Mayor’s Mental Health Task Force
February 11, 2009
Task Force Members Present: Natalie Ammarell (Chair), Rick Allen, Kate Barrett, David Chapman, Linda Foxworth, John Gilmore, Gwen Harvey, Trish Hussey, Thava Mahadevan, Anna Scheyett, Mark Sullivan, Michelle Turner, Judy Truitt
Task Force Members Absent: Clay Whitehead, Tom Reid
Staff Members Present: Andrew Pham
Members of the Public Present: Cim Brailer, Commissioner Bernadette Pelissier
§ Approve Jan 14 Minutes
§ Presentations by Task Force Members
§ Working Group Updates
§ Planning for Listening Sessions Feb 24-25
§ Next Meeting Date
Natalie Ammarell called the meeting to order at 4:10 PM on February 11, 2009 in the Conference Room at the offices of Orange-Person-Chatham Area Office (OPC). Those present re-introduced themselves.
Approval of the Previous Meeting Minutes
The Task Force approved the minutes of the previous meeting without corrections.
Presentations by Task Force Members (See http//:mentalhealthnc.wordpress.com/2009/02/17/task-force-meeting-11-feb-2008-quick-report/ for materials that were distributed.)
Natalie noted that several people had commented to her that we don’t really need presentations because we all know about the system and each others’ agencies. She observed, however, that while there is a great deal of depth knowledge among us, we do not always know the details about one another’s work. These presentations are an effort to put us more on the same page.
Freedom House: Trish Hussey
§ Founded about 1974
§ Operating budget: $6.65 M in 2008; $7.5 M in 2009 (Multiple sources, including: OPC, Durham Center, United Way, Orange County, Towns, Voc Rehab…)
§ 5-acre campus in Chapel Hill where comprehensive substance abuse services are provided (detox/crisis support; intensive outpatient; transitional living; after care planning/support)
§ Outpatient services at 5 clinic sites in Orange, Person and Chatham counties
§ Facility-based crisis and detox services, outpatient and long term residential, supervised living and transitional programs in Durham County
§ In 2008, provided services to 6,250 individuals
§ CASP (Cross Area Services Program) – resources of multiple counties are pooled and Freedom House provides an array of substance abuse programs in communities of those counties
§ Core elements of Freedom House services are based in “best practice”
Anna Scheyett focused on mental health workforce issues. Key points:
§ There is currently a serious shortage of trained mental health social workers.
§ Two key barriers to increasing the social work workforce are lack of field placements for training (students cannot bill; clinical supervision takes time away from billable activity) and lack of jobs (provisional LCSW issue-can’t get a Medicaid number until fully licensed).
§ There are currently 68 UNC Social Work students in 58 field placements in Orange County. Of these, 55 are considered mental health placements.
§ Each year, 120-140 MSWs graduate from UNC School of SW; each year 45-55 students declare their concentration to be direct practice in mental health.
§ Pretty much every NC resident who graduates from UNC School of SW stays in NC.
Caramore: David Chapman
§ Our role is to focus on providing practical supports for adults with severe and persistent mental health. Our community-based structures and supports enhance the effectiveness of traditional clinical support services such as psychiatry and therapy.
§ Funded to provide Group Home, Supervised Apartment, Supported Employment, Long Term Vocational Support and Work Adjustment/Job Coaching services.
§ Advocacy is an important component of what we do.
§ The context for Caramore’s work: Symptoms, Self-image, Stigma.
§ Caramore does not provide acute/crisis admissions or support those who are unable to work.
§ Number of clients per year: 92 (35% Schizophrenia; 20% Schizoaffective; 21% Multiple/Dual Dx
§ Caramore is a CASP – 30% clients from OPC area.
§ Primary insurance: 59% Medicaid/Medicare
§ Strong reliance on UNC for provision of psychiatric and therapy services
§ Many collaborative partnerships
§ Total budget: $1.4 M.
KidScope: Linda Foxworth
§ KidSCope is a program of Chapel Hill Training and Outreach Project, Inc. – provides programs in Orange and Chatham Counties
§ Orange County – Children’s Learning Center and Community Outreach Programs
o Services for children with persistent challenges: Intensive individualized interventions; Parent-child interactive therapy; Trauma-focused DBT.
o Services for children at risk: Social-emotional teaching strategies; Incredible Years;
o Child care consultation
§ Target population – Children 0-5 – born premature/medically fragile; experienced loss and grief/separation or divorce; traumatized through abuse or neglect; severe behavioral issues/poor social skills; diagnosed with Autism/Global developmental delay/Genetic Disorders/Mental Health Disorders
§ Served nearly 3,000 children ages 0-6, their families and caregivers in Orange County
§ In Orange County, about 30% of children substantiated for abuse/neglect or found in need of services by DSS were ages 0-6
Crisis Unit – Chapel Hill Police Department: Michelle Turner
§ Crisis Unit is one of three units of the Police Department’s Crisis and Human Service Division – the other two are Human Services and Project Turnaround.
§ All funds provided by Chapel Hill Police Department to serve only Chapel Hill populations with mental illness.
§ Crisis Unit serves about 3000 clients per year, of which 1/3 are identified as persons with mental illness.
§ Services: crisis, counseling and advocacy services to stabilize persons and their families impacted by victimization, trauma, mental health and substance abuse emergencies.
§ Crisis Unit serves as a liaison with community mental health resources
§ CU is staffed by 4 FT and 8 contract masters-level persons.
§ Annual budget of CU – $315,000.
XDS, Inc. (Cross Disability Services): Thava Mahadevan
§ Very small, “specialty” program – one-stop-shop – in Chapel Hill
§ Dedicated to serving individuals 18 and older with multiple disabilities of mental illness, developmental disabilities and/or substance abuse disorders.
§ Program offers a “clinical home” over a long period of time (some clients have been there 20 years).
§ Two clinical teams – Assertive Community Treatment Team (ACTT) and Community Support Team provide a wide range of individualized services ranging from assessment to case management – psychiatric services – supported independent living – dual diagnosis treatment – whatever a person needs.
§ New contract to partner with Doctors Making House Calls for primary care services.
§ Budget is close to $2M
§ 20 FT and 6 PT staff.
Orange County Department on Aging – Aging Transitions Program: Kate Barrett
§ Dept. of Aging, which serves about 4000 people annually, does not have a funding stream specifically for mental health services.
§ Three key categories of mental health issues for those 65 and over: Dementia, On-set Mood Disorders (depression, suicidal), Chronic Mental Illness (often complicated by dementia and aging).
§ Aging Dept. LCSW, LCSW-P, MSW and OTR/L provide these mental health services: screening clinic for mood, memory and mobility; caregiver education; support groups for caregivers of people with dementia; respite programs for caregivers.
§ Factoid of interest: Standard care for depression is medication BUT 68% of 65+ population stop anti-depressant medication within 4 weeks.
UNC Department of Psychiatry/UNC Hospitals: John Gilmore
§ The numbers:
o 76 inpatient beds – 2,312 inpatient admissions/year
o 20,840 outpatient visits/year (includes clinics and ER, STEP, Geropsych, Child/Adolescent, OASIS, etc.)
o ER walk-in clinic – 960/year
o ER – 2,940/year
§ Orange County specifically: 1,134 ER visits (underestimate; not captured if admitted); 1,000 admissions; 13,965 outpatient visits. Inpatient charges=$12.2 M; collect $5.2 M through OPC contract, insurance, Medicaid/Medicare, self-pay)
§ Recently got a grant from Duke Foundation to beef up interdisciplinary training
§ New community clinic has opened at Carr Mill
Inter-Faith Council for Social Service: Rick Allen
§ Not a mental health facility – provide food to people, secondary to help with homelessness. Approximately half of IFC clients may have mental health issues.
§ Food First, serves many people who need mental health services.
§ 60 people stay at the community house. 20-30 women and children at Home Start.
§ Budget: $1.8 M – most from individual donors but County, Town of Chapel Hill and Triangle United Way are sources.
§ Very large group of in-kind volunteers – value comparable to the $1.8 M budget.
§ Robert Nixon mental health clinic at Community House – all volunteer effort with professionals (psychiatrist, pharmacist, psychologist) from UNC. From May to November, served 144 clients. Partnerships to get medications.
§ Greater emphasis now on case management and tracking services.
§ New Men’s Residential Facility on path to construction and will be moving the kitchen.
Presentations were ended at this point in the meeting to allow time to plan for the upcoming Listening Sessions. Mark Sullivan, Tom Reid and Judy Truitt will present next time. Natalie distributed a written statement by Clay Whitehead.
Reports from Working Groups
Quick Reports from each working group meeting were part of the materials distributed at the meeting. Copies of these reports can be found at https://mentalhealthnc.wordpress.com. Linda summarized the work of the group that is trying to define what the mental health delivery system serving various populations looks like. Anna Scheyett and Trish Hussey gave a summary of the discussion of the group exploring the expansion of mental health services through increased availability of capacity to supervise social work students.
Listening Session Planning
The group then discussed coverage and plans for the two public listening sessions to be held at Chapel Hill Town Hall on February 24th (6-7:30 p.m.) and 25th (5:30-7:00 pm).
The meeting was adjourned at 6:15 p.m.