Mental Health Task Force Minutes 11 Feb 2009

Mayor’s Mental Health Task Force

Meeting Summary

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

Agenda:

§  Welcome

§  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.

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One response to “Mental Health Task Force Minutes 11 Feb 2009

  1. A mental Health Consumer Provider’s experience working on two Programs of Assertive Community Treatment

    After an accident I was disabled for five years. During this time I received Social Security Disability Income and counseling. I joined a club house in Newton Massachusetts for vocational counseling. After volunteering there I got a temporary employment placement. I did janitorial work on two days each week for two hour shifts at some group homes. On one night each week I attended a vocational support group to discuss issues related to the job. After this I found a part time telemarketing job. This independent employment was a step in the right direction. I had an excellent college education but had difficulty getting hired. This may have been because I had a disability. Employers are careful in hireing and this can exclude applicants who can do the job but have been disabled and unemployed. I was grateful that a program was available in my community to help disabled people get jobs. Being excluded from work creates a unique poverty of the soul. I vowed that someday I would help disabled people with finding jobs.

    A year and six months into my recovery I got a residential counselor job working with individuals called mentally retarded. I slept overnight three nights. This was an excellent situation for someone with depression. I got off public assistance and was a self supporting, productive and responsible member of society. After you worked for a year at this job you were eligible for tuition reimbursement. I took advantage of this and took a course at the University of Massachusetts in the Rehabilitation Counseling program. After taking one course a semester for three semmesters I was accepted into the program. I moved into a therapeutic community where I worked as a counselor. Working in a supportive environment and go to school helped me grow as a person. I was able to nurture the growth of the clients I worked with. I enjoyed good supervision and liked the folks I worked with. I was a member-counselor in this community for five years. After I earned a Masters in Counseling I got certified as a rehabilitation counselor.

    Then I took a job with a Program of Assertive Community Treatment (PACT) in central Massachusetts. I was able to advocate for clients and help them with a lot of problems. I liked the fact that we did outreach and helped clients where ever they were. This type of work brought me to homeless shelters, schools, work places, hospitals, jails and client’s homes. The psychiatrist and staff were supportive. Because the program was associated with a University teaching and learning was emphasized. I received good performance reviews over through-out my time working there. I handled numerous crisis situations effectively. I helped clients to find jobs and housing. Some clients just needed weekly counseling and I enkoed these meetings.

    After four years I was offered a better paying position at another PACT. I had twelve years experience and not one complaint on my record. I moved near to Malden take a position as a Vocational Counselor with a PACT at Tri-City Mental Health Center (TCMHC). The company was merging with Eliot Community Mental Health (ECMH). This was because the board of directors could not see that management acted in an ethical manner. The company had committed fraud in billing Medicaid. The director of rehabilitation stole money from clients. I understood that the company was in transition. I was confident in my ability to help clients. I I have a good work ethic and thought that would be enough to succeed. I hoped the new management would be able to provide ethical leadership. No one new I had a disability when I took the job. But this issue was never a big problem with other employers because they usualy accepted the fact that people have different abilities. I had the experience of being on an effectively operated PACT. This experience was valuable to this PACT because the program had never had a solid team that could work together.

    After taking the job I saw that clients were not getting services they needed with housing and employment. Clients needed help. Some staff would say that clients were to “symptomatic” to benefit from help with these important issues. Some clients were treated in a condescending manner. I raised my concerns about client treatment with Aaron Katz the new program director. He did not have the required credentials or experience to manage the program. Because of this clients did not get the counseling thet wanted. PACT programs are designed to serve the most disabled and vulnerable mental health consumers. The response I got from the program director was “mind your own place and business”. Aaron Katz would blame subordinates for his mistakes. His approach to management was to bully subordinates, use intimidation and push people around. For example he and another manager would co supervise a counselor. During counselor ‘supervision’ A Katz sat at a computer taking notes as if it were a disposition while a manager questioned the counselor. You never knew what was being written. I asked if I could take notes during meetings but was told this was not allowed.

    In my first month of employment I was asked to take a client to get a toxicology screen. The test results could get the client in legal trouble. I thought that this task was a bad idea for our first meeting. I found out latter this client had been charged with attempted murder. I was never told about his background but just to take him to get tested. I refused to do this. This is just one example of a number of problems where clients and staff were put at odds because of poor management. Once I got repremanded because a client asked questions about the medication I delivered when the client was just suppose to take it. (Reports to DMH were written to distort what was going on.) Some cients were under court order to take medication and some clients had the program manage their money. Clients could be sent to the hospital againsts there will. These “assertive” aspects of the program creates a situation where the mental health program has the power to exploit clients. The only way to be sure clients are not coerced and staff are acting ethically is for there to be effective communication between all parties involved. However, this was not possible at the ECHS PACT. All communication was one way. The program director (A Katz) gave orders and expected staff to obey his orders without question. It was as if the clients weren’t people but animals to be feed anti-psychotic medications. The program director (A Katz) would say “I have to micromanage everything”. When a team meeting was going on counselors were expected to raise there hand and ask for permission to go to the bathroom. We were in team meetings ten hours a week.

    The work place became hostile. I think it was because other staff saw that I advocated for clients in meetings and management felt threatened. I got the “you aren’t fitting in talk” from the manager. Then I got a written warning that threatened termination. This was for late paper work. Some of the paper work was the program directors (A Katz) responsibility. I explained that I had dyslexia and I asked for some extra time to complete the paper works. I advocated for my self and asked for the accommodations that I am entitled to under the American’s with Disabilities Act. Other than this minor issue I had demonstrated leadership in important matters. I helped client’s find jobs and housing. I managed crisis situations. My request for more time to do paper work was denied by a Katz.

    Then after a client in crisis did not get help from management in a timely manner a blame game started. I had brought the client in crisis to meet the manager. I got blamed because this client who needed to be hospitalized ended up driving in Malden. This happened after I warned the manager that he needed help. A staff person from the day program was in his car. He could have crashed his car into someone. But I was blamed for this management neglect. I filed two grievances with the SEUI union. Management ignored them. I developed health problems as a result of the stress I was under. The management created a hostile work place. I even got treatment for job related stress. I let A Katz and M Mathews a senior manager know I was being treated for job related stress. The work place got more hostile. I requested time off but this was denied. Even though I had a doctors note as evidence that I had job related stress and both vacation and personal time.

    Basically I was thrown out like the trash. The reason was because I advocated for clients, workers rights and would not accept unethical behavior by management. ECHS management contested my unemployment claim. At hearings M Mathews and Aaron Katz committed perjury. After four hearings the Massachusetts Department of Employment and Training found I had an urgent and compelling reason for ending the job. I was paid unemployment compensation. ECHS management also refused to pay me for my last two weeks work. I went to small claims court and named Pam Burns the Human Resources Director in my complaint. I had an excellent case but the hearing officer was a Malden court clerk named Paul Burns. Without considering the facts I lost my case.

    Because of all this I lost my health insurance and couldn’t continue treatment. Now, I can not get a good job because I do not have a reference from my last employer. My health problems have not been treated. I am applying for Social Security Disability. I found management’s main interest was in misleading the Massachusetts Department of Mental Health about how the PACT was operated. Ethical issues were not to be discussed. Dishonesty and hostility were the foundations of management’s practice. They treat counselors like dogs and laugh at the SEUI union.

    Signed,
    Dog Meat

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