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HomeMy WebLinkAboutHSAC Forum agenda 091300"Mental Health: It Affects All Ages" Orange County Human Services Forum September 13, 2000 The Friday Center Agenda 8:00 a.m. Registration`s 8:45 a.m. Agenda /Forum Update /Introductions Welcome Commissioner Barry Jacobs 9:00 a.m. Keynote Address (Part 1) "Mental Health: Blueprint for Change" Ralph Campbell, Jr., State Auditor 9:30 a.m. Keynote Address (Part II) "Redesigning the Mental Health System in North Carolina" Representative Verla Insko, Chair N.C. Mental Health Study Commission 10:15 a.m. Break IL 10:30 a.m. Panel Discussion Moderator: Judy Burke, J.D., Developmental Disabilities Training Institute Panelists ■ Tom Maynard, Director Orange- Person - Chatham Mental Health Center ■ Wendy Trueblood, Executive Director The ARC of Orange County ■ Hudson Fuller, J.D., Acting Chair Family Violence Prevention Center of Orange County ■ Dan Blazer, MD, Ph.D. Duke University Medical Center ■ Shirley Strobel, M.A. Consumer 11:45 a.m. Working Lunch / Strategy Sessions 1:30 p.m. Group Presentations of Strategies 2:15 p.m. Forum Evaluation 2:30 p.m. Adjourn Participant Evaluation Orange County Human Services Forum September 13, 2000 I am satisfied that the information provided by the speakers and panelists has increased my knowledge of Mental Health. 1 2 3 4 5 Strongly agree Strongly disagree Comments: The design of the forum assisted me in developing strategies for addressing Mental Health issues. 1 2 3 4 5 Strongly agree Strongly disagree Comments: a. Please indicate what you liked most about the forum. b. Please indicate what you liked least about the forum. The Human Services Advisory Commission sponsors an annual workshop or roundtable. Please list any ideas for future topics: Thank you for sharing your comments. They will be carefully reviewed and given serious consideration. Please turn in the completed evaluation before leaving. PREFACE FROM THE NORTH CAROLINA STATE AUDITOR This study of the State's psychiatric hospitals was mandated by the General Assembly in Section 12.35A of Chapter 213 of the 1998 Session Laws. The General Assembly outlined work to be performed in two broad phases: confirmation and update of previous work done by MGT of America, Inc. on the psychiatric hospitals, and examination and assessment of the overall mental health delivery system for the State. The Office of the State Auditor was asked to oversee this important study by retaining and managing the work of an outside consultant. In late February 1999, we contracted with Public Consulting Group, Inc. (PCG) to perform this work. The interim report for Phase I was mandated to be submitted by May 1, 1999, with the final report due not later than December 1, 1999. This report represents PCG's interim findings and conclusions relative to Phase 1, confirming and updating the previous study's recommendations for the State's psychiatric hospitals. While PCG was able to accomplish an amazing amount of work in a very short period, we should caution the reader that this report does not contain firm recommendations as to the number or type of beds needed, nor the proper location for the hospitals. Personnel from the Office of the State Auditor, the Department of Health and Human Services, and PCG agreed that to make such recommendations at this time would be premature. PCG needs time to complete its examination and assessment of the overall mental health delivery system before it can address these fundamental questions. The proper role and use of the State's psychiatric hospitals will depend on the structure of the mental health delivery system. The hospitals are just one component of that system. Therefore, PCG has properly identified potential issues surrounding the hospitals that will need to be reexamined as work on Phase II proceeds. Our goal is to develop a blueprint for the delivery of mental health services in North Carolina. This report is the first step in that process. Respectfully submitted, Ralph Campbell, Jr. State Auditor April 30, 1999 Executive Summary North Carolina has a long and proud tradition of providing services to citizens who have mental disabilities, including mental illness, developmental disabilities and addictive behavior. The State has built a statewide system of care valued at $1.2 billion annually. This study is part of an effort to restore that tradition. It is an effort to resume North Carolina's history of innovative services, and its ability to reach out to all parts of a very complex and diverse population and to support community services by generating significant resources within the State and the Counties, and from the Federal government. During the past decade, the tradition has been shaken. Issues of management, governance and finance have made it difficult to harness effectively all of the system's resources — those within the communities and the counties and those within the State hospitals and the regional centers — and to turn those resources toward common purposes. There have been a number of setbacks and warning signs: the loss of the Carolina Alternatives waiver for children's services; the financial crises that have closed several Area Programs; the required Medicaid paybacks for certain community -based services; the recent problems in staffing and record keeping at Dorothea Dix Hospital; the closing of several community residential and inpatient services; the turnover of leadership at the top of the agency; and several re- organizations of State agency staff. While these events are not foreign to a public mental health agency, their continuing occurrence has left staff discouraged, Area Programs and providers untrusting, and the Legislature and general public uneasy. Among the professionals and advocates for developmental disabilities services, there is a growing sense that the system has lost its ability to innovate. The national movement toward self - determination, in which individuals with developmental disabilities and their families play a leadership role in making decisions about their future, has not yet taken root in North Carolina the way it has in other states. Services in large intermediate care facilities and regional centers dominate North Carolina's State spending. The ability of the State to provide direction and leadership for developmental disabilities services has repeatedly come into question. This report, under the auspices of the State Legislature, and the leadership of the State Auditor, the Honorable Ralph Campbell, is an attempt to put forth a blueprint for transforming the system. It does not dwell on past problems, nor does it assess blame. It sets out a number of new directions, innovative ideas, changes in structure, and a process for bringing together the key elements of the system in an implementation process over the next five years. It does not attempt to paint the complete picture. Rather, it attempts to begin the work with a number of bold and perhaps controversial directions, creating a new public structure and process that will, eventually, transform the service system and restore the tradition. One caveat is in order. Although a lot of money is involved, money, by itself is not the answer. In fact, we believe that the current amount of State spending is not necessarily to blame for system problems, although North Carolina can do better. The problem is that the spending patterns are not aligned with the directions the system should be taking. Too much money is being spent on too few clients. Too much money is being spent on State hospitals, on small groups of clients who have been under court order, and on intermediate care facilities — both small and large. To realign spending with innovation and quality services for people who rely on the public service system, and to create a structure that supports effective governance and financing mechanisms — these are the important challenges that North Carolina now faces. Section L Summary Report Page 1 of 35 Executive Summary This report calls for the major changes outlined below. Many more recommendations are found in the report summary that follows. The details are in the fall report. 1. A transformation of the governance structure is recommended, so that the responsibility of local management is shifted to counties and to groups of counties, acting under long -term contracts with the State to manage services. Local County Programs will coordinate all mental health, developmental disabilities and substance abuse services in community networks. 2. Benefit packages for community assessment and acute care services are recommended for all mental health and substance abuse clients entering the State system. 3. Specialized services are recommended for target populations which have been served in the State Hospitals inappropriately, for lack of appropriate services. These include individuals with serious and persistent mental illness; those with dual diagnoses of substance abuse and mental illness; clients who are geriatric; children; and adolescents. 4. The new County Programs are encouraged to increase local services to target populations through a matching process which will provide additional State funds for service expansion. 5. A new Developmental Disabilities Division is proposed. It should attract strong leadership, focus management resources on providing innovative and less costly community services, and restore confidence in the public developmental disabilities system. 6. It is recommended that the State hospital system be reduced by 667 beds over the next five years, with the savings going directly to community services. This involves the closure of Dorothea Dix Hospital and the substantial renovation and rebuilding of Broughton, Umstead and Cherry Hospitals. 7. The study projects that reduced reliance on State hospitals will save the State $51 million in operating costs. The savings can be leveraged to over $95 million in total resources from all funding sources. 8. Most of the resources necessary for the system's transformation should be achieved through State hospital savings and through the reconfiguration of current services, financial operations and administrative costs through the new County Programs. At first, however, "bridge" funding will be needed to strengthen the community as the primary locus of care. Additional funding for target populations may be necessary once the system is better aligned in the new County Program structure. 9. The Department of Health and Human Services, the State agency legally responsible for managing the State's Medicaid program, must restructure and unify Medicaid policy and operations across the three agencies responsible for services to persons affected by this report: the Division of Medical Assistance (DMA), the new Division of Developmental Disabilities (DDD), and the new Division of Mental Health and Substance Abuse Services (DMHSAS). Section L Stannimy Report Page 2 of 35 10. The State should establish a Blue Ribbon Implementation Commission to oversee and provide guidance for these changes over the next five years. We sincerely hope that this report and its recommendations will stimulate a productive and lasting public discussion that will lead to the transformation of North Carolina's system of services for persons with mental disabilities. Section L Summary Report Page 3 of 35 Strategy Sessions Facilitator: Sue Russell We can improve access to Mental Health Services in Orange County during Early Childhood by Facilitator: Rebecca Young We can improve access to Mental Health Services in Orange County for Adolescents by Facilitator: David Thompson We can improve access to Mental Health Services in Orange County for Yount Adults by Facilitator: Dee Gamble We can improve access to Mental Health Services in Orange County for Mid -Life individuals by Facilitator: Debbie Kinert We can improve access to Mental Health Services in Orange County for the Elderly by Wintergreen Facilitator: Debbie Kinert Recorder: Nancy Pagciga Sessions: Mental Health for the Elderly 1. Frank Abernathy OCDAC 2. Martha Barbee OCDAC 3. Kate Barrett Orange County Dept. on Aging 4. Ann Bradford Orange County Dept. on Aging 5. Ethel Burns Chatham DSS & Pittsboro Town Board 6. Moses Carey Orange Board of Commissioners 7. Tara Ann Dean OCDAC 8. Mary C. Dowe UNC -CH School of Nursing 9. Mary Alice Eckman Chapel Hill- Carrboro Meals on Wheels 10. J. Wilbert Edgerton, Ph.D. MHA /Orange County 11. Ann Harris Inter -Faith Council 12. Walt Jacobs Orange Enterprises 13. Kimberly A. Lassister Orange County DSS 14. Shirley Marshall EMS Advisory Council 15. Felicia McLean - Torry Orange County DSS 16. Timothy Miles OCDAC 17. Jerry Passmore Orange County Dept. on Aging 18. Peggy Politzer Shaping Orange County 19. Charlene Riedel -Leo, MSW Intern Orange County Dept. on Aging 20. Debbie kahler Siegel NC Council on Development Disabilities 21. Rosie Summers Orange County Health Department 22. Joan Terry Clerk of Superior Court 23. Terri Tyson HSAC Board of Chapel Hill 24. Anne Wells OCDAC 25. Mark Twilla UNC Health Care 26. Ginni Wolpin OCDAC