A Legislator’s Perspective on the State of NC Mental Health Reform: An interview with Rep.Verla Insko

By Lisa Hamill

WHAT DO YOU SEE AS LEGISLATIVE RELATED MENTAL HEALTH REFORM ACCOMPLISHMENTS?

his is not just reform, it’s really a  transformation of the entire system. One of the most important changes has to do with best practice or evidence based practice. Under the previous system our service definitions were out of date, so providers couldn’t deliver an array of best practice treatments because they couldn’t get paid to deliver them. In reviewing all the services across the state, we found that the best practice treatments some area programs were delivering were not completely true to the model.

We went through a long process to develop new service definitions and new rates.  These new service definitions have recently been approved by the Federal Center for Medicare and Medicaid Services (CMS), and new rates will apply. [See news bulletin on page seven] This huge accomplishment allows us to contract with providers who will be clear about what services they can provide and how much they will be paid for each service. With the new service definitions—that cover the best possible treatments we know about today- we will be making better use of public dollars.  We also put into place a process for continuous review and updating of the definitions so we won’t get so far out of date again.

Of course, we have to make sure the providers are trained to deliver the new treatments and that they know how important it is to maintain fidelity to the model.  Fortunately the Area Health Education Program and the Area Health Education Centers are taking the lead on training sessions across the state that will bring all providers up to date.  

System of Care is a good example of a best practice model. Last session, I put a special provision in to the budget that set up Child and Family teams in school systems.  The Child and Family teams use the System of Care model.  When a child is identified the team leader will pull staff from various agencies to work together with a family member to provide appropriate services that will help the student be successful.  Child and Family teams are based in the schools but they pull in staff from social services, public health, the court system and any other agencies that can be involved to work with the student.

Creating different levels of support provides alternatives to hospitalization and helps move money from state institutions to community based services. For example utilizing mobile crisis units means less spending on hospitalization. Durham is working on minimizing state institutional stays and in return, may receive the money saved to spend towards local community services.

Another goal of reform was to create more consumer/family involvement. The Consumer and Family Advisory Councils (CFAC) are one way to do this. The local and state CFACs are an accomplishment that enables more involvement from consumers and their family members.

WHAT BARRIERS OR CHALLENGES FACE MENTAL HEALTH SYSTEM REFORM?

Lack of service funding is the biggest barrier.  Federal funding cuts and the economic downturn in NC with the loss of jobs in tobacco, textiles and furniture has affected the amount of money available. This legislative session there will be a big effort to move more money into the mental health system. We could also save administrative money if we could merge some of the smaller LMEs.  Merging would free up more funds for services. Progress has been made in this area.  We used to have 40 area programs and we now have 30 LMEs

This new system really demands a different kind of leadership at the LME level.  Under the previous system, Area Programs delivered mental health services and many of the program directors were former service providers.  For mental health reform to be successful, we need to make sure our LME directors have the right set of management skills.

LMEs also need to have board members with management experience. Board members are unpaid volunteers and some have more experience than others. Their time commitment varies from LME to LME.  To strengthen boards, we may make some kind of board training mandatory, such as taking a course at the School of Government at UNC-CH.  

Another challenge is finding enough money to provide services to consumers who are in the target population but do not qualify for Medicaid.  Previously, area programs had more flexibility in providing these services. We will have to put more money into the system to meet this need.

HOW CAN THE STATE ADDRESS THE NEEDS OF INDIGENT CLIENTS?

Under the previous system the Area Programs had clinicians who were supported by Medicaid dollars.  They could work some of the indigent clients into their case load.  That was the main way indigent consumers were served.  Now we have to support these same consumers with 100% state dollars. As you well know, the state dollars are not distributed fairly across all LMEs. In March, 2006 the NC Division of Mental Health, Substance Abuse and Developmental Disabilities will be required to submit a proposal utilizing a new formula that takes into account the incidence

of MH/SA/DD clients, in order for funding to be distributed more fairly across the state.

In any county, when folks aren’t getting the services they need, they or their advocates should call their legislators and let them know. They can

contact the NC Department of Health and Human Services, Division of MH/SA/DD, to ensure consumers get the help they need. In Orange County, Rep. Insko is the one to contact. (verlai@ncleg.net  919-733-7208)

HOW DO YOU SEE THE LEGISLATIVE OVERSIGHT COMMITTEE PROVIDING CLOSER OVERSIGHT, DIRECTION, AND LEADERSHIP WITH THE MENTAL HEALTH REFORM PROCESS?

The Legislative Oversight Committee is requiring the Department to develop a strategic long-term plan to work on challenges. This plan should address service gaps for all three disability groups.  This should include crisis services, respite services, developmental day care, ACT teams, clubhouses, etc.   This long range plan is being done for the first time.  

The Legislative Oversight Committee will also be following LMEs too make sure they know how to evaluate outcomes and to know when to get more training.  It is important that government oversees how public dollars are spent.  This is especially hard with health and human services because outcomes are hard to measure and for years we have measured how many services we provide instead of whether the services make a difference.

ARE THERE ANY MENTAL HEALTH RELATED BILLS COMING UP IN 2006?

One probable Mental Health bill could involve strengthening local boards. This would require members to be trained to understand their role and understand MH/DD/SA disability groups.

Each year a Mental Health parity bill is submitted by Rep. Insko and Rep. Martha Alexander. The insurance industry is opposed to this. The problem is that insurers are set up to make a profit, not to provide health care, which creates a counterintuitive system.  We will try again in this session to have this bill heard and voted on. 

Lisa Hamill serves on the NAMI Orange Board of Directors.   lisahamill@earthlink.net