A place to talk about mental health issues and services in the Chapel Hill area

Welcome!

This is the blog of the Task Force charged by Mayor Kevin C. Foy to create awareness and generate discussion about the mental health service system in the Chapel Hill/Orange County area.  It is a chronicle of the Task Force’s ongoing work and also offers a forum for community comments, feedback, experiences and opinions regarding mental health.

We have already posted a lot of useful information here and we’re looking for additional resources that you might know about. Please use this blog as a means to communicate with the Task Force and read my musings in “View from the Chair“.

Natalie Ammarell, Task Force Chair

For ease of navigation please use the following links to postings in this blog.

About the Mayor’s Mental Health Task Force

Upcoming Meeting Dates

**Public Listening Sessions – February 24th and 25th**

“View from the Chair” postings

Mental Health Task Force Documents

Task Force meeting agendas

Task Force meeting minutes

Brief summaries of all meetings/activities

Mental Health Data

State

Local

Mental Health Reform

Mental Health Models

Opinions on Mental Health

Press/Media about Mental Health

7 responses to “A place to talk about mental health issues and services in the Chapel Hill area

  1. As a parent of a child with mental health issues, I am curious to know what mental health services there are in Chapel Hill apart from volunteer support groups such as FAN. All OPC can do is offer a list of for hire agencies with no ability to recommend or warn (and most of which don’t take private insurance). CHCC schools are totally unprepared to deal with mentally ill children; my child has not received a FAPE her five years in the schools. The state cut payments to paraprofessionals, causing our agency to cut out all PP’s. We finally found help at Wright School, and now the governor plans to close it. Any talk of support to those with mental illness is just that—talk.

  2. Linda,
    It may not be any consolation to you or your daughter, but you are not alone in your frustrations with the state’s implementation of mental health reform. There are sources of support for you and your daughter, but it sounds like those sources are harder to find than they need to be.

    I encourage you to contact one of our family advocates. While our Family Advocacy Network (FAN) does offer a volunteer-led support group, there are several other ways that they can support you and your daughter.
    Our FAN services are free, but they are not all volunteer. Our advocates are full-time, paid professionals who know what it is like to raise a special-needs child, and have both personal experience as well as extensive training working within the mental health and special education systems to help get kids and parents what they need.

    OPC operates under strict requirements from the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services in terms of how they can make referrals, but there are a few agencies that do provide some of the community support services that you and your daughter need.

    Many of us are concerned about the closure of Wright School, but certainly none of us are as concerned as you and other parents who don’t have anywhere else to turn. That is why it is so important that you continue to make your voice heard. I hope that you will come to our Legislative Breakfast this Saturday, Feb. 21 from 8:30-11:30 am at the Friday Center to talk to our state legislative delegation about the importance of maintaining what resources we have.
    Please feel free to contact me directly at msullivan@mhaorangeco.org

  3. Dear Sirs,

    I am a psychiatrist who has practiced in North Carolina since 1986. Never have I seen more confusion in the delivery of mental health care. This situation developed as the legislature listened to money saving ideas rather than considering value, quality and input from working physicians. You cannot privatize a system which is inherently not profitable. Certain portions of care delivery will be of interest to sensible business people if the reimbursement rates are reasonable. Physicians were almost completely excluded from this reform and privatization because of the half-baked idea that doctors would fight to fill their practice with Medicaid and Medicare recipients and that provider agencies would rush to hire doctors so their clients would receive the full range of services. Completely dismantling a system that worked fairly well was at best naïve when a few changes would have permitted more efficient care.

    Here are some suggestions:

    1-Stop the grand paperwork scheme that discourages physicians, nurse practitioners and PA’s from providing care for indigent people. If a health professional is qualified to deliver care for Medicaid or Medicare patients, then they are qualified to deliver care for a county.

    2-The county approval of services is bizarre. Instead of the physician who directly provides care making decisions, it has to be presented by some agency who discusses it with some under-qualified county employee who then talks it over with an accountant and so forth. If I have evaluated a suicidal patient who needs to be seen again the next day, I should not have to talk with the CSA and then they talk with the county administrator and then they check the budget. Why do legislators wonder that the hospitals are bursting?

    3-Encourage rather than discourage use of physician extenders. Psychiatric nurses and PA’s and NP’s are often paid much less or given no financial credit for the work they do. I can see twice to three times the number of patients with physician extenders. The mental health system in Stanford was a good model of how this can work.

    4-The new County Mental Health has moved from actually delivering a service, albeit with some inefficiencies, to managing money and blocking others from delivering health care. There is little consideration made for preventative work to prevent hospital stays, no attention to the problem of no-shows in public mental health clinic, little encouragement of personal responsibility in healthcare, no integration with the patients other health needs, which they often get through another county agency. I suspect these problems come from the way budgets are managed. If the county can save money by not delivering care, then their budget looks better. Unfortunately the hospital expenses go way up. If emotionally disturbed people spend time in jail, then the mental health budget again looks less urgent. There are accounting tools to give a true accounting of costs across budgets.

    5-Prevent high priced managers from sucking the money from the system. We do not need a repeat of the enormous salaries and compensation packages paid to some county administrators, United Way directors or Wall Street executives. Compensation packages should be reasonable and in keeping with NFP guidelines or standard government salaries. Physician rates are very low while case management rates are relatively better. Pay those actually doing the work rather than all the managers.

    6-Closing hospitals or effective programs like Wright School is very short sighted. There are no major treatment advances in psychiatry that would warrant such optomism so these closings must be driven by simple-minded accounting. HOMs decimated the inpatient child psychiatry options in North Carolina and now it appears the state plans to do the same for all mental health.

    7-Models of mediation and collaboration with area universities, private physicians and those in management could be implemented. Currently, competition either to maintain county systems or maximize profits or obtain some academic award seems to be the order of the day rather than improving the quality and efficiency of healthcare. There are many talented people in the area who could work together to get this fixed. Keep the eye on QUALITY FOR PRICE when considering the health care system.

    Sincerely,

    Mark C. Chandler, M.D,

  4. I would like to make two comments, one on the need for dual diagnosis approaches in medical treatment, and the other on the hidden injuries to the mental health in the Hispanic community.

    1. I fear for the mental health of our Hispanic residents. Whether they are documented or not, their well-being has a major impact on our community’s future and safety, not to mention our honor and self-respect. I’d guess that most Hispanics cringe or silently fume at the sight of any policeman, even if they are a citizen or have a documented right to be in NC. (Consider the deportation threat for the legal Hispanic resident who forgets his or her driver’s license, which all of us do from time to time.) Their children must feel all the more vulnerable and rejected. I would therefore suggest: (a) stopping the lunatic identity checks on Hispanics when stopped by police for non-violet reasons, and (b) make a visible effort to communicate to the public that we appreciate the hard work of visitors, students, and future citizens from all ethnic backgrounds. Even something a simple as posters or a decree or a letter to the editor.

    2. Create a capacity for managing dual diagnosis patients in mental health facilities (and school). These cases are rather rare–it’s when someone who is, say, mentally retarded, suffers an episode of mental illness. My son was one such case and I believe he nearly died from being pigeon-holed as “merely” mentally ill. In retrospect my son probably went bonkers due to a one-time event (accidental poisoning) that failed to resolve normally due to a deficit in regulatory enzymes that are produced by genes which are missing on one of his two copies of chromosome 9. We now have a rough plan for what to do should he have another attack, but all such mysterious cases in dual diagnosis patients need to be evaluated holistically. Butner is the only facility set up to do comprehensive research studies on such cases, but it only has a capacity to handle three or so such patients at a time, and it has a case backlog. My son gradually recovered on his own, but in the process I had to quit my job and suffered from clinical depression. A remedy could be quite cheap, but “expensive” in terms of cultural change. I believe the Butner option wouldn’t even have been raised had we been able to address his case here in Chapel Hill with an interdisciplinary TEAM of doctors at UNC Hospitals, much like UNC already does with its breast cancer patients. The doctors are wonderful, but isolated by professional specialties and pecking order.

  5. Readers of this site and writers to the site should be aware that there is a moderation process that takes some time. This suggests that there may be censureship of ideas expressed on this blog. The length of time it takes the moderator to release a comment may discourage dialogue.

  6. Natalie Ammarell, Task Force Chair

    The moderation process is not for censureship purposes and we apologize for any delay in posting your material. I believe, in fact, that I encouraged you to post it.

    Our moderator is a student intern who works in the Mayor’s office and he attends classes, etc. so there may be delays. I also have moderator privileges and will try to check in more frequently so we can process approvals ASAP.

    We are trying our best to run an open, transparent site and process…a totally unmoderated site would not make sense for what we are attempting to do – which is to create a CONSTRUCTIVE community dialogue.

  7. Mark Sullivan

    Dr. Chandler,

    While this is a moderated site, I can assure you that the intention is to promote dialogue, not shut it down. The idea behind having a moderator is to insure the safety of the space, that’s all. We are fortunate to have this forum supported by the town.

    You have some excellent insights and ideas. Thank you for expressing them. The crushing paperwork that obstructs direct care providers from actually providing care and the non-uniformity of paperwork across service areas is a major problem. This is one more result of workers on the ground having been “listened” to, because protocol demanded it, but not heard. Among other things, your comment about the fundamental lack of understanding about how market forces would impact the system is right on, in my humble opinion.

    Let’s be sure that we are holding the people responsible for policy decisions about MH, DD, and SA care in NC accountable, and give credit where credit is due. Orange County plays a very small role in how the system functions. Their only roles are to supplement funding provided by the state, and to have one county commissioner sit on the board of the Area Program, also known as the LME. I have been disappointed that the county hasn’t done more in the past to fill holes, and that political considerations about not taking on the state’s responsibilities may have resulted in missed opportunities for improved care in Orange County. However, Orange County is a victim just like the rest of the state, not a perpetrator in this case. And relative to other counties, they are pulling their weight.

    I am no apologist for the many failures of mental health reform. However, I will say that OPC is forced to operate within the confines of policy dictated by the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, which is a division of the Department of Health and Human Services. I can also tell you that, by and large, the people that work at OPC are as committed to helping the population you serve as you are, and in some cases, overqualified for the jobs they are performing. I can only imagine that many of them are as frustrated as you and I are with the current state of affairs. I frequently work closely with several members of the OPC staff who work long and hard to make the best of a difficult situation, and frankly, take a lot of lumps that they don’t deserve. I think we can make better recommendations when we don’t paint public servants with a broad brush.

    Unfortunately, NC ranks 43rd in funding per capita by state in mental health funding, and the people responsible for how those limited state funds will be spent need to make tough decisions that necessarily exclude care for deserving and needy citizens. Utilization management for those (un?)fortunate enough to qualify for Medicaid is provided under contract by the for-profit, multi-state corporation Value Options. I hope that you will support returning the UR function to LMEs, as well as single-stream funding that would give them more flexibility to use dollars where they are needed most, rather than being restricted to rigid categories. Single-stream funding has been given to several LMEs, including Durham, I believe.

    I totally agree with your point about utilizing the untapped resources of our university system. There are efforts underway that are gaining traction. You might have heard the UNC Dept. of Psychiatry recently opened a new “Center for Excellence in Community Psychiatry” in Carrboro. Gov. Perdue has endorsed developing similar sites across the state. Also, the UNC Gillings School of Global Public Health is funding a project led by Dr. Joe Morrissey to utilize computer modeling to better quantify service needs across NC. Also, the UNC School of Social Work is leading an effort to develop a tuition forgiveness program that would place clinical social workers in underserved parts of the state.
    Allied professionals, especially clinical social workers, are being wiped out under the current regime, another foolish tragedy of reform that is the legacy of Easley’s DHHS.

    In my opinion, real solutions can only be implemented by a new management team at the Division of Mental Health, Developmental Disabilities that demonstrate a new orientation to developing policy for the system of care in North Carolina. As your post illustrates, there is no shortage of good ideas in North Carolina. Implementing them is the crux. I think we can all agree, the public lacks confidence in the leadership at the Division of MH, DD, and SA. Bringing new leadership there is a critical next step. If you agree, you should let Secretary Lanier know.

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