Thursday, April 16, 2009

Transparency at the top of the food chain encourages transparency below as re: mental health providers & mental health concerns

Transparency as per NC DHHS and its maneuvers associated with that private psychiatric hospital in Winston Salem wolfing down the beds from the public psychiatric hospital, Broughton Hospital, in western NC, starts at the TOP:

My letter to the Prez:

April 16, 2009

Dear President Barack Obama:

I've never written so someone holding your office before. It never seemed like it would matter----at all.

I am writing to encourage you to release details associated with the CIA interrogations. You appear to be leaning against such a disclosure.

This is of particular importance to me as a psychologist as I have been active in the American Psychological Association as re: military psychologists' participation in these activities-----which APA continues to cover up.

A signal from you regarding an increase in transparency would also encourage APA to 'come clean.'


Marsha V. Hammond, PhD

information on this matter as per recent article and commentary (article was in Wall Street Journal:

Obama Tilts to CIA on Memos
Top Officials at Odds Over Whether to Withhold Some Details on Interrogation Tactics
April 15, 2009

"...A decision to keep secret key parts of the three 2005 memos outlining legal guidance on CIA interrogations would anger some Obama supporters who have pushed him to unveil now-abandoned Bush-era tactics. It would also go against the views of Attorney General Eric Holder and White House Counsel Greg Craig, people familiar with the matter said. Top CIA officials have spoken out strongly against a full release, saying it would undermine the agency's credibility with foreign intelligence services and hurt the agency's work force, people involved in the discussions said. However,Director of National Intelligence Dennis Blair favors releasing the information, current and former senior administration officials said...."


For them to say that releasing these memos would provide Al Qaeda with a propaganda tool is simply outrageous. Releasing memos that officially confirm what we already know about interrogation techniques, and that incidently we aren't even supposedly using anymore, won't help Al Qaeda but it sure worries those high officials who are concerned about being prosecuted for their own role in the Bush torture program. And if those specious arguments they made aren't bad enough, they are also cynically using the rank and file CIA as tools to manipulate a new president into buying into their little coverup....

You'll notice that each of these "reasons" they offer share one thing in common - each of them represent the same "playing the fear card" routine that former V.P. Cheney is so fond of using whenever he doesn't have a good argument to make. It's so obvious what they're doing that it's amazing that Obama would even listen to one word of it much less think that it's a valid argument worthy of being "reviewed."

Wednesday, April 08, 2009

NO Mental Health Parity in NC : BCBSNC makes their own rules (and you'll like it or just shut up, Rep Martha Alexander)

Fitzsimon File
The special interest health plan
Wednesday, April 8th, 2009

"......The House Insurance Committee picked up things from there, bowing to the wishes of the lobbyists for chiropractors and physical therapists by reducing the co-pays for their patients to same level as primary care physicians.

That would raise the premium for family coverage to 10.1 percent a year.

The House Appropriations Committee was next and Wednesday morning's meeting began with Chair Mickey Michaux announcing that any proposed amendments could not increase the cost of the plan, which is exactly what the Insurance Committee had done days before.

That didn't stop Rep. Martha Alexander from proposing that co-pays for mental health visits be reduced, which seems only fair since they are at least as important as seeing a chiropractor.

Michaux promptly ruled that out of order because it would cost the state more. The rules that apply to chiropractors apparently do not apply to psychologists."


Looks to me like the NC Psychological Association hasn't done an adequate lobbying job......since that's what the world is about these days.

What's there to lobby? Oh, I dunno: maybe the MH Parity Law that was passed with such a lot of horn-honking & ballyhoo that you had to guess that in actuality it was 180 degrees in the other direction (a clear way to know that things are bogus).

Psychologists wrote letters and called people; and NC Psychological Association talked about what a swell thing had passed.....and lo and behold....nothing really happened at all.

BCBSNC, insuring about one-third of paying people in NC simply did what it wanted to do and the State Legislature----their overseers----simply walked past the corpse whistling.

Doesn't matter what the law says as per Mental Health Parity for BCBSNC was able to just toss the MH parity matter-----which was Martha Alexander's balliwick (thanks Martha!)

Yep: until BCBSNC is overseen by SOMETHING OTHER THAN THE NC STATE LEGISLATURE, we ain't getting anywhere re: MH Parity in this state.

Yes, check the stats: BCBSNC has as insured, paying people, almost one-third of the population of the state of NC.

Bring on the legislation to get the overseeing of BCBSNC OUT from under the State Legislature and OVER into the Department of Insurance.

Besides the non-availability of MH Parity, I've been writing letters to the Department of Insurance for almost two years now re: the non-availability of screening colonoscopies in western NC for people aged 50 and over.

The American Cancer Society recommends screening colonoscopies beginning at age 50.

There's a law denoted as 'colorectal screening' which mandates it.

Doesn't matter. BCBSNC, one of the top wealthiest 'Blues' in the US (there are 28) hords its gold and asks for hand-outs which the State Legislature caves in to.


Colo-rectal screening is THE LAW in NC but that doesn't mean that BCBSNC can't tell you have to drive hours w/ a Fleet's enema in your colon in order to get screening colonoscopy .

I hope someday to hear about the travails of some BCBSNC official having to 'hold it' while trying to get somewhere important.

Nope: daddy can't stop the car just yet...... just hang on......

WNC (Family Care) Homes: DSS Buncombe finds rule violation as re: mental health client re: opening of private mail

Well, now, we can proceed w/ that HIPAA violation with all of its hefty fines.

Letter from Buncombe County DSS, April 3, 2009:

"Dear Dr. Hammond:

This letter is being written in response to your complaint received on 3.24.09 regarding WNC FCH #7. All of the allegations were thoroughly reviewed at the time of the investigation. Rule violation(s) were found and DSS will be monitoring these areas. Should you have any questions about the investigation, please contact me at 775 2956, Sincerely, Marsha Cox, Adult Homes Specialist."

This complaint involved the opening of private mail sent directly to a resident associated with his intentions to persue becoming his own legal guardian so that he could receive his own disability check. Not only was the private mail opened, but the Family Care Home administrator flaunted the letter at a DSS Buncombe meeting a few weeks ago as he tried to prove that this clinician had no good sense trying to ask Pisgah Legal Services to assist the client w/ re-attaining his own legal guardianship.

Amazing, you say: he cannot receive his own disability check. Astounding: he has no privacy as re: his mail.

This happens dozens of times a day as related to competent adults living in Family Care Homes as their civil rights are essentially shredded: from the lack of privacy of their mail; no privacy re: their relationships, be it therapists or visitors; demanding that they take 'their pills'; and essentially, simply be warehoused.

Out of sight! Out of mind!

98% or more of the disability checks are sent directly to the Family Care Home administrators and the by-law change they get back is $46-66/ month---regardless of the amount of their disability check. Be it $900 or $670 (the amount associated w/ SSDI checks for people who have not vested enough in the SSA system in order to receive the larger SSDI checks)----that's what they all get back minus their co-pays for medications which can be sizeable but are mostly $3/ medication.

The only good news on the horizon is that the Special Assistance funds of these Family Care Homes has been slashed by Governor Perdue as associated w/ saving money. This means several things:

1. things will get even worse at the Family Care Homes

2. people will move out (but where will they go?) ; the Family Care Homes are essentially the only thing standing between these adult residents and homelessness----unless you count the shelters----which is where the above mentioned client just went because he was so tired of having his civil rights repeatedly violated and he wanted something of an independent life.

Now, many of them just need to find Section 8 housing and the Community Support Services should be able to assist them as they are all Medicaid clients.

So, let's take a look at that DHSR SCOREBOARD as pertaining to Family Care Homes. Is this home losing its 3 star/ maximum points that the public is dying to see prior to sticking their unwanted 'loved one' in?

WHOOPS: Its not even listed. But this IS listed (one wonders if DHSR is having a problem w/ getting the numbers of the houses straight: Family Care Homes are assigned numbers as associated w/ the administration of the home/ company):

Its one of only five Family Care Homes so far rated in NC that get the 'no stars' rating. Now if they could get all the homes on their grid.

WNC Family Care Homes, LLC dba WNC Family Care Home #10
230 Country Time Circle

Tuesday, April 07, 2009

How the Medicare/ Medicaid paperwork makes the mental health providers crazy in NC

Psychologists and other mental health providers bill utilizing CPT codes. For instance, the CPT code (CPT is a trademark associated w/ the American Medical Association) for 45-50 min of psychotherapy, is 90806.

Back in 2000, the American Psychological Association was instrumental in creating what are known as the Health & Behavior codes, specifically, 96150, 96151, 96152----continuing thru the series as associated with group therapy and family therapy. However, these first three are the most commonly utilized.

Why was this important for psychologists? Because the H & B codes are on the MEDICAL side of billing rather than the MENTAL HEALTH side of billing. Medical CPT codes are reimbursed at an 80% rate. Mental health codes are reimbursed at about 55%.

To suit: "Tobacco dependence among individuals with a mental illness or an addiction is a tremendous problem that goes largely ignored."

BIG DIFFERENCE in pay for the psychologist or mental health provider.

However, the problem is this: Medicaid will only crosswalk (that is the automatic procedure whereby a Medicare code----Medicare is always primary with people who have dual eligibility---and that is most people who have Medicare) as per the 96150 and 96151 ASSESSMENT codes.

This means that I cannot be reimbursed when I continue to see someone who has overlapping physical health issues and mental health issues.

Most people w/ mental health issues have overlapping physical health issues.

Indeed, 80% of people w/ mental health issues of a chronic nature, smoke cigarettes compared to 20% of the rest of the population.

That's a lot of chronic illness and it has not even begun to be addressed. And these H & B codes are one way to do that but not if one is being paid at the lousy 90806 (series including 90804; 90808) rate.

I have asked APA's Diane Pedulla to comment on this matter. She is an attorney who works at APA in Washington D.C.

Here is my letter to the regional coordinator for NC Medicaid regarding this matter:


Marsha V. Hammond, PhD: Clinical Licensed Psychologist, Asheville, NC
cell phone: 404 964 5338 email:

March 7, 2009

Dear Melanie Whitener, the NC DHHS Medicaid regional consultant for many counties in western NC:

You stated, as per the Health & Behavior codes, specifically 96152 (this is what 96152 is: Service: Intervention-Individual), that there is no crosswalk from Medicare to Medicaid :

"I checked in the Medicaid system, and there is no crosswalk code for 96152. This service is not reimbursable to your provider type/specialty at this time. With the recent added coverage of the 96150 and 96151 code, we do anticipate changes to also cover 96152, but I do not know for sure when that will happen."

This is concerning to me as 96150 (this is what 96150 is: Service: Assessment-Initial) and 96151 (this is what 96151 is: Service: Re-Assessment) are both assessment codes but which are not being followed up by the ability to utilize them further as pertaining to psychologists.

This means the following: when I have a dually eligible client (has both Medicare, as primary, and Medicaid), with chronic health problems overlapping with mental health issues, I have no way to be reimbursed as per their Medicaid account.

Can you please advise me as to how I can register my concern associated w/ this matter?

Thank you.

Marsha V. Hammond, PhD

Clinical/ Health Licensed Psychologist, NC

Monday, April 06, 2009

Like I said: the DHSR regulatory people have no intention of truly rating the Family Care Homes w/ residents having mental health challenges

Marsha V. Hammond, PhD: Clinical Licensed Psychologist
E mail: cell: 404 964 5338
Confidential fax: 828 --------

April 6, 2009

Dear DHSR (Department of Health Service Regulations: Adult Care Licensure Section: Central Office where the Complaint Division is : address: 2711 Mail SAervice Center Raleigh, NC 27699-2711: AND Asheville Regional Office 12 Barbetta Drive Asheville, NC 28806:

Over the past 1.5 months I have made, I think, 8 complaints regarding various houses associated w/ WNC Homes. I suppose you think I have nothing better to do but frankly I do. These are, nevertheless, important matters, as pertaining to the civil rights of disabled people w/ mental health challenges living in Family Care Homes.

And I am sure you are very busy yourselves. And the WNC Family Care Homes in Leicester, NC, Houses 10,11,12,13,14-----are a good 30 minutes from Asheville—-which is why this psychologist thought it a good idea to see her clients in their homes. However, DSS and DHSR have gone along w/ this psychologist being banned from seeing her clients in their home; now, they one by one are taken to their appointments, sometimes sitting for hours in the van supplied by WNC Homes. This occurs, though in every home, as per requirements associated with Family Care Homes, there is a statement on a laminated poster indicating that residents ‘have a right’ to private visits.

No they don’t, it seems.

Moreover, I find that your reports/ letters back to me contain no valuable information. There is the same statement from you (see below) regardless of what I reported. Moreover, regardless of whether the report which I submitted was AFTER the date when you last visited the homes which was basically March 6 thru March 10 or so-----you still use that to underline ‘what we found.’ Thus, I am confused as to how you are investigating the matters which I report.

And what I have reported as per the WNC (Adult) Family Care Homes seems to me to be significant: I call during regular business hours and am denied being able to speak to my client on the phone in house #12, client BRC; my client continues to state that he has not received his PNA; I was denied being able to speak to my clients in Hse #11. I’m curious: do you just call them up and ask them did they do this and they deny the matter and you accept it?

I am going to start calling DSS immediately when one of these events happens so that Ms. Simcox of DSS Haywood can call immediately and I will strive to find witnesses to the events such as these. Indeed, I did have a witness to one of the events associated w/ Hse # 12, a Community Support Services worker----and I gave you that person’s name and the contact information. Nevertheless, that complaint got the same response (see below) from you. I’m really at a loss as to how to bring your attention to these matters which have a great deal of impact on the residents of these homes.

All of my complaints, except the first one, have been written on the complaint form and I have clearly indicated what took place; who was involved; the data and time; the setting, etc. I am, nevertheless, sending back your ‘green’ Customer Service comment sheet. It does not include, really, anything to do w/ the paper complaints and so you might consider revising it.

Moreover, this week I will be filing yet another paper complaint-----one which is associated w/ health care; and I am assuming you will simply dismiss it again. This time it concerns another resident in House #11 who states that he has asked WNC Homes administrator, Jeff Clifton, about the matter of why the pharmacy utilized by WNC Homes, is not using his CIGNA Rx (medication) card which should, he believes, result in no co pays and therefore he would have a bit more money in his pocket as associated w/ his PNA (Personal Needs Allowance). When you only have a couple of $20 bills in your pocket, a bit more makes a lot of difference. According to the client, Mr. Clifton simply left and would not answer the question though repeatedly challenged to do so by the resident. As you know, the Family Care Home law indicates that residents are supposed to get an answer regarding their finances.

However, they don’t get an answer from WNC Homes and I don’t get an answer from you unless it is a confusing one. This therefore supports what I at first thought about DHSR under NC DHHS ‘scoring’ the Family Care Homes. It’s bogus; there’s no ability to impact your system.

There is one exception and that is associated w/ WNC Home #7. Confusingly, I received TWO letters about this report (they are enclosed). One is dated March 23; the other March 25. They state entirely different things but are about the same event as I talked to the client and he advised me that someone from Buncombe DSS had gone to his home and spoken w/ him.

This is the statement that is associated w/ all 8 complaints (bearing in mind that I received the second letter, two days later, as pertaining to the same event regarding the resident in WNC Home # 7): “Based on the evidence collected, the allegations regarding 10A NCAC 13G. 0909 Residents’ Rights and 10A NCAC 13G 0902 Health Care were not substantiated. The fact that the allegations were not substantiated does not mean, of course, that they were not valid. It simply means that based on the information available the allegations were unable to be verified at the time of the investigation.”

I will keep filing complaints as matters arise.

Marsha V. Hammond, PhD

Friday, April 03, 2009

WHY DOES VALUE OPTIONS KEEP CHANGING THEIR OUTPT AUTHORIZATION FORMS?: mental health providers spend their time chasing forms

Its a good thing I don't live wherever Value Options is in NC.

I would drive over there and give them a piece of my mind.

They've changed their ORF2 (outpatient therapy authorization, which you have to obtain after 8 therapy sessions) AGAIN. AGAIN. Its unbelieveable.

They just changed it....just as a load of mental health providers were about to send in their authorization forms as they have just now bumped up against the limitation of the 8 psychotherapy outpatient sessions for Medicaid clients.

Here it is March....just about that time...and they've changed the form and no one has told any of us.

The LME's have not informed us.....and they are supposed to be overseeing NC Medicaid.

The difference from the new form and the old form are just subtle enough that it send the entire NC mental health care system into a tailspin.

I don't think this kind of jerking of providers around is ever going to stop.

Here is the new freakin form.


Will NAMI take those w/ mental health challenges to the cleaners in asking for a repeal of the IMD exclusion rule?

I might be reading between the lines but it seems to me as per Dihoff (Executive Director of NAMI NC) that NAMI National is going for the repeal of the IMD exclusion rule which means the below. She stated in an e mail letter to mental health advocates the following (see below for entire statement of hers: "The fear is to make sure that it doesn't take the place of badly needed community housing and community evidence based treatments. "

This is what I hear: NAMI is going to allow it to happen. That means that NAMI will be advocating for non single stream payer plans.

Man alive. I hope I'm wrong.

I intend to figure out how to follow the bill until it dies a timely death. Mike: do you have a 'name' for this 'bill'?


Mike Mayer writes:

"From: Mike Mayer [] Sent: Wednesday, April 01, 2009 10:45 AMTo:; hammondmv@netzero.netCc:;;; Debra Dihoff;;; andy@triadmentalhealth.orgSubject: RE: IMD exclusion: ? to Andy/ MHA Forsyth: Re: Fwd: H.R. 1415 -- MEDICAID E...

"First, John Tote and Debra Dihoff probably know twice what I do.

All I know is that the bill for the modification of the IMD exclusion is out there. Without a fairly strong consensus across the MH community I doubt it will get far. The 'big boys' of MH (private hospital groups) may be able to get some traction but the Feds are very concerned about opening the IMD can of worms from what I have heard. We don't want to replace the public institutions of 1960 with private institutions in 2010. I think the bill tries to address this but I just haven't heard the groundswell of support for it that it would take to get it passed as a stand-alone bill and you can expect that at least some survivor/Recovery focused groups and other advocates, like ADAPT, will not support it. However, it could get tucked into an appropriations or other must pass piece of legislation.

Mike Mayer
Senior Partner, CRA

Deb Dihoff, Executive Director, NAMI NC:

"It's definitely on NAMI (national's) radar screen and making its way onto their public policy agenda. Holly Hill has done some talking with legislators about this, and when I was recently in DC Jim Pitts and I brought it up with our delegation. The fear is to make sure that it doesn't take the place of badly needed community housing and community evidence based treatments. Once somebody else pays for something, everybody goes there. What's easy to bill is easy to use."

Deby Dihoff, MA
Executive Director, NAMI/NC
309 W. Millbrook
Raleigh NC 27609
919 788 0801
FAX 919 788 0906

My response to the above:

Marsha V. Hammond, PhD: Clinical Licensed Psychologist, Asheville/ Waynesville NAMI Member

April 3, 2009

Thanks for your comments on the IMD matter, Mike Mayer and Deb Dihoff.

If the IMD rule is repealed, there will be two sets of hospitals....just like it was in the 1980's and before.

One set of hospitals will take the indigent clients. That's the state hospitals. They will be the hospitals everyone will want to avoid. Any work that has been done in order to improve hospitals like Cherry, etc., will be for naught. All the energy will be completely sucked out of this effort.

The other set of hospitals will take the non charity/ non disabled/ non Medicaid patients. And those sets of hospitals had their own set of weird problems. All those Charter hospitals?---remember them? where they put all the Dissociative Identity Disorder clients who got sicker by hanging out w/ just each other? I could tell you some tales from both Atlanta and Asheville re: those Charter hospitals. They sucked their insurance policies clean and left many of them high and dry.

I don't see any difference between this and 'separate but equal' arguments that preceded desegretation of US Schools.

This, in particular, is why the Centerpoint LME/ NC DHHS/ Old Vineyard secret little hospital plan is so concerning. I have not heard a word from Cansler re: my request for the minutes and information that were part of what NC DHHS participated in (public information: right; transparency: right). And did Cansler have a role as a lobbyist re: this effort? I'm dying to know.

Why must we keep returning to solutions that don't work and that are retro----to say the least?

We need one payer stream of funding.

I will be extremely disappointed in NAMI if they go down the road of having the IMD exclusion rule repealed. It will reveal that they are indeed in the pockets of private industry and Big Pharma---and this is an argument that is certainly there and entertainable even now.

I'm a NAMI member. I'm a mental health provider. Better step carefully here, NAMI.

I want a one payer system. The entire country is screaming for a one payer system. All except 'the big boys' as Mike Mayer so tellingly described the private psychiatric hospital people.

There is no good reason for NAMI to support the repeal of the IMD exclusion rule---unless they are in the pocket of the 'big boys' of private psychiatric hospitals.

Thursday, April 02, 2009

22% of 2006 hospitalizations were for mental health challenges

"One in Five Hospital Admissions Are for Patients with Mental Disorders

About 1.4 million hospitalizations in 2006 involved patients who were admitted for a mental illness, while another 7.1 million patients had a mental disorder in addition to the physical condition for which they were admitted, according to the latest report from the Agency for Healthcare Research and Quality.

The 8.5 million hospitalizations involving patients with mental illness represented about 22 percent of the overall 39.5 million hospitalizations in 2006. AHRQ's analysis found that of the nearly 1.4 million hospitalizations specifically for treatment of a mental disorder in 2006:
Nearly 730,000 involved depression or other mood disorders, such as bipolar disease.
Schizophrenia and other psychotic disorders caused another 381,000.

Delirium — which can cause agitation or inability to focus attention — dementia, amnesia and other cognitive problems accounted for 131,000.

Anxiety disorders and adjustment disorders — stress-related illnesses that can affect feeling, thoughts, and behaviors — accounted for another 76,000.

The remaining roughly 34,000 hospitalizations involved attention-deficit disorder, disruptive behavior, impulse control, personality disorders, or mental disorders usually diagnosed in infancy or later childhood.

These findings are based on data from Hospital Stays Related to Mental Health, 2006 (HCUP Statistical Brief #62). The report uses statistics from the 2006 Nationwide Inpatient Sample, a database of hospital inpatient stays that is nationally representative of inpatient stays in all short-term, non-Federal hospitals. The data are drawn from hospitals that comprise 90 percent of all discharges in the United States and include all patients, regardless of insurance type, as well as the uninsured."

Wednesday, April 01, 2009

COMMUNITY CHOICE ACT: Giving disabled people w/ mental health challenges a way to live on their own: HELLO REP HEATH SHULER:1st to sign for NC?

Please feel free to use any part of my letter in order to write a letter to your local US Congress person so that we can get NC on track re: this very pressing, important issue. THERE ARE NO NC SPONSORS YET. Continue reading.....


"...The Community Choice Act establishes a national program of community-based attendant services and supports for people with disabilities, regardless of age or disability. This bill would allow the dollars to follow the person, and allow eligible individuals, or their representatives, to choose where they would receive services and supports. Any individual who is entitled to nursing home or other institutional services will now be able to choose where and how these services are provided.

The Community Choice Act Senate Bill 683 and House Bill 1670The Community Choice Act gives people real choice in long term care options by reforming Title XIX of the Social Security Act (Medicaid) by ending the institutional bias. The Community Choice Act allows individuals eligible for Nursing Facility Services or Intermediate Care Facility Services for the Mentally Retarded (ICF-MR) the opportunity to choose instead a new alternative, "Community-based Attendant Services and Supports". The money follows the individual! In addition, by providing an enhanced match and grants for the transition to Real Choice before October 2011 when the benefit becomes permanent, the Community Choice Act offers states financial assistance to reform their long term service and support system to provide services in the most integrated setting.

It would fit very nicely w/ Community Support Services
No one is sponsoring in NC (yet):;&sort=D

supported by at least one Republican: "This creative proposal addresses a glaring gap in Federal health cover-age. The time has come for concerted action in this arena."
- Senator Arlen Specter Republican, Pennsylvania
You can sign up to help here:
_____Please list our organization as a Community Support Act Supporter.
_____We would like to work on the state level to support Community
Choice Act.
_____ We can provide in-kind resources to support Community Choice Act.
_____ We can provide financial support for Community Choice Act.
_____ Please add us to the Community Choice Act Email* list for
Name of Organization: _______________________________
Contact Person: __________________________________
Address: ___________________
City: ____________ State: _________ Zip: __________
Phone: ( ) ____________ Fax: ( ) _____________
TDD ( ) ____________ *e-mail: _______________
Our group is a national ________ / state ________ / local ________
Send to:
ADAPT of Texas1640 E. 2nd ST. Ste. 100Austin, TX 78702512/442-0252512/442-0522 (fax)EMail to ADAPT
Date: ______________
dbs_____ list_____ pkg____
The Community Choice ActSenate Bill 683 and House Bill 1670

April 2, 2009

Marsha V. Hammond, PhD: Clinical Licensed Psychologist
356 Biltmore Avenue, suite 313, Asheville, NC 28801

Dear Representative Shuler:

Thank you for supporting the interests of disabled people in western NC. I am speaking, in particular, of disabled people with mental health challenges---as I am a psychologist.

The purpose of this letter is to ask you to be the first US NC Congressional representative to support House Bill 1670, specifically, The Community Support Act : A COMMUNITY-BASED ALTERNATIVE TO NURSING HOMES AND INSTITUTIONS FOR PEOPLE WITH DISABILITIES (see:

As a licensed psychologist, I have been working w/ residents of Family Care Homes over the past year or so. I have seen people at facilities managed by various owners.

While having a roof over one's head is probably better than being homeless or living at the Mission on Patton Avenue in Asheville, something some of my Family Care Home clients have talked seriously about doing----in order to have some spending money other than the $46 of pocket change they are given once/ month----so they could get their teeth fixed rather than pulled------I would like to suggest that its not much better and it is a form of imprisonment which quickly moved into place subsequent to Wyatt v Stickney (1972 court case wherein people w/ mental health issues, who were in state psychiatric hospitals, were turned out into the community re: they could not be interned w/o appropriate treatment).

Here is how (Adult) Family Care Home funding takes place. All of the disabled person's disability check---be it $900 or $670---except for $46 (don't forget to take out the copay for the medications from the pharmacy)-----goes to paying for their room and board. Most of the Family Care Homes have bedroom accommodations that house 2-3 people. The rest of the funding comes from a local Department of Social Services fund called Special Assistance (as associated w/ Medicaid) to make up the cost of approximately $1300/ month/ resident/ room and board.

They have no spending money and therefore they cannot interface w/ the world. Therefore, their mental health worsens as does their physical health.

So, you might ask: why is living in Family Care Homes mostly the only option that many people w/ mental health issue have? Their families cannot house them or will not house them and without the Family Care Homes or the mostly unavailable Section 8 Housing, they would be homeless and living at the Mission on Patton Avenue.

The Family Care Homes is quite a big business as you will see if you look at their associated lobbying website associated w/ long term care in NC. You will see two full time lobbyists and a 20 member board which is composed of people who run Family Care Homes. Here is their website:

And so, what are the arguments that you might hear from this lobby? They might advise you that they render 'compassionate' care, as per a recent Raleigh News & Observer 'Opinion' piece. They might advise you that as per Governor Perdue's recent reductions as per the state budget, that the Special Assistance funds----which is the other stream of funding besides the 98% of the disabled person's SSDI or SSI check----is being reduced. This is yet another reason to create alternative housing for people who have disabilities. Already strapped for money, the Family Care Homes are going to have to cut back on what are already very meager services.

I know what I'm talking about: unlike many psychologists I go INTO the Family Care Homes to see my clients.

An additional reason to support The Community Choice Act House Bill 1670 is positively associated w/ NC Mental Health Reform. As you probably know, there is a NC DHHS Service Definition which has been the lynchpin piece of mental health reform in this state, entitled, Community Support Services (CSS). Though far from being available at the level that was first envisioned by creators of NC Mental Health Reform, it has done a good job of motivating people w/ disabilities to improve themselves and gain or improve skills associated w/ functioning better in the world such that they are more independent. And indeed, independence is a core matter as pertaining to disabled people.

Most recently, I was threatened with arrest by the administrator of WNC Homes that has a facility right around the corner from you and I---as per our mutual office w/ the address of 356 Biltmore Avenue----at Thurland Avenue. WNC Homes has a facility in Leicester, NC, in Buncombe County, which is very rural and very isolated. Related to that event, a few weeks ago, as I was having therapy w/ one of my clients early on a Sunday evening, the administrator of WNC Homes called the Buncombe County Sheriff who told me I had to leave or risk arrest.

Why would WNC Homes go to such an extreme? I had been working w/ the clients to define their civil rights as related to the Family Care Homes law.

I have also been speaking to Disability Rights NC and have been forwarding my clients, as they desire, to their intake as associated w/ what seems to me -----and has been assayed by non-profit legal firms throughout NC----as low hanging fruit---the matter of disabled people being relegated to Family Care Homes and their loss of their civil rights.

In my professional opinion, there are frequent and flagrant civil rights violations of my clients living in this Family Care Home and I have continued to file complaints with the Department of Health Service Regulation in Raleigh. Right now, WNC Homes continue w/ their 'superior' 3 star rating.

As you might recall, Secretary Cansler indicated that rating the Family Care Homes would avail consumers of a way to judge for themselves in terms of placing a family member in such a place. However, this has not so far been evidenced. I will continue to file complaints about civil rights violations such as: no privacy in terms of their mail; I cannot speak to them on the phone in order to set up an appointment.

INdeed, I had to go to the Department of Social Services (DSS) of Buncombe County for a two hour meeting a few weeks ago, as associated with the above matter as I had complained to the regulatory people who oversee Family Care Homes, specifically, the Department of Health Service Regulation.

DSS Buncombe, who oversees at the local/ county level the Family Care Homes, and more specifically Cheryl Simcox, within DSS Buncombe, was present at that meeting along with three representative from WNC Homes. At that meeting, WNC Homes agreed to that Dr. Hammond would be allowed to speak to her clients during regular office hours. This has not happened and I continue to be barred from speaking w/ my clients.

While WNC Homes may be an outlyer in terms of the (Adult) Family Care Homes business, my concern is at the level of there being in place an institutional bias which truncates Family Care Homes residents of their freedom and basic civil rights. As you perhaps know, there is a deficit of Section 8 Housing in Buncombe County. Nevertheless, as much as possible, I continue to work w/ Community Support Services to move my disabled clients into Section 8 housing in Buncombe and Haywood county.

To summarize, these are the reasons why it would be a good idea for you to support House Bill 1670, The Community Support Act:

1. disabled people (and I am working w/ those having mental health issues though the arena is broader as pertaining to this Act) merit being able to be as independent as they can be. This will save money, as per health care and mental health care services, over the long run.

2. The Community Support Act overlaps positively w/ the agenda of NC Mental Health Reform which has at its crux the creation of more skills and therefore more independence for people w/ mental health challenges.

3. there is a lot of sniffing around as per a class action lawsuit as per the perceived civil rights violations of disabled people living in (Adult) Family Care Homes. Contact Disability Rights NC and you will see what I mean. You can talk to Senior Attorney Mr. Rittelmeyer. Or talk to Douglas Sea, senior attorney, at Southern Piedmont Legal Services outside of Charlotte.

4. The Family Care Homes law outlines only matters associated with the 'internal' activity of the Family Care Homes and has little to nothing to say about how disabled individuals can interface w/ the external world. My interest in trying to forward interested clients to Disability Rights NC has been in terms of hoping that the law would be changed such that disabled people w/ mental health challenges would have extended rights in terms of choosing where they want to live.

5. I assure you, that if you went with me to a Family Care Home, and if they did not know that you were Heath Shuler, that you would be shocked at the boredom, non-stop cigarette smoking, completely neutered existence of people who live there. It is a disgraceful dismissal of all that humans can be and achieve. I frankly am driven to find another way to assist my clients in interfacing w/ the world or I just can't live w/ myself.

I am looking forward to speaking to you about this very pressing issue and I hope that you will support House Bill 1670, specifically, The Community Support Act : A COMMUNITY-BASED ALTERNATIVE TO NURSING HOMES AND INSTITUTIONS FOR PEOPLE WITH DISABILITIES (see:


Marsha V. Hammond, PhD: Clinical Licensed Psychologist, NC