Wednesday, July 02, 2008

What happened to the LME CFACS : the failed experiment that was written into law and ignored

Information, information everywhere and none of it being attended to re: the lack of functioning of the CFAC's as evidenced by the below information


If anyone has details about other CFAC problems, I would be glad to document this at Madame Defarge:
**What is a Consumer and Family Advisory Council or CFAC as per NC DHHS?
Each LME has a Consumer and Family Advisory Committee (CFAC). They are 'advisory' to the LME.

**Who appoints the members of a CFAC?
63% are appointed by the CFAC. One assumes then that 27% are appointed by the LME.

**Where is a good overview/ suggestions related to the functioning of CFAC's as per NC DHHS?

**What did the State CFAC, per NC DHHS, indicate were the problems re: mental health reform in 2007? (overwhelming number of problems):

**What did NC DHHS do when a member of the Centerpointe LME CFAC, as encouraged by Centerpointe LME, voted to disband the legally mandated CFAC?
".... Half of the CFAC members, with the assistance of Disability Rights N.C., sued the LME. They lost the suit.....the Consumer Empowerment Section of the DMH empowered the LME administration rather than the consumers in this argument."

**Is there any reason to expect something different from NC DHHS in terms of other CFACs and lack of support:

NO evidence is present per the NC DHHS website that indicates they would back the CFAC, as per their online guidelines, proposing assertiveness (but with a history of NC DHHS never having supported the functioning of a CFAC at:


Who is Laurie Coker? There is a page and a half on google about her very hard work as a mental health advocate in eastern NC.

participant in the following (as easily gleaned from google):

AND SUBSTANCE ABUSE SERVICES Advisory Committee Minutes Wednesday, April 12, 2006

**Chair of CenterPointe LME CFAC member

**Guest Speaker for CFAC meeting associated with Cabarrus, Davidson, Rowan, Stanly and Union Counties

The following statements are from Laurie Coker. This was shared with several dozen people who received e mails between myself and Laurie Coker in June, 2008.

As per google, and as per her own statements below, Laurie Coker was a member participating in CenterPointe LME's CFAC and ended her activity in 2005 along with some other members of the CFAC, with the apparent encouragement of the LME, voting to disband the CFAC.

AMAZING that they could get away with this. AMAZING. It speaks volumes to the lack of ability of consumers and advocates to provide input to NC mental health reform.

The below is her description of what took place.

It is posted here as a matter of documentation so that people can consult the information and realize they are not alone in their difficulties.

Moreover, it is posted on Defarge in order to alert people to what has already taken place so that they do not have to reinvent the wheel, which in this case, is completely broken e.g., the LME CFACS which were written into law by the NC State Legislature.

Laurie Coker, as per her below statements, stands behind the creation of NC-CANSO, seeing it as the best substitute for the broken CFAC system.

My opinion, as a provider, in a very different place than Coker, is that the LME's, though they do not yet have their fangs sunk into NC-CANSO at this time, may figure out just how to manipulate this new organization which is being, at this time, developed w/ support of the LME lobbying arm, NCCCP: North Carolina Council of Community Programs.Here is info on NCCCP:

Sorry: too much water over that bridge and too many wasted opportunities on the part of the LME's as they have ignored and profited even----at the cost of consumers/ advocates/ providers in NC.

I don't know the answer to this problem but I have a suggestion re: the defanging of the LME's. The LME's rule their areas like feudal lords.

Standardization of the Utilization Review across the LME's would be part of the answer in trimming their sails so that citizens can receive efficient mental health care.

I have asked for a meeting w/ Pat McCrory, the Republican gubernatorial candidate. I am a registered Democrat.

Would that I could see Bev Perdue attending to these matters but NC seems to be locked into death spiral as re: don't challenge the system in place which is run by the Dems.

The Joint Legislative Oversight Committee of the NC State Legislature, co-chaired by Verla Insko (D-Orange) and Martin Nesbitt (D-Buncombe) wrote the law. It has failed. What do they intend to do about it?

Laurie Coker's dismissal is in keeping with my inability to make any contact----at all----with the Smoky Mountain Center LME CFAC.

E mails/ telephone calls/ US Post letters all were for naught as associated with no mental health services for my state funded client. The Clinical Manager of SMC LME, Stephen Puckett, insisted she be funneled into Meridian Behavioral Health Services (run by retired SMC employee) Recovery Education Center (R.E.C.) which is manned by non professional, $10/ hour employees. SMC LME has a contract w/ Meridian as associated with they covering the mental health services of state funded clients (the only clients administered by any of the LME's in NC at this time) and it is extremely difficult if not impossible for other Endorsed Provider companies to provide services to state funded clients under SMC LME"s catchment area.

Here is Laurie Coker's statement about the failure of a CFAC. Some advocates may see this as a challenge to 'do better'; I think it is a grim assessment of how the CFACs have failed----and WILL fail----unless they are legislatively strengthened.

Laurie Coker:

"As far as I am concerned, CFACs have become, by and large, a failed experiment. But then again, so many of the products of reform have failed us in large part because we have little respect for the very policies we develop. One of our LOC co-chairs has said we have spent too much time on policy. But system thinkers from outside of our state say that it is our history of not implementing policy with due respect which has added to the mess we now have.

In deed, our statutes often translate to nothing. Our CFAC was "disbanded" when one of its own, without it having been even placed on the agenda, made a motion before the agenda for that meeting was even begun, that the CFAC be disbanded. Our LME director and board chair, who had begun to attend all the meetings, (arguably NOT in the name of forging a "constructive partnership"), sat by and, some feel, gloated. Those are harsh words, and sad to have to write.

Half of the CFAC did not wish to disband. There was no procedure in our by-laws to support disbanding, and the maintenance of an effective CFAC is actually one of the six primary duties assigned to an LME in Statute. Half of the CFAC members, with the assistance of Disability Rights N.C., sued the LME. They lost the suit, with the local judge stating that since the LME Board had by-laws that provided for its own disbanding, then the CFAC was protected to disband. So much for the independence and autonomy of a CFAC.

And sadly, the Consumer Empowerment Section of the DMH empowered the LME administration rather than the consumers in this argument. I will not go any further with details as it would simply impede the progress of the new organization, for the Division had not wished that House Bill 1888 would pass.

While I have not served on the CFAC since 2005, I have been as concerned as many other local citizens about the demise of our CFAC. I had already tried to encourage the Commission on MHDDSAS to consider writing rule which would help to strengthen the statute and perhaps develop an objective grievance process. But being one of a very few consumers serving on the Commission, the issue was easily dropped when Department (HHS) attorneys said we did not have rule-making authority in this matter. I disagree, considering the scope of the responsibilities the Commission is tasked with in Statute. But let's say I was weary of "speaking truth to power" without support and had begun feeling most conspicuous.

I think we (knowledgeable service users) have probably just been considered too cumbersome to include in processes at both state and local levels. I think it is the nature of bureaucracies to guard the status quo versus engaging new processes and people. For change is risky, and it is risk management that so many public agencies seem to keep at the fore, rather than solutions. CFACs are too much attached to the LMEs they are to advise. Yet ours has not been a service culture that is results-driven, so advisory input often feels divisive to people who were already comfortable with original results.

The NC Council is not so fixed in its own identity, from what I have observed through the past seven years. While it does have a lobbying role, it is not married to any particular service model, and in fact Council directors have been very frustrated that the Division has not properly implemented policies re: fiscal accountability, site visits, etc. For until we resolve to achieve a certain standard for/with our citizens, the status quo is less secure when some LMEs behave as they have."


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