Perdue's MH Reform platform reveals a lack of knowledge about the BARRIERS preventing mental health care from being DELIVERED in NC

my comments to Perdue's outline of mental health reform matters on her webpage are discriminated by ***

marsha hammond, phd

THIS IS WHAT IS ON PERDUE'S WEBSITE RE: MENTAL HEALTH REFORM IN NC: http://bevperdue.com/release_details.asp?id=1070

"Specifically in the mental health arena, my priorities include the following:

1) Extend Community Care model to mental healthNorth Carolina's Medicaid program has recently moved to the forefront in emphasizing the importance of a "medical home" for the primary care of adults and children.
____________________

*****state funded mental health care clients have a 'clinical home' and so what is she talking about? Is she talking about putting all the mentally ill under a PHYSICIAN such that we are back to square one wherein no doctoral psychologists have any control over what takes place w/ their clients? This is, of course, something for NCPA to attend to. However, what I get from NCPA is sad shakes of the head and absolutely no sense of 'hey, we should tackle that.'****
_______________________

..... Our Community Care of North Carolina has developed a very cost-effective and quality-driven model of statewide case management through health care community networks. As Governor, I will extend this kind of collaboration and community network to the delivery of mental health services. Every person served by the mental health system should have the benefit of strong and effective case management to maximize treatment and service plans. In my view, the concept of a medical home should play a major role in helping to revitalize our badly tattered mental health system, for Medicaid recipients and others served by the system as well.

As North Carolina's next Governor, I also want to establish the national model for an integrated approach to behavioral and primary health services for patients with mental health, development disability, and substance abuse problems. One of my top goals will be to break down the barriers to the coordination of mental and physical health care.

2) Establish a “safety net” for those in needWe must also develop a basic safety-net which those in need of mental health services will have available to them.
________________________________

*****This is terribly terribly vague. There ARE safety nets in terms of the 'clinical home' and backing that up, the LME's and their 'core' people who will see to someone who cannot get to their 'clinical home.' It just seems that she has no idea what is already in place and therefore no idea what needs to be fixed. What needs to be attended to is the REMOVAL OF BARRIERS so that professional providers can provide the necessary services. If I have to fill out 8 forms, 5 pages long each one of them, in order to advantage someone to services, how quickly are they going to obtain services?

*****If, like Western Highlands Network LME, in Asheville, states that there are no more than 8 therapy sessions unless someone has a personality disorder, and then only a continuation if you also make available DBT oriented group therapy, how helpful is that?

**********If you have the other LME in western NC, Smoky Mountain Center LME, who allows NO THERAPY to state funded clients except under the continually diminished Community Support Services, how helpful is that?

*******I have mentioned these 2 problems over and over and over to NC Psychological Association, Nesbitt, Insko, Janet Fisher, Dempsey Benton, the LME's themselves.
_________________________________

......These core elements will provide a strong foundation for a true community-based system of care. Today there are just too many opportunities for people in need to fall between the cracks. The quality and degree of care cannot be dictated by zip code. That is why I will take such immediate steps as expansion of the Office of Rural Health's loan forgiveness initiative to place more mental health professionals in the rural parts of North Carolina where they are desperately needed. This kind of state incentive can make a huge difference in the choices young students and professionals make when they are considering careers in mental health. As chair of our state's Health and Wellness Trust Fund, I have already developed an innovative loan assistance initiative to help our rural hospitals modernize and provide more up-to-date services across the board. Modernizing hospitals as well as attracting new health care providers will represent significant boosts to economic development in our small towns and surrounding rural areas, while at the same time enhancing the level of care for some of our most vulnerable citizens. I know that we cannot neglect the need for strong in-patient services. To the extent possible, these services should also be community-based, close to home, family, and other resources. But the state cannot walk away from its obligations. If needed services are absent in a local area due to a lack of private providers, we must work to put them into place through public facilities.

........3) Overhaul system to focus on outcomesThe state's overall approach to planning and implementation in mental health care must also be overhauled. We need a fundamental shift to a focus on outcomes – setting high program and service standards and then clearly stating what results we can and should expect while setting up the conditions most likely to achieve the best possible outcome for each person. One way we can foster the highest quality services is to actively promote the best practices in the field.
________________________

******************Again, this 'best practices' belies a knowledge lacking in what is already in place and any information about what the BARRIERS TO CARE are. Best practices are in place across the board. We are not out here doing voodoo and poking dolls with pins.
_________________________

...........My vision is for the state to develop centers of excellence within our colleges and universities to advance evidence-based models and continue to build capacity for high-quality services across the state.
____________________________
***********You will have no takers re: people willing to be trained in NC and then STAY in NC as providers if you cannot remove the Barriers to Care. We have ALL the models we have ever needed and all are blocked by very specific barriers that are simply ignored.
_____________________________
......Through these evidence-based models we can point the way to more effective and efficient services. We can also better support the ongoing training and development of our professionals who work in the fields of mental illness, developmental disabilities, and substance abuse services.I know that changing mental health care in North Carolina is something far more easily said than done. Yet we cannot stop until we have a system that achieves access to high-quality mental health, developmental disability, and substance abuse services for all North Carolinians. We certainly need better funding. Our low standing in the National Alliance on Mental Illness' rankings of expenditures per capita is inexcusable. But funding is only one piece of this puzzle. We must work on many fronts to achieve the changes and improvements we need. Many people, both professionals and volunteer advocates all across this state, are working their hardest every day to improve our system. The scale, complexity, and rapidity of change that they have endured over the past few years have been daunting but they are committed and determined. Our state needs the benefit of multiple perspectives as we work through the serious issues now facing our system. We will need to adopt a disciplined approach to maximizing system improvements. And we must make sure that government officials and the mental health community listen to and learn from one another. As North Carolina's next governor, I will be directly involved in meeting our mental health challenges. I understand that our efforts will need sound leadership, accountability, policies, and coordination throughout state government and the system of services for mental health, developmental disabilities, and substance abuse. We all know someone – a family member, a friend, a co-worker – who is dealing with the challenges of mental health concerns. These are deeply personal issues for all of us. And they are critical issues for building a better North Carolina as well. I pledge to be the leader our state needs to establish a system of high-quality services that yields the best possible outcomes for those it serves.