Mayor’s Mental Health Task Force
December 03, 2008
Present: Natalie Ammarell, Rick Allen, Kate Barrett, David Chapman, Linda Foxworth, John Gilmore, Gwen Harvey, Trish Hussey, Thava Mahadevan, Tom Reid, Anna Scheyett, Mark Sullivan, Michelle Turner, Clay Whitehead
Absent: Judy Truitt
Guests: Cim Brailer, Daniel Goldberg
Staff: Andrew Pham; Carlo Robustelli
Mayor Kevin Foy opened the meeting by welcoming all task force members and thanking them for their willingness to serve. He discussed the charge of the task force and noted that the Chapel Hill area is unique; we are in a position to enact change and be leaders. He noted that while he has convened the group within the context of “Chapel Hill”, he means by that Chapel Hill, Carrboro, Hillsborough and Orange County. He said that he is chair of the NC Metropolitan Mayors Coalition, the largest 26 cities in NC, and is interested in seeing our work be of use to other municipalities in the state.
Natalie Ammarell, task force chair, introduced herself and then asked everyone around the table to introduce themselves.
Natalie distributed notes containing themes distilled from her individual conversations with task force members as she was recruiting them to participate. She apologized for not having included children and their mental health issues. She noted that we are not here to “fix” the state or the LME; we are not here to attack or defend. Our challenge is to build a shared understanding of the issues and jump outside the box to seek new solutions to identified local issues. We should also be promoting awareness in the community at large and, as noted by Mayor Foy, thinking about how what we do locally can serve as a model for other municipalities. Natalie said that we will have a site on the web that we will be organizing for use by the task force and as a way of engaging others.
Mayor Foy noted that there has been a positive response to the creation of the task force: If nothing else people are hopeful.
Natalie noted that we are here to learn, explore, inquire and seek solutions. She said that she hopes we will create opportunities for drawing others who are not part of the task force into our work. She said that she was aware that not all perspectives are at the table and that we will find ways to enable them to be shared.
Key Issues/Themes Discussion
Natalie then opened the meeting for general discussion about the issues and concerns related to mental health service delivery. What are some of the things missing from the themes list – other areas of concern? Key points:
§ Affordable housing is a critical piece- there is little safe, affordable housing. Not having housing creates more problems.
§ Substance abuse is part of every category of mental health service.
§ 18-22 year olds fall off the map. This age group has difficulty accessing services. This is not ONLY because they are transitioning from DSS. Some of them don’t have family, some can’t get Medicaid coverage, some have simply been failed by the system. Someone who presents without Medicaid has a very steep hill to climb.
§ People figure how to make the system work and teach others what the “workarounds” are.
§ State system doesn’t lend itself to creating a network of care; just silos of care. People are not working together as they need to be. There are exclusions, etc. that work against a network of care.
§ We need to define the “box” a bit more – what are we really dealing with? Also important to recognize that “inside the box” we have some wonderful services – we need to recognize the strengths and the places where good connections can be made.
§ Public education and reaching out can be a big piece of it. There are probably assets/resources in the community we aren’t aware of, and people who want to join. Raise the moral outrage of the community.
§ How many providers lose money?
§ System is like a water balloon. Finite amount of money and a huge need. Many ways in which funds get siphoned off. A lot of inequity in the field.
§ More money won’t solve these problems. For example, we’re sending money back to the state for adolescent substance abuse because we don’t have providers to offer the services. [Answer: That’s because it is such a negligible amount, so the providers who do want to come in can’t make it.]
§ There are providers and there are quality providers. Task force should think in terms of more localized authorizations for Medicaid – much more control of pot of money; more knowledge of provider expertise.
§ People are lobbying to get the LME more control. Piedmont LME pilot – ability to grant Medicaid waivers. One fund for waivers – takes a sophisticated management capacity so all the money isn’t used up before the end of the year. Danger – end up with 5-6 waiver regions within the state – how would people moving from one region to another make that transition?
§ Fight the fight but take care of the wounded. At the same time we are advocating for change with the state, we have to find solutions locally.
§ Importance of finding ways to deal with folks in a crisis without having to deal with red tape.
IDEA: We are underutilizing the well trained students in the community. A good clinic could be started with the area using residents from the hospital and students. Create a cooperative system with shared supervision. Students could rotate through the organizations to the benefit of all.
Organizing our Work
Natalie distributed a sheet with her thoughts about how the task force might organize its work. She suggested that we could form working groups to focus on particular issues. We could also have some “learning” sessions – basics that we all need to know to be “on the same page” – and “listening” sessions – opportunity to hear other perspectives missing from the group (e.g., Latino, justice system, consumer).
She asked for ideas from the group about how to proceed with our work:
§ Gather key data – statistics about service; local funding amounts and allocations (both direct/indirect; private/gov’t); State tracks by paid claims which is inaccurate, difficult to see the full picture; costs at Butner, jail – prevention could save money.
§ This is a reality check about what is happening locally. Here’s what is not working and we want to change. Here are steps necessary to make those changes.
§ Asset mapping approach would allow us to map all the assets we have for mental health service delivery and then apply a value set to that map to figure out strategies for moving forward.
§ Key players – Fed, State, County, local – try to get a picture of each.
§ Just knowing the money part doesn’t get it all. How is the money parlayed into services, etc.
§ What are some of the losses that occurred when mental health reform was implemented? LME was a “one-stop-shop” capability that we lost. Some providers are very good at certain services, but the state structure now doesn’t enable them to provide them. We have a lot of underutilized talent and resources in our agencies.
Next Meeting – January 14, 4-6 pm – Town Operations Center
Agreement to use January as a “learning” session. Everyone should send info to Andrew and Natalie – Andrew can serve as the central repository for data. Natalie will send out an email to everyone framing this.