Friday, April 11, 2008

Why this hard-core Dem might vote for a Republican governor : IT'S THE MENTAL HEALTH CARE FIASCO, STUPID

Well, this Dem might have to vote for this Republican, for governor. Can we get a new NC DHHS along with that order?

NC DHHS is hogging the road and won't give up the wheel and refuses to ask the passengers where they'd like to go.

Unlike what Mr. Graham (Republican gubernatorial candidate for governor) has stated (see below), the care was not 'rolled out too quickly'; rather, it was badly planned in terms of services that would be authorized and it appears to have been planned by administrative types rather than by mental health professionals and consumers.

YES, there was a need for community based services, moving the practitioners into the community. YES, this has happened to some significant degree.

And YES the paperwork associated with creating mental health care for state funded clients (REMEMBER: this is ALL that the LME's do currently: they only are managing state funded consumers, the 'working poor') in terms of Person Centered Plans (PCP's); Intakes; IPRS's; ACCESS centers, within the LME's correspondence and telephone calls; and last but not least, Post Payment Reviews, whose agenda is to TAKE BACK the money that was spent. The paperwork is CRUSHING the Endorsed Provider private companies.

Privatization was not a bad thing in and of itself.

The community mental health centers which morphed into the LME's were manned by people who sat in their offices and when their clients didn't show up for a variety of reasons, they continued to get paid. This is not so re: privatization as providers do not get paid unless they see their clients.

When reporters talk about the unavailability of mental health services on the weekend or after hours, they are not talking about any of the mental health providers that I know.

What would the mental professionals suggest? Here's one professional's suggestions:

1. fund mental health reform in NC or stop belly-aching and posturing. NC is 43rd out of 50 in terms of funding : "you get what you pay for"

2. realize the existence of mostly rural western NC and its mental health needs by placing providers and consumers from western NC on key committees associated with DHHS & the LME's. A corollary: team up the mental health providers and the LME's such that the LME's actually have to LISTEN and USE what the providers suggest rather than stage an intermittent dog and pony show----which has no provider input.

3. find clients and clients' family members who will serve on the Consumer and Family Advisory Committee's (CFAC) and give the CFAC's more leverage over the LME's. First thing that will have to happen is that the CFAC's actually work and feed into the LME decision making process. One look at the Smoky Mountain Center LME website as associated with who attends the CFAC meetings and what they do will clue you into how dysfunctional the CFAC's really are. Demand that the CFAC's interact with consumers and providers.

4. fund emergency services (return to step #1) in terms of psychiatric beds for adults and adolescents; step-down beds for those needing a temporary reprieve from life's problems which is aggravating a mental health condition; create more useful group therapy within the psychiatric units re: real world problems.

5. promote Basic Services, that is: psychotherapy and medication management, as tolerated. Community Support Services (CSS), that much ballyhooed entity that has reportedly wolfed down $450 million----all for naught we are led to think-----should issue OUT of good therapy and significant contact with the client rather than be CONCOCTED on the basis of some NC DHHS administrator who thought it was a swell idea whose time had come.

6. hire some good value psychiatric nurse practitioners besides the few that are in the Balsam Center in Waynesville, NC (that's IT for western NC, outside of private psychiatrists, Dr. Mark Lawrence, who is at Balsam, and Dr. Matt Holmes, who is the ACTT team psychiatrist). Remember: western NC LME's are accountable for 20% of NC's 100 counties.

7. significantly streamline the paperwork re: state funded clients. Make clear that state funded clients is preceding universal health care vis a vis mental health care in NC in order that people UNDERSTAND just what is taking place here and its importance. There is no need for the repetitive sections of the Person Centered Plan (PCP) as has been in place for several years now. Moreover, if you're not going to listen to what the client wants, please rename this 15-20 page monster. Its only 'person centered' if you listen and create as a possibility what the client requests. As it stands, there is simply an illusion of doing that. And while you're at it, ask DHHS to PAY the providers for this work which entails meeting with the client, perhaps several times, writing up the report, turning it in.

8. Make more $$ available for state funded clients with the money saved/ time saved by stream-lining the paperwork and as per suggestions from professionals who know what they're talking about. Currently, state funded clients (the working poor) receive only 8 sessions/ year of therapy, regardless of severity of mental illness. Oh yeah: you can tell them that the client has a personality disorder in which case they can be advantaged to psychoeducational information vis a vis Dialectical Behavior Therapy ( one session / week/ 90 days...however no therapy after 8 sessions! ....which is part and parcel of any therapy session for any personality disordered client by any well trained professional). Keep the administrators on their side of the fence and entertain LISTENING to the providers.

9. Community Support Services (CSS) serve a very real purpose and are not associated with hand-holding or taking little Suzie to the pool so that the CSS worker lounges in the sun. Its disgraceful how CSS has been painted by reporters. However, much of what CSS is associated with could be 'cured' by: a decent transportation system in rural areas; more sheltered workshops to provide job training and work hardening for those out of the work force for some time ; education of the population about hiring those with mental health issues; and, JOB CREATION.

10. Ask the North Carolina Psychological Association where the hell have they been re: salient comments re: mental health reform in NC . Given the level of education within that bunch you would think that it would have more to say than it has, which is essentially nothing. Ditto all the other professional organizations in NC.

Here is what Mr. Graham mentioned about mental health reform (which the Democrats seem to be doing an excellent job of ignoring given that the screw-up was made by a 8 year Dem governor):

"....He said the current mental-health reform effort, creating larger regional management entities, was “rolled out too quickly for the care that was going to be delivered on the ground.” Graham wants to go back to smaller, more local management entities, develop more mental-health hospital beds, and keep services closer to home.“We shouldn't have to ship a family member across the state for drug or alcohol treatment,” Graham said.

“This is a Raleigh failure, hook, line and sinker.”Graham said, as governor, he would create a committee made up of mental health professionals and have them deliver a report with recommendations within 30 days. “I figure they already know what they need,” he said...."


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