Friday, June 17, 2011

Republican Led NC State Legislature Puts Education BEHIND MS: MA Mental Health Worker Slain by Mentally Ill Man

Matters overlap. Behaviors can be predicted. And you can predict that the further shredding of NC Medicaid and Public Education by NC Republicans will lead to scenarios like the following.

But first, let's just be perfectly clear what has taken place here as per the midnight vote of the NC State Legislature, wherein the NC Republicans and the 5 Democrats who voted with them are responsible for what is about to happen to NC citizens:

In that the best predictor of future behavior is past behavior, and in that MA has had (not even nearly) the budget cuts to public mental health that NC has had, this is the kind of scenarios that you can expect to occur in NC as a result of the callow, misguided vote of the NC Republicans and the 5 Democrats whom did not seem to be able to stand behind the Dem governor:


NYT Friday, June 17, 2011

"....The state mental health commissioner, Barbara A. Leadholm, said she believed her department was providing high-quality care despite the budget cuts it was obliged to accommodate.

"We have to be responsive to what the administration and the legislature feel they can financially afford.....

But advocates for the mentally ill, along with mental health care providers and experts, paint a picture of a underfianced department straining to meet the varying needs of its clients....Over the last two years, the department has increased its reliance on private community providers who say they are underfinanced and struggling to stay afoat. It has closed one state hospital and a small inpatient psychiatric center. It has whittled its client list by almost a thousand. And it has laid off a quarter of its case managers, severing important relationships for thousands of people with serious mental illness and transferrig them to younger, lower paid workers in the private sector......Over the last half-century, as Massachusetts eliminated over 20,000 long-term psychiatric hospital beds and many of the public, unionized jobs that went with them, the state developed a network of private agencies, mostly nonprofit, to provide care for severe mental illness.

The community system never had enogh money, many experts say, but recent budget cuts, combined with Medicaid reimbursement rates that did not keep pace with rising costs, have seriously weakened it.

"The outpatient treatment system in Massachusetts is dying on the vine,,", said Vicker V. DiGravio III, the chief executive of the Associaton for Behavioral Health care, which represents providers in the state." ....."The end result,", Mr. DiGravio said, "is a system where the folks with the least professinoal experience are serving the clients with the most intensive needs---because the Department of Mental Health serves only those people with the most severe mental illness."....

Care in "institutions for mental disease" has never been covered by Medicaid; community care is. Indeed, in the view of experts on public psychiatry like Dr. Jeffrey Geller of the University of Massachusetts Medical School, cost-shifting has been n"the major driving force" behind deinstitutionalization, "with the philosophy a tag-on." ...

Today only 3 percent of the Mental Health Department's clients live in state hospitals. For those in the community, the department has shifted in recent years from a model of care that sees serious mental illness as a long-term disability to a "recovery" model, which seeks to move clients into increasingly less restrictive, less supervised and less costly living situations.

"Its all about getting people discharged as opposed to getting them treatment," said Jill Homer, a state employed case manager for three decades who nnonetheless feels that the system has "fumbled through" its downsizing fairly well.

Dr. Marie H. Hobart, medical director of Community Healthlink in Worcester, said she worried that the new approach "pretends" serious metal illness is linear, that people who improve will never suffer setbacks. She said that seriously ill clients were being allowed to leave the care of the Department of Mental health, with some ending up homeless or in jail.....

"THE ELEPHNAT IN THE ROOM IS THE STATE MENTAL HEALTH BUDGET," she (Laurie Martinelli, the executive director of the NAMI in MA) said. "Did the murders have something to do with funding cutbacks?"

The "historical budget levels" posted on the department's Web site show a nearly 10 percent decline in appropriations for mental health from 2009 through 2011.

(Regarding the mentally ill man whom stabbed and bludgeoned the mental health care worker at the family care home):

"....Mr. Chappell was admitted to Massachusetts General for a couple of weeks. that is when schizophhrenia was diagnosed and he was prescribed antipsychotic medication, his mother said. Over the next couple of years, though, he did not take his medication consistenty because the side effects bothered him, she said. ....

The psychologist, Jeffrey Miner, cited non sequiturs that Mr. Chappell had spouted in a private session. He said that Mr. Chappell, a native of nearby Chelsea, told him various that he hailed from Texas and rooted for the Wasington Redskins and that he wanted "a lawyer from UCLA with a 3.5 grade point average." When Dr. Miner asked a follow-up question, Mr. Chappell responded, "Masseuse." ....

Ms. Moore, the chief executive of North Suffolk, would not discuss Mr. Chappell's case. Asked what her employeed did if residents becamse non-compliant with their medication, she said: "I don't like to use the word 'compliant.' that implies you can force people to take medication, which you can't." Still, she said, "Our staff is trained to observe and document, to note and report any changes, any symptomology. We would not ignore it." ....

Overall, the risk of violence from people with mental disorders is considered low. But studies have shown that it can be elevated by various factors apparent in Mr. Chappell's profile----delusions and hallucinations, a lack of treatment or failure to take medication, abuse of alcohol or drugs. the strongest predictor of violence by a mentally ill perso nis believed to be past violence...."


Rest in peace, Stephanie Moulton. You did the best you could under the circumstances. The blame lies squarely in the lap of the Republican Party, both nationally and on a state-by-state basis.


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