Cuts in Community Support beginning: Adult MH, in particular, affected; Contracts and MH delivery

I was talking to a major Endorsed Provider of children's services in Haywood county. That company is set up such that it has a contract with the county school system in order to provide services for behavior-problem kids (who have DSM diagnoses, quite probably: these are therefore Medicaid children, for the most part).

Carry-over as associated with CS (Community Support) will move over into the home. When in school, the children are pulled out of the classroom in order to obtain services---something that seemed to make sense to that provider re: the fact that they would have been experiencing behavioral difficulties anyway. In other words, the CS workers are there, in the school, and the reason they are able to be there is associated with this contract. So, it is assured money, from what I understand, that has created stability for this company.

It seems to me that contracted services might very well be the way to go. Smoky MOuntain Center LME contracted state funded MH client services to Meridian Behavioral Health more than a year ago. This has made it next to impossible for state funded clients (adults, for the most part; children can obtain Medicaid) to receive anything other than the group services which are cohort run. That's a contract that to my mind, does not look as useful as the first matter.

More on the news services coverage of what the cutting in $$$ means to MH across NC:

http://www.carrborocitizen.com/main/2007/06/07/mental-health-care-reductions-take-effect/#comment-1188

Marsha V. Hammond, PhD: Licensed Psychologist
NC Mental Health Reform blogsite:
http://madame-defarge.blogspot.com/

1. Hooker Odom’s DHHS created ‘Service Definitions’ which are engraved-in-stone guides to Mental Health Services . The Service Definition associated with Community Support (CS) stated NOTHING about CS providers being master’s degree practitioners. There were no non-high school graduates acting in such roles.

2. Emergency Services have been cut (& bear in mind that CS services are emergency services also re: contact w/ clients being available 24/7). At the same time that psychiatric beds have significantly been cut and hospitals have been closed or are about to be closed (Dix), there is also a cut in these emergency services.

THIS IS A WITCHES BREW OF A DISASTER.
Marsha V. Hammond, PhD

Carlotte Observer quotes Easley as indicating that LME's set pay for providers

(my letter submitted to the Charlotte Observer):

Governor Easley is incorrect about mental health providers pay:

Governor Easley has the habit of throwing around information which is so broadly stated that it becomes incorrect. He indicated in an article about one LME Director's enormous pay that the mental health providers are also paid whatever the LME wants to pay them.

In fact, the 2 LME's in Western NC pay mental health providers on the Medicare scale----which is to say, not very well at all. Mental health services, unless they are associated with Behavioral Health, are paid 60% of a fee set at a state and federal level. All insurance companies fees are more or less in that range also.

Martin Nesbitt is correct that DHHS should have been overseeing the LME's more rigorously. Indeed, DHHS, under Hooker Odom, is an agency that not only does not oversee, but has for years sent out conflicting, confusing messages which has been noted by THIS provider in attending LME provider meetings. "

Yes, indeed: as associated with the recent Supreme Court ruling which prevented (mostly) women from suing companies who had for years been paying them differently than their male cohorts (the ruling indicated that a filing had to be made within 180 days of being hired): LET'S FIND OUT WHAT EVERYONE IS MAKING in terms of their salaries.

Think this is a Democratic State? : (VIVA LA PROGRESSIVE DEMS): NAMI wants the $ re: sale of Dix to stay in MH: hahahaha

Bill (Franklin: Dem, Almance county: cursed by mental illness himself, as he will be the first to state):

you forwarded this NAMI info: "NAMI North Carolina asks that the monies gained from the sale of Dix be kept in the mental health system and not revert to the general fund. "

When I see the privatization of Medicaid going forward I say to myself: we are totally screwed. For god's sake, get this state legislature out of session.

Good luck to whomever cares re: this money being kept in mental health and being used for that purpose.

How can we put pressure on the state legislature to do this? If we cannot keep up with where the millions----MILLIONS---- of state dollars go as associated emergency psychiatric care----then how are we going to keep up with this money? Should we put a 'scent' on it or 'spray paint' it so we can keep up with it? Some kind of smoke bomb in order to alert us to the getaway car?

Does anyone know when this state legislative season is over? this is beginning to be like counting the days until George Bush is gone---and this is supposed to be a state run by Democrats. Citizens see the lobbyists coming and going and all of our entreaties are simply dismissed.

Don't want Mr. Nesbitt's (D-buncombe) (Mr. Nesbitt is described as being the 'crew chief) son to be racing NASCAR Blue Cross Blue Shield ADVANTA car ----in terms of advertisement? Well, who cares.

Don't know where the emergency psychiatric money that was slated for such is going? Good luck. We'll ask the comptroller.

Think that Charles Thomse (R-Buncombe) might have suspicious connections to business interests in that he is a 'financial advisor'----as associated with he succesfully ("the 1st time NC Senator 'scored a coup') keeping mental health parity from being passed as applicable for companies with 25 or fewer employees? Get a life.

Want to keep mental health dollars within mental health? Silly you.

marsha hammond, phd

Next (Dem?) governor will be defined by paying attention to mental health issues: GIVE YOUR OPINION

Chris (Fitzsimmons) (of NC Policy Watch):

thanks for your quote in Rosomer article: ""I can't think of better evidence of the chaos in our mental-health system - that the people at various levels of state government are so widely divergent," said Chris Fitzsimon, the executive director of
N.C. Policy Watch, a liberal-leaning group in Raleigh."

Here is Rosomer's article: Sunday, June 3, 2007
State budget plan faces some study; Critics say mental health is slighted
By James Romoser JOURNAL RALEIGH BUREAU
Sunday, June 03, 2007
Next (Dem?) governor will be defined by paying attention to mental health issues: GIVE YOUR OPINION
Chris (Fitzsimmons) (of NC Policy Watch):

http://www.journalnow.com/ (Local News, 3rd item) OR

http://www.journalnow.com/servlet/Satellite?pagename=WSJ%2FMGArticle%2FWSJ_BasicArticle&c=MGArticle&cid=1173351462026

GIVE YOUR OPINION TO THIS STORY AT THE ABOVE URL,at the bottom of the article

I'd like to suggest that there are strong currents just below the surface:

FIRST AND FOREMOST: . Governor Easley has no intention of assisting mental health patients or advocates. Every one of his actions verified this: supporting Hooker-Odom; choosing the lowest amount with which to fund mental health care, etc. Accordingly, the Dem Party of NC needs to be called on the carpet about this critical matter and in association with who is to run for governor next.

In reading across the available online literature associated with how mental health has been addressed over the past 27 years in NC, one comes up with the following cursory conclusions. The matter of state legislators being 'widely divergent' is associated with all the bait and switching which has taken place at the behest of DHHS. IMO, the state legislature needs to have a very tight reign over DHHS. This agency has proven it has no capacity to stay on point and maintain a direction. This is completely evident when one attends provider meetings at the local LME, such as I attend vis a vis Smoky MOuntain Center LME :

As I read across the below, attempting to map out what has taken place and more pointedly what has not, these are shadowy matters which seem to be in the foreground:

1. very little has changed in terms of upgrading mental health care as associated with 'official' overview of what mentally ill people need (if you think about the strides that western medicine has made in terms of cancer treatment and surgical techniques, the lack of progress is even more glaring).

2. people are out of the hospitals and the Willie M. case, in particular, which caught the attention of a NC state legislator (Willie M was a male adolescent with behavioral problems who was kept w/o rx in some facility in NC) caused people to focus upon children's mental health care matters----in particular.

3. It appears that with people out of the hospitals, psychiatric hospitals have been defunded which is only acceptable if you fund fully the 'pre-hospitalization' services. Thus, Community Support's intention was to do this in part. Community Support includes 24/7 emergency services.

4. Now we have the predicament of defunding of emergency pscyhiatric care and defunding of the mechanism which, in part, was to address issues prior to necessary psychiatric hospitalization.

5. It seems to me that the movement ouf of institutions e.g., psychiatric hospitals, is one matter which has been legislatively determined at the federal and state level. This clock will not be turned back. However, what has not happened in a very pointed manner is that 'pre-hospitalization' services which might be residential homes; emergency foster care; formal psychosocial support systems which provide social contact (for adults), etc., are being cut. You can't both: cut in emergency psychiatric services----which is legislatively demanded as associated with multiple lawsuits and a cut in 'pre-hospitalization' services.

Careful attention to full funding and overviewing of 'pre-emergency' services MUST be the first and consistent item of business. MAKE YOUR CHOICE: return to psychiatric hospitals (and this cannot be done in terms of federal and state legal precedent) OR fund and overview 'pre-emergency' services such as Community Support; crisis care; psychosocial support; etc.

I will call Jerry Meek this week to see what is being done about this matter. It is curious that he is an attorney who works with mental health matters and there is so little coming out of the Dem Party website re: this critical matter. Attention to this will define the ease of election of the next possible Dem governor, or not.

Marsha V. Hammond, PhD

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