert Orr, [R,G], Hampton Dellinger[D,LG,], Bill Graham [R,G], Dan Besse [D,LG], Dennis Nielsen [D,G], Beverly Perdue [D,G], Richard Moore [D,G], and finally, Walter Dalton [D,LG].
The forum was the presented by the Coalition for Persons Disabled by Mental Illness (CPDMI), and focused on four main questions that the candidates were given ahead of time so that they could prepare their remarks. What I found most telling was who was best prepared for this event.
Before I discuss the speakers or the questions, we have some housekeeping to take care of First, let's dispense with the initials, which can be confusing if you are not in the field. This forum was concerned with three areas covered by the umbrella of mental health care. DD stands for Developmental Disabilities. MH stands for Mental Health. SA, or SAS stands for Substance Abuse or Substance Abuse Services (I think.) I leave it to Gordon to correct me.
Now, a brief background on the system and why this forum was held. In 2001, legislation dismantled the state system of locally-run, public mental health agencies and outsourced care to private agencies. The problem with this is that the private agencies were not necessarily equipped to handle the onslaught of patients with which they were flooded. Mental health care is not profitable; there's almost never a situation where a provider can put a band-aid on a scraped knee, sign a form and bill for it. Mental health care is on going, quite often for the lifetime of a patient. Because there is no profit in it, some of the private agencies stopped doing it. The recent closure of Caring Family Network in Durham left 1500 people without care. That's just one tri-county area. There are thousands of your North Carolina neighbors who need help who can't get it.
This is the "free market" at its worst. Audits show that these private providers have put profits before patients and overcharged NC by $45 million dollars annually. The state contracts with Local Management Agencies (LME) to oversee the contracts of these private providers. Honestly, I couldn't tell you what they do - again, Gordon will have to chime in. At any rate, of the $12 million dollars budgeted annually for the LME's, half of that goes for administration. As the director/manager of a non-profit agency, I can tell you - that is bad. For example: only 8% of the funding of my agency goes towards administration. 50% is very, very fat, indeed. I'm surprised the state goes for that.
There is currently a plan to certify the private mental health providers in order for them to be able to receive state funds. It sounds like a good idea, doesn't it? Well, in theory it is. I'm sure when they thought of it in Raleigh, they patted themselves on the back. But if that certification were to go into effect today, 80% of the current providers would not be able to meet the qualifications. That could leave most of the state with out a mental health professional when they need one.
Other issues contributing to the mental health crisis in NC:
- There is currently no coordination between the Division of Medical Assistance and the Division of Mental Health.
- Projected populated growth will aggravate hospital bed shortage.
- Transportation is a growing issue, especially in rural areas.
- NC's growing Spanish speaking population presents a couple of issues. Finding a translator in areas where there is no Spanish speaking professional is very difficult. Also, NC's licensing board often does not recognize the qualifications of professionals who were certified in their home countries. I see this in my own field as well NC is going to have to deal with this in every area. Mental Health, Child Care, Nursing, everything.
Instead of giving a play by play for the day, which would take forever - I have literally 20 pages of notes - I am going to tell you who I think was best prepared. I missed Fred Smith's remarks. He left his book on the table, I could have picked it up. I didn't. Oh well. Here is what Julia Leggett policy coordinator for The Arc of NC posted of his remarks.
"Seven or eight years ago in MH reform-this administration had good intentions they wanted to reduce the use of state MH Hospitatls they wanted people to return to their communities.
All of those intentions are good - hope is not a strategy while hope is important to accomplish the mission takes strategic planning and it takes hard work."
My apologies to Pat Smathers. I broke the speed limit trying to get there for his remarks, and I walked in just as he was finishing. As I've posted in another place, he made quite an impression on folks. Julia was concerned that people wouldn't know who Pat Smathers was. That shocked me. Really? Are those people living under rocks? Whatever. She did helpfully post a link to his website. However, as I've posted before, Pat made an impression on several folks there. One gentleman told Christopher and me that he wished that Pat would run for Governor.
The first candidate I got to hear was Republican candidate for Governor, Bob Orr. I have to tell you - I think we might want to try to bring this guy over to our side. He was very well prepared, knew the issues that the people in the room wanted to hear about, and spoke knowledgeably about them. I was very surprised when he said:
(paraphrasing)It might sound funny coming from me, a Republican.There are somethings that government does better. Privatization might not have been the best way in this situation. The state has never really had a mental health plan.
I can see why James has had good discussion with Justice Orr. He came across as a reasonable, intelligent man, with whom I might disagree, but to whom I'd still like to speak.
He responded to questions from the audience in a clear, succinct, natural manner. If he's the R nominee, the pageant winner on the D side is going to have trouble in a debate.
Next up - Hampton Dellinger. Hampton gave the group a lot of background on his family, and talked a lot about what he would do. I really don't want the back-draft I'm going to get for this, but in my opinion, he seemed very arrogant. It was as if everything that had been accomplished in every office he'd ever worked in was his accomplishment. He told us he wasn't going to talk about his family a lot, and then he told us all about his family. He stated that when he was Lt. Governor, he would put MH in his budget priorities, and would ensure that the Governor would listen to him. I've heard him speak before, and he wasn't bad. Today, he sounded like the teenagers I've judged in debate tournaments. Also, he talked about Dix a lot.
After a trip to the SBOE and a delightful lunch, Christopher and I came back in the middle of Bill Graham's remarks. Oh Bill. He was asked about the issue of transportation and how it affected the mentally ill. He quickly affirmed that NC needed more roads. There were audible snickers in the crowd. I don't think I need to say much more about him. His closing line was "We have to have sunshine and drain the swamp."
Then it was Dan Besse's turn. He started out giving background about himself, and how in his career as a legal aide attorney he often crossed paths with people who were in need of mental health care. He said that 2008 was a year for a "sea change" opportunity. He also gave a good primer to the audience about just what the LG's office can and can't do,such as set budget priorities, and how he would use the office as a bully pulpit when necessary to speak for those without a voice. He also pointed out that the LG serves on several boards, including the Health and Wellness Trust Fund.
Dan admitted he was not an expert on mental health, but he would listen to experts; it is incumbent on the LG to have a basic understanding. Dan got the first applause of the day when he said that the system was inadequately planned, inadequately funded, and inadequately administered. That lead to sick & suffering individuals not receiving care, and chronic homelessness. If I had more time and more space I would write more - Dan was on, and the crowd was with him. I expected a mainly Democratic group - now I knew this was a Progressive Democratic group.
Our next speaker was Democratic candidate for Governor Dennis Neilson. I know. I'd never heard of him either. In fact, it wasn't until late that night that I discovered he was a Democrat. He sure didn't sound like one. He and I had a brief exchange:
DN: Government doesn't work, so...
LC, (under her breath, but not quietly enough): So why are you running for Governor?
DN: Excuse me, what did you say?
LC: If government doesn't work, why are you running for governor?
DN: I'm going to fix it!
LC: But...(Christopher hits LC on the leg and says "Don't fight with him!") Christopher is a spoilsport.)
I really was surprised to find out he's a Democrat. He was ill-prepared, and used the standard "you've been sitting all day, so we'll end my part early" trick to get out of answering too many questions.
Bev Perdue came next, and no, I'm not going to tell you what she was wearing. She connected with the audience well by telling us about her granddaughter who has special needs. She lives in GA., and gets much better services. Perdue said that she knew the history of the Coalition, and she knew the Mental Health system was failing. Changes are needed, and -
I am the leader who will make those changes happen
She said that her goal for NC was to have the best educated workers in America, and to have NC become the healthiest state in America. She is a realist, and knows there is a long long way to go.
I really liked that Perdue said that you can't separate MH/DD/SA from physical care. She wants to see a breakdown between the barriers between MH and primary care, and move toward and integrated approach so that eventually everyone would have a "medical home" that would be the case manager of all care. In theory this makes good sense to me, but I would like to see the nuts and bolts of how she would accomplish this. It could provide a much needed safety net for many people, but I think there are parts of the state where there are still no primary care physicians. So how is this going to work? She didn't say.
She stated that the quality of your care should not be dictated by your zip code. Everyone matters. NC has an obligation to expand quality community based professionals. This can be done through the office of rural health and loan forgiveness, the Health and Wellness Trust Fund Program for Rural Hospitals.
In response to a question from the audience, Bev seemed to indicate that she thought that "none of this is my fault". She had no influence, nothing to do with the crisis, and couldn't have done anything to stop it. I'm not sure that was a good answer - as head of the H&W Trust Fund, she must have had some influence. As LG and titular head of the Senate, she must have had some influence. Not a good way to make a point, Beverly.
This post is ridiculously long - as was the day.
Next was Richard Moore. His opening comment was that there weren't cracks in the system, there were chasms. He also said that he was no stranger to the state's mental health institutions. There again - I'm not so sure that's something you want to be saying when you run for Governor. (I know - he didn't mean it that way.)
He was adamant that everyone in NC should have access to mental health care. They should have care early, those with disabling mental illness should be able to get services and support to live in their own communities.
He stated that he should be elected Governor because he is "one hell of a public manager."
He said that we should put the customer first, stop relying on our prison system, and have a strong leadership team at the Department of Health and Human Services. Ultimately, he said, the public should hold him, as governor, accountable.
Last, but not least was Walter Dalton. I have to give him credit again. He opened with a cute line.
I am the candidate you've been waiting for!
He got laughs and applause for being the last candidate of the day and acknowledging that the chairs were not comfortable.
He stated that the mental health system should be about person-centered caring. He also said that he had no illusions, the LG had no silver bullet, but if he's elected he will try to do what he has tried to do the whole time he's been in the Senate.
He thinks that not only does DD/MH/SAS need a louder voice at the table, they need a larger table. They need a task force to include providers, Dept. of Corrections, Hospitals, Dept. of Social Services, Families, Local Government, etc.
He said that personnel is policy, if you put the right person in the right place, the right thing will happen. He would like to pilot certain things like community crisis centers. He stressed using resources that we already had. When he was asked about transportation, he talked about using school buses that sit idle during certain time periods for community transportation. This wins big points from me - transportation is a huge issue for a lot of my clients, too. I'd love to see the school buses put to use when they're not transporting children.
And then, we went home.