New DHHS Proposals Include Fourth State Mental Hospital | Eastern North Carolina Now

   Publisher's note: The author of this fine report, Dan Way, is an associate editor of the Carolina Journal, John Hood Publisher.

Legislative committee also discusses problems facing returning combat veterans

    RALEIGH     North Carolina's mental health programs have faced fiscal challenges for several years, and the programs now are running a $35 million deficit. Nonetheless, a legislative committee is pushing for the possible creation of a fourth state psychiatric facility and broader mental health treatment programs for returning combat personnel and military veterans.

    Most of the topics discussed Tuesday at a meeting of the Joint Legislative Oversight Committee on Health and Human Services revolved around finding solutions to "critical shortages" in areas such as psychiatric inpatient beds, the number of practicing psychiatrists and psychologists, and treatment options for veterans.

    Amid that backdrop, and with the visitors gallery overflowing, state Secretary of Health and Human Services Aldona Wos met for the first time with the committee and told lawmakers she was "now a whole 16 hours smart in this industry."

    With a $4.7 billion budget that accounts for 23 percent of General Fund appropriations, the Department of Health and Human Services is one of the main drivers of state spending. Its costs and various budget overruns have rankled many legislators for years.

    During her brief remarks, Wos said she planned to make the department "accountable, reliable, and that you can count on information that you receive from them."

    The next time she meets with the committee, she said, she will bring "roller skates, boxing gloves, and a very, very sharp No. 2 pencil" to lead the department "on a sustainable path in the improvement of the lives and in running the business of the state."

    The oversight committee, comprising members from both the House and Senate, unanimously approved a four-part report recommending that the General Assembly direct DHHS to:

   • Explore the costs and feasibility of establishing a south central mental health region including Anson, Cabarrus, Davidson, Mecklenburg, Montgomery, Moore, Randolph, Richmond, Rowan, Scotland, Stanly, and Union counties, and investigate creation of a new mental health facility for the region.

   • Work with the Department of Veterans Affairs and other military groups to increase training for mental health professionals working with active or retired military, do more outreach to get more veterans into Medicaid and other federally funded assistance programs, and decrease homelessness among veterans.

   • Develop with community hospitals a plan to address delayed payments and revise three-way contract payments from single-rate to a tiered rate.

   • Establish a plan for statewide telepsychiatry services, and explore incentives to remove barriers to increasing the supply of psychiatrists, psychologists, and other mental health professionals, particularly in rural and underserved areas.

    "I question the wisdom" of building a fourth state-operated mental health center, said Sen. Martin Nesbitt, D-Buncombe.

    "One of the best things we've done" was to direct mental health patients to private hospitals for care, Nesbitt said. "They make money, they can stay in business, you can keep people closer to home" where their families and caregivers are easily accessible.

    State centers too often are housing mental health patients who shouldn't be tying up beds needed for patients with long-term needs, he said.

    "They should not be there for short stays, they should not be there for crisis management," Nesbitt said.

    When implementation of local contracts first began, more than half of the people in institutions were there less than seven days, he said. The number of short-term stays still accounts for an unacceptable 20 percent to 30 percent of bed occupancy, he said.

    A decade ago, before states began "de-institutionalizing" patients, North Carolina's state-operated centers had 1,755 beds, said Rep. Justin Burr, R-Stanly, a committee co-chairman. It is now less than half that.

    "I don't think 850 beds is sufficient to take care of those folks with the most severe mental health needs," especially since the state's population has grown by 1.5 million residents over that time, Burr said.

    "I think there's a clear need for additional beds in a variety of categories," said committee Co-Chairman Rep. Nelson Dollar, R-Wake, conceding there are cost considerations.

    He noted that Wake County built a new crisis facility that is becoming more operational.

    "But they are already, in the short time of operation, having problems with people getting backed up," staying in rooms that were "designed for a matter of hours," not for several days, Dollar said. "There is such a range of needs that is out there."

    Nesbitt and Sen. Louis Pate, R-Wayne, were most concerned about behavioral health issues involving combat personnel returning home from military action.

    Nesbitt said there are many cases of closed head injuries, which are "really insidious. They cause changes in your behavior," and alter the ability to make good decisions to do the right thing.

    "It's much like Post Traumatic Stress Syndrome. People won't ask for help," he said.

    Because of the number of concussion bombs now being used in combat, the number of those injuries "will exceed any we've ever seen," Nesbitt said.

    In past wars, active-duty military personnel returning to Fort Bragg or other bases received screening, and treatment, if needed. But because so many combatants are now in the National Guard, "Our people are coming back and they're going to Rocky Mount or Asheville" and nobody is aware they have suffered these injuries, Nesbitt said.

    "We are receiving more and more veterans who are coming in with TBI [Traumatic Brain Injury] - battlefield fatigue it used to be called," Pate said. "Perhaps we aren't even aware of all of them yet." He said he's not convinced the state is doing the best job locating them or that the military is identifying them properly when they separate from the services.

    Dollar said Gov. Pat McCrory attended a public event after his swearing-in sponsored by North Carolina Veterans Leadership Council that raised "at least a quarter-million dollars."

    The council is working on a facility in Butner capable of accommodating as many as 400 beds for veterans, "particularly those who are coming back from war and have a variety of mental health issues, need some help, need some training, need some wrap-around services," Dollar said.

    In budget-related matters, Beth Melcher, DHHS deputy secretary for health services, said the mental health budget is $35 million in the red.

    Much of that is due to liabilities carried over from past years when the state had to step in and run hospitals and other facilities that lost accreditation, Melcher said.

    Sen. Tommy Tucker, R-Union, questioned why a projected $52 million in savings is shrinking as the state turns over mental health services to a new management model known as local management entity-managed care organizations.

    "That number's probably closer to $43 million right now," said Steve Owen, DHHS chief business operations officer. Delay in implementation of the program statewide is chewing the savings up, he said.

    Dollar said the final group of counties scheduled to be converted to the new system on Jan. 1 was moved to a Feb. 1 start date "to allow for additional testing of the systems, particularly the IT systems, which we are all very concerned about."