Loading...
HomeMy WebLinkAboutMinutes - 20021008 APPROVED 11/19/2002 ORANGE COUNTY BOARD OF COMMISSIONERS PUBLIC FORUM on MENTAL HEALTH REFORM TUESDAY, OCTOBER 8, 2002 7:00 PM The Orange County Board of Commissioners met for a public forum on mental health reform on Tuesday, October 8, 2002 at 7:00 p.m. at the Southern Human Services Center, Chapel Hill, North Carolina. COUNTY COMMISSIONERS PRESENT: Chair Barry Jacobs and Commissioners Alice M. Gordon and Stephen H. Halkiotis COUNTY COMMISSIONERS ABSENT: Commissioners Margaret Brown and Moses Carey, Jr. COUNTY ATTORNEY PRESENT: Geoffrey Gledhill and Sean Borhanian COUNTY STAFF PRESENT: County Manager John M. Link, Jr., Assistant County Manager Rod Visser, Assistant Manager Gwen Harvey and Clerk to the Board Donna S. Baker (all other staff members will be identified appropriately below) NOTE: ALL DOCUMENTS REFERRED TO IN THESE MINUTES ARE IN THE PERMANENT AGENDA FILE IN THE CLERK'S OFFICE. ALL RECORDINGS OF THE MEETING WILL BE KEPT FOR 5 YEARS. 1. Welcome and Introductions Chair Barry Jacobs welcomed everyone to the forum. He said that this was a public forum and not an official County Commissioners' meeting. This meeting is mandated by the State as part of mental health reform. The Board will meet on October 9`h to discuss the outgrowth of tonight's meeting. Chair Jacobs said that Orange-Person-Chatham Mental Health Director Tom Maynard would make the presentation and go over what the groups will be talking about. He made it clear that this is an opportunity to share some concerns in the small groups. He thanked the OPC Mental Health staff and the County staff. He mentioned that there is a Mental Health Reform Steering Committee that is made up of elected and appointed officials from all three counties. 2. Overview and Orientation OPC Mental Health Director Tom Maynard gave a PowerPoint presentation. He said that they have already done this in the other two counties. The State reform movement started with a State Auditor's report. After the legislature heard continual feedback from citizens that services were not as good as they should be, the State Auditor conducted a report. After the report was filed, the State changed State law. The State Statute said that the Secretary of Health and Human Services had to develop a reform plan. The local plan is due January 1, 2003. Each county has to propose a strategic plan for how they will address the demands of State reform. The objectives of the reform are to reduce the use of institutions, strengthen community services, hold local programs more accountable, transfer governance to counties, increase citizen input, reduce administrative expenses, and encourage service system choices —free enterprise model. The major principles of reform include person centered planning, self- determination, use of"best practice" methods, outcome driven, and client choice and competition. The major changes of reform are that the Local Management Entity (LME) will be directly controlled by County Government, the State chooses "priority populations" (The priority population aspect has more exclusions in the area of substance abuse because the resources are so inadequate), State payment methods change — more restrictive, LME's must consolidate by 2006, and LME's are not permitted to deliver services. This is a major change. The idea is that if they are going to have person centered service, then the public agent responsible for administering such a system has a conflict of interest if it is also the service provider. In the event that no alternatives can be found in a particular community, there are provisions for an LME to continue filling the gap until a suitable arrangement can be made. One of the main issues in reform is how to manage the fact that there are not enough resources to go around. The funds available are not sufficient to meet the need. The main idea of the reform effort is that the decisions of how to ration care should be local decisions, with more citizen input and increased scrutiny. This forum is an opportunity for public input on these issues. An independent consultant administered questionnaires and public information has been circulated. The idea of reform is to have daily feedback. The Board of County Commissioners can oversee the operation and hold them accountable. This is not the last time for the public to speak on this issue. There has been an agreement on governance and the three counties have decided to stay together and keep the reform strong and commissioner driven. The County Commissioners have recommended a strong LME structure, which means that OPC would like to have more control over the local expenditure of funds. The County Commissioners have instructed OPC to keep an eye on a number of local guiding principles as we go forward with implementing a plan. The principles are as follows: assure services are not interrupted, assure fair treatment for all staff, strengthen services for citizens, assure county level integration of services, and meaningful input and involvement of the consumers/stakeholders. Regarding how the LME would work, it would not provide services, it would manage the local public process for assessing needs and deploying resources, the resources would not be tied up in fixed programs, and the money would follow the client and the purchase of services would be individualized. There are some choices to be made in this process and questions need to be answered as follows: How should citizens, families, and consumers monitor and influence decisions? How can County Commissioners best discharge their responsibility? In what ways is divestiture a good thing, an opportunity, or a threat? How can we best maximize the good and limit the negative? What services would you most want to see more of? What services are of lesser importance? What features of the service system need to change/not change? Tom Maynard said that tonight's discussion should focus on what the public would like to see addressed and what improvements are needed. Also, how the public would prioritize services and consumers. The information from the small group discussions will be submitted to the County Commissioners at the work session tomorrow night. Cassandra Brown spoke about a study quoted that the University of Pennsylvania did on the cost of taking care of the mentally ill. They followed people and took the homeless off the street and gave them food, clothing, services, etc. and compared them to the plain homeless and there was only a $100 difference per person. She said that we were spending the money one way or another. Mark Leffuerer, an OPC staff person, made a plug for the Consumer and Family Advisory Committee. He said that if anyone is a consumer of the mental health system that all were welcomed to join this group. He asked people to contact him if they wanted to be on this group. Chair Jacobs said that we have many distinguished guests this evening - Judge Divine and Judge Buckner, State Representatives Joe Hackney and Verla Insko, and Senator Kinnaird. The attendees broke into one of seven small groups in the room on a topic of their own choosing. The seven groups were: Developmental Disability Services, Mental Health Services, Substance Abuse Services, Child & Family Services, Qualified Provider Network Information, Community Agencies & Departments, and Services for the Hispanic, Deaf and Hard of Hearing Community. 3. Summary from Small Group Discussions The groups came back together at 8:40 p.m. Developmental Disabilities Vickie Shea said that they had the benefit of written notes from the Chatham County meeting. The group endorsed the ideas from Chatham County. The group did not want to prioritize the ideas because they were all so important. They compromised on voting for some of them. The number one issue was to increase the range of housing options. The second item was to work, live, play, and retire in our community. There was a tie for third with transportation, increased respite care, and self-determination. Qualified Provider Network Angela Annis said that there was much concern voiced about the timely movement of funds from institutions to area programs and service providers in order to serve people who are now in institutions. The second concern was marketing services to the LME. The third concern was that there were providers and potential providers who wanted to be involved in the process and have input along the way and not let the voice die out. Community Agencies Royce Hardin said that there were five main issues that community agencies are concerned about. The first issue is whether local agencies could provide services. The second issue is accessibility of services to the population. The third issue is the need to collaborate between agencies. The fourth issue is the de-institutionalization process. There is concern that this will result in an increase in the homeless population, depression, and increased substance abuse. The last issue was the need to empower the vulnerable populations throughout the process. Substance Abuse Mr. Speaker (Bert) said that it cost a lot more to incarcerate someone than it does to treat for substance abuse. One of the ideas from this group was to develop less expensive services (i.e., Freedom House, Oxford House, etc.). Another idea was services wrap around. There is a need for more residential services. There is also a need for systems to include family support services. Child and Family Services Ms. Speaker spoke about this issue. This group discussed having an integrated system of mental health services for children and family. Also, there should be a system that finds ways to minimize the different categories of funding. She said that preventive and pro-active services are hard to fund. There should be coordination of services and communication between entities about families and children. Usually, there is substance abuse involved with these families. Mental Health Melanie said that she works at Club Nova. She said that continuation of programs like Club Nova that provide multiple levels of support receive multiple checks. Also, affordable, decent housing was one of the things discussed in this group. They talked about getting people out of institutions like family care homes and rest homes. The third issue is a drop—in hub center for clients, which could direct clients to the services that they need and advocate for clients. This could be a separate entity from OPC. Services for the Hispanic, Deaf, and Hard of Hearing Community Gwen Colman, parent of a deaf child, spoke for this group. She said that these groups have a hard time accessing services due to communication problems. All services should be available to the Hispanic and should not be limited because they are Hispanic. There is a workload issue because there are not enough interpreter/translators. There needs to be enhanced education and training for cultural sensitivity in working with these populations. Translators need to be paid for their services. The two big issues are the new growth in the Hispanic community and a stable deaf population that needs to know what services are available. Chair Jacobs welcomed any questions. Ms. Speaker asked about reducing administrative costs. She said that if all of the services split off into small non-profits, the cost of services would skyrocket. She said that they already get economical services from OPC and it works. Judge Buckner said that one of the problems that OPC has is the inability to serve everyone and that they cannot be out there to fix everyone's problems. He said that the courts are committed to helping also. Vickie Shea said that there is support for OPC in the community but people want more. Chair Jacobs said that the County Commissioners are proud of OPC and our staff. He said that in Orange County, we are committed to making sure that no one is left behind. Tomorrow night there will be a Board of County Commissioners' work session and they will be discussing the next steps on mental health reform. Also, in another room in this building the Affordable Housing Advisory Board was meeting and Orange County has $4 million in bond monies to start to provide more affordable housing. He knows that single room occupancy and rental units are the highest priorities in this year's funding cycle. Commissioner Gordon thanked everyone for coming tonight and she hopes they will continue to come out and to give support. Commissioner Halkiotis said that the information on the flip charts in the groups really captures the concerns of this County. He spoke about where he came from in Massachusetts and the poor farms. He saw that one of the concerns was getting people out of rest homes and he said that he hopes people do not end up in rest homes in the first place. He said that we should have the courage to stand up to a bureaucracy and insist that the bureaucracy has to go out to the people and not sit behind a desk and wait for the people to come to them. These people need follow up. He said that one of the best things he did was to vote for Tom Maynard as the Director of OPC. He has been the greatest gift to mental health in North Carolina. He asked everyone to stick with the process. With no further items to discuss, the forum was adjourned at 9:05 p.m. Barry Jacobs, Chair Donna S. Baker Clerk to the Board