Saturday, January 22, 2011

Joint Legislative Oversight Committee on Mental Health is Being Pushed off the Cliff by NC DHHS

This was posted at the website where Martha Brock, a mental health care advocate, outlined how the Joint Legislative Oversight Committee (LOC) for mental health reform, has been disbanded due to 'budget restraints.'

Here is that information indicating that NC DHHS is now telling the state legislature 'what will happen':

"Tomorrow's meeting of the Legislative Oversight Committee (LOC) led by Co-Chair Verla Insko of Chapel Hill may be its last based on interviews with senior legislators and a briefing by the top official at the Division of MH/DD/SAS in the Department of Health and Human Services (DHHS).

In a meeting with members of the State Consumer and Family Advisory Committee Thursday, Mental Health/Developmental Disabilities/and Substance Abuse Services Director, Steve Jordan, said that it is possible that there will be a change in the coming session of the legislature that begins Wednesday, January 26th.

Jordan speculated that rather than limiting the scope of an Oversight Committee to one DHHS Division as it has been in recent years, the new Republican leaders may appoint instead a "DHHS Oversight Committee."

Here is my comment:

"Having a committee to oversee 'all things Medicaid' at NC DHHS will simply dilute any actions to remedy problems associated with mental health issues. In that you will not be able to call up Verla Insko or Martin Nesbitt, co-chairing the Joint Legislative Oversight Committee on Mental Health Reform, nothing will get done but will simply pass through an endless number of committees that have no accountability. Therefore, citizens, advocates, and practitioners will have no ability to impact the process.

"Who will rid me of this troublesome priest?", said Shakespeare.

"Who will rid me of these troublesome advocates?"

Why, we have no money to have these legislative oversight committees. Golly gee. Let's bury everything in a NC DHHS oversight committee so large that we can't wrestle the beast.

Marsha V. Hammond, PhD
NC Mental Health Reform blogspot :

Friday, January 14, 2011

Two Models of Comparison: NC DHHS's CABHA model vs Well-trained Available and Mobile Mental Health Provider

There's a lot of talk about CABHA, the newest version of NC Mental Health Reform to be rolled out starting 1.1.2011.

Here are some comments re: CABHA from mental health advocates across NC. Secondly, I present a model which I think works superiorly to that administratively-heavy model.

HI all:

Here is Dr. Hammond, Licensed Psychologist, whom has created another model (and there are lots of Dr. Hammond's out there, perhaps------whom operate beyond the confines of CABHA).

I continue to stay outside the CABHA loop and bill directly to Medicare/ Medicaid/ 3rd parties. My license as a psychologist allows me to do this.

Moreover, best I can tell, I perform most all the duties of the CABHA: I provide high quality therapy; I wrap around to primary care physicians and specialists by phone and letter; I cross link across Departments of Social Services, physicians, attorneys, probation officers, and clients. Another name for this is case management. This is an item associated w/ CABHA services as is therapy or outpatient therapy.

You might recall that Governor Perdue was keen on case management. This is a mistake, in my estimation, as a case manager does not stay 'close', if you will, to the client, whom, I might venture to say, is empowered by being included in the process of 'getting better.' Case management is all about creating paperwork which inches its way through a system in an attempt to get things cranked. Enough already, I say.

So, contrary to case managers, I know the clients and their families very well as I see them regularly--- and in their homes.

The only thing I don't provide is intensive in home therapy; no, I'd have to say that as re: families I see, what I try to do is PREVENT things from going to that intensive level.

And I don't see state funded clients because the paperwork does not get paid for and I didn't earn a PhD in order to fill out paperwork well.

Additionally, I believe I save NC Medicaid money by keeping people out of the psychiatric hospitals due to my availability. As you might surmise, people really do not like going into a psychiatric unit and will do a lot in order to avoid having their freedom removed, even for a few days.

I'd say that the most valuable property of any mental health service is AVAILABILITY; MOBILITY is a subset of being available as many people w/ mental health issues have transportation challenges.

Moreover, I might suggest that the quality of the system can be evaluated as associated with the paperwork requirements: a lot of paperwork means, implicitly, that the system that was created is burdened by run-away administrative costs, inefficient, and commonly not helpful to the client in a timely manner.

All my model requires is that I be mobile----that I see my clients in their homes----a subset, as I stated, of availability. This works well in rural western NC and I have a zip no-show rate and command a decent salary. Additionally, the IRS provides a nice tax deduction in terms of mileage as associated with business costs impacting my salary.

Thus, to my mind, the mental health model that works for clients and assumeably practitioners, is associated with mobility and availability. This attends to the nature of mental health issues. Strike while the iron is hot in terms of issues and you can make a lot of progress in terms of clients learning how to handle their own challenges---such that they get it 'right' or at least 'better' the next time around. Thus, they are empowered and become more self sufficient and move away from spending the mental health care $$.

If CABHA is heavy w/ paperwork, it won't work; moreover I assume it appears that NC DHHS still has not figured out that paperwork has nothing to do w/ mental health care (this is probably too radical a thing to expect of such a large organization, frankly). If you are using licensed or certified or appropriately qualified providers, you can get the work done efficiently as long as you remember what their expertise is and its not in doing paperwork.

This is why we need a one-provider medical system (remember that?): because administrative work, inclusive of paperwork, weighs down the system and diminishes availability and mobility which is what must be in place re: the mental health care business.

Marsha V. Hammond, PhD, Licensed Psychologist, Asheville, NC

Here is a comment outlining an advocate's concern re: CABHA:

Lets see if I understand all the issues in this email:

1. Why was there not consumer input?

2. Who thought of CABHA?

3. Who are they accountable to?

4. Will it be another “boondoggle” as described in the email

Just my opinion …

1. There was lots of consumer input but indirectly…….community support rolled out, LME s divested and everyone had a fit because EDs filled up and state hospitals filled up. Community support agencies treated kids and Medicaid, statistically speaking and fraud was prevalent. Everyone wanted something different and things had to move quickly

2. Who thought of it? Well that is a good question. It is not rocket science…..lets see the Area Program model with limited dollars worked. You have similar safety net type models with local health departments and DSSs…..and then you had PBH that had a comprehensive provider model that seemed to work. The state could not manage a 1,000 providers billing the day lights out of Medicaid community support. So it is not a stretch or some conspiracy to say that the state leaders did not have to look far to see what direction to drive the ship in. They just had to decide on what to call it.

3. Who are CABHAs accountable for……in a non-waiver area they have many masters. They are accountable to the State, the LME and the Feds. In waiver areas it is just accountable to the LME for they control all state, local and federal dollars.

4. Will it be another mess……….well it should prove to be less of a mess at worst. But the reality is that the devil is in the details. This good idea has not gone without its glitches. For example, the large number of CABHAs has increased supply and demand on MDs and that has driven up cost beyond reimbursement rates. Then you have child and adult CABHAs. Well what means is the child CABHAs will be Medicaid funded and adult CABHAs will limit the indigent they see and treat only Medicaid when possible or they will take their Medicaid earnings to support the indigent adults. Fat chance with a private company of that happening. Just my opinion but CABHAs need to be CABHAs, not child, adult or SA. You don’t have a local DSS to have a child DSS or an Adult DSS do you? No, they have different units within the same DSS because it is cheaper, creates synergy between professionals and is less confusing to folks needing the service. So a boondoggle? I don’t know. Growing pains, yes. Step in the right direction? Yes.

Sunday, January 09, 2011

Sarah Palin : Enemy of the State & Mental Health Treatment: She Targeted AZ Congresswoman for Supporting Health Care Reform

Yesterday I called Heath Shuler's office in D.C. to find out how he voted on the matter of the House of Representatives repealing the very minimal health care reform we gave so far been thrown-----like a dog being thrown a bone. His aide quickly indicated that he had not voted for repeal. I informed him that if I had a sense he would not support Obama's health care reform (BRING BACK THE PUBLIC OPTION NOW PLEASE), there would be no reason for me to vote for there would be no discrimination between Republicans and Democrats.

This afternoon, a Democratic Congresswoman, Gifford, was shot in the head, her aide killed, a 9 yr old child slaughtered, and others killed or maimed----and that Congresswoman was on Sarah Palin's hit list of Blue dog Dems to be taken out---to be 'targeted.'

Here is what Sarah Palin's Nazi-style plans are. It seems to me she needs to be charged federally with events leading up to this slaughter. God, that should get rid of that worthless woman.

Lack of health care reform means lack of mental health reform:

"....Miss Giffords had been named in March as a political campaign target for conservatives in November’s elections by former Alaska governor Sarah Palin for her strong support for the health reforms of President Barack Obama.

Mrs Palin had published a “target map” on her website using images of gun sights to identify 20 House Democrats, including Miss Giffords, for backing the new health care law.

Wednesday, January 05, 2011

Mental Illness is COMMONLY Chronic in nature: What NC's DHHS has Missed Regarding Critical Access Behavioral Health Agency Program (CABHA)

Long, long ago, in another galaxy, when NC Mental Health Reform was instituted (in 2000) so that consumers would have a 'choice' regarding providers (this never panned out) and so that 'free enterprise' would losen the bolts of a system disallowing a proliferation of providers (many have gone out of business due to the waxing and waning of funds vis a vis NC DHHS), there was a Service Definition created by NC DHHS called Community Support Services which was to create vital services for people with mental health challenges such that they could 'get back on their feet' ( a rehabilitation model).

However, as could have been expected, there was not enough money to pay for such a model and so it collapsed in 2007 or so. Then NC DHHS attempted to recreate something like this (CABHA)---- with an expanded array of services----to be manned and administered by a increasingly shrinking number of providers (for no one could keep up with the paperwork).

All of the models associated with NC DHHS thinking denies something as plain as the nose on your face: for many people, mental health challenges are chronic and a system that fesses up to this reality and utilizes $$ in an efficient and informed manner----is what is being called for.

The below is excerpted from a recent news article pertaining to the creation of this CABHA.

"....The N.C. Consumer Advocacy, Networking, and Support Organization, led by local advocate Laurie Coker, said its concern with CABHA is that providers "will be largely focused on quick medical fixes for symptoms and not on truly working with a more comprehensive, recovery-focused approach."

"There is nothing compelling CABHA to move toward timely interventions and supports, which reduce crises and promote more self-regulated living....

The state has flipped the switch on its latest attempt at mental-health reform — the Critical Access Behavioral Health Agency program.

Though CABHA has been 14 months in the planning, there has been lukewarm confidence among many advocates, beneficiaries and providers that the program, which took effect Saturday, was going to begin smoothly.....The N.C. Department of Health and Human Services said the purpose behind CABHA is ensuring that critical services in five categories are delivered by a clinically competent organization with appropriate medical oversight.

The categories: case management; peer support for recovery initiatives; community support teams for adults; intensive in-home treatment for children; and day treatment for children and adults dealing with such issues as substance or sexual abuse......

It's a bigger-is-better approach, leading to fewer, but larger, providers. It has reduced the number of statewide providers in those categories from 966 in November 2009 to 161 CABHA qualifiers as of Dec. 23. ..."