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HomeMy WebLinkAboutHSAC Forum report 2000DR. AFT Mental Health: It Affects All Ages Prepared by Human Services Advisory Commission Prepared for Orange County Boaxd of Commissioners and forum participants F(R uA,- R!1 FT BACKGROUND "Mental Health: It Affects All Ages," was the topic of the 2000 Human Services Advisory Commission (HSAC) forum. Recent legislation at the statewide level brings this subject to the forefront of local policymaking. As the forum title suggests, people need mental health assistance across the spectrum of age, as well as across socioeconomic and cultural groups. Family members, health professionals, and human services agencies also share significant stakes in mental health planning. The Orange County Board of Commissioners benefits each year from information and recommendations garnered from the HSAC forum. It also gives concerned citizens, government officials, and agencies the opportunity to come together, communicate, and work out solutions together. Attendees at the September 13, 2000 meeting numbered close to 140. OVERVIEW HSAC co -chair Debbie Kinert convened the 11"' annual forum before turning the floor over to Orange County Commissioner Barry Jacobs. He spoke about the period of transition North Carolina is in, growing out of long struggles for equitable, adequate, appropriate, and affordable treatment for those with mental health concerns. Jacobs said that North Carolina's funding levels for community programs remain low, while it institutionalizes people at a rate higher than 40 other states. He also said that one -third of the nation's homeless have diagnosable mental illness and that the N.C. Mental Health Association estimates that 30 to 35 thousand people with mental illness are waiting for help from housing to vocational services to outpatient therapy. Finally, Jacobs affirmed the County's goal to improve the mental health of its citizens in the future. Steps already taken include funding for housing and information gathered in the Master Aging Plan that addresses mental health issues for seniors in Orange County. North Carolina State ,QUESTIONS POSED BY THE 2000 FORUM M Representative Verla What are the is surrounding, the mental health system? sues s ? g Y Insko began the ♦ What are the needs of persons with mental illness? keynote address by emphasizing how What are the available resources?,: long it had been What are the gaps in service delivery? since North Carolina How do we better inform the public about existing services . had looked at its ♦ How can government and non - profits partner to improve access mental health to services and share resources for mental health? - system — 30 years. Despite an Increase 2000 IISAC Fortun ) ]_'111 A F T in knowledge, service delivery was stuck in the past. The state legislature needed to address the issue, but also needed to be informed by experts in the field and the community -at- large. State Auditor Ralph Campbell continued the address with a description of the mental health study requested by the General Assembly in 1998 that was released earlier this year. Phase one of the study consisted of an update of the 1998 MGT of America study on the four state psychiatric hospitals. Phase two included an examination of the area programs and an assessment of the mental health delivery system. The contractor chosen — Public Consulting Group (PCG) — made recommendations in three broad areas: services, finances, and governance. Many of the issue's stakeholders were brought into the process: area mental health program directors, hospital administrators, and county commissioners. Significant service PCG FINDINGS REGARDING THE STATE HOSPITALS changes involving ♦ Reduce hospital bed capacity by 667 beds, reducing the total the state's four capacity from about 2,300 to about 1,600 _p Y outdated psychiatric ♦ Close Raleigh's Dorothea Dix Hospital, leaving only three hospitals were renovated campuses recommended. The i ny? I: It's the most expensive hospital to operate. Potential savings MGT study as well represent $13.2 million annually. 2. Area offers good opportunities for as PCG stated that the development of community -based services and employment alternatives for staff. 3. With proper planning, the "safeo) net" can be the hospitals needed maintained. 4. Dorothea Dix offers the richest opportunities for re -use. to be renovated � significantly, or else rebuilt entirely, at a PCG- revised cost of $490 million. PCG found that the state hospitals should focus on providing intermediate and long -term facilities rather than being the only choice for care for many patients. Many services can be provided by local organizations, although "additional analysis is needed in order to assess current services and to develop a strategy for planning, funding and implementing high - quality community based programs," according to PCG's summary report. It also stated that "North Carolina's mental health system does not currently have the capacity to treat all groups of individuals at the community level. Proposals to move entire populations into the community are not realistic and would not constitute an appropriate plan." PCG also recommended establishing a standard or core benefit package for all mental health clients, due to wide variations in community services across the state. The report found that existing local programs lack accountability both to state and to local government, and that governance and funding are not coordinated. PCG proposes adopting a County Program model that will "shift management responsibility for mental health, developmental disabilities, and substance abuse services to North Carolina's counties." Counties would be able to partner together within State guidelines. However, this shift would not become an `unfunded mandate.' 2 PCG FINANCIAL FINDINGS ♦ N.C.'s funding for mental.health and substance abuse services is higher than. .the national average The largest percentage of funding is going to support the four psychiatric hospitals ♦ Area program budgets for services and administration costs vary widely, Administration costs at area programs have been increasingly leaving less. funding. available for -:services at the local level Mental Health: It Affects All Ages In fact, "although a lot of money is involved, money by itself is not the answer." PCG recommends establishing a financing process for the basic benefits package, clearly defining target populations and services required by those populations. "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," according to the report's executive summary. PCG's study was expanded to include an assessment of the feasibility of establishing a separate division for developmental disabilities. They found that strong leadership is necessary at the state level and that the state should consider establishing a separate division, although further study is needed, especially at the local level. At the time of the study, the Office of the State Auditor recommended a five -year transition process and the establishment of a Blue Ribbon implementation commission. Insko said that a legislative oversight committee was established instead that would have statutory authority that would be ongoing. The to -be- appointed committee will have eight Senators and eight Representatives and will be called the `Joint Legislative Oversight Committee for Mental Health, Developmental Disabilities, and Substance Abuse.' She asked the audience to insist that we build community -based services before de- institutionalization. The next segment of the Forum consisted of a panel discussion whose members included: Tom Maynard, Director of Orange- Person - Chatham Mental Health Agency; Wendy Trueblood, Executive Director of the ARC of Orange County; Hudson Fuller, Acting Chair of the Family Violence Prevention Center of Orange County; Dan Blazer, professor of Psychiatry and Behavioral Sciences; and mental health advocate and author Shirley Strolbul. (SP. ?) Maynard spoke in favor of the auditor's report. His view is that "the system is broken and needs fixing," and he agrees that there is not enough accountability in N.C.'s current system. He also supports reorganizing services at the county level, although he hopes the state recognizes that more resources are needed. However, locally, Maynard Some clipart 3 2000 HSAC Portia .1.) 1 i . F 1.1 said that OPC Mental Health has been trying very hard to give consumers and taxpayers a better result per expenditure than in the past. The budget has decreased over the last ten years, and three- and -a -half times as many people are being served. OPC Mental Health spent 14% less this fiscal year than last year, and services were increased by 6 %. This year's budget also dedicates more resources to improve crisis services. The organization is rededicating itself to strengthening the three primary systems of care — child services, developmental disabilities, and mental health/substance abuse for adults. Trueblood explained that the ARC's mission in Orange County was to provide opportunities for families and individuals with developmental disabilities to live as fully as possible in all areas of life. She said that family members have a difficult time navigating the care system and that they find that there is no consistency within the state. The ARC concurs that developmental disabilities should be pulled out of the mental health/substance abuse system. The ARC is also glad to hear that OPC Mental Health is stepping up its crisis services because it is a big area of need, especially with children. Fuller said that violence is a mental health issue because of the severe emotional effects that violence has on children. Violence in the home can also lead to neglect of individuals in the family suffering from mental illness or developmental disabilities. Children from homes where there is violence, whether directed at them or not, face a huge number of problems including a suicide rate six times as high as in homes without violence. Older children are 74% more likely to commit a crime against another person and 50% more likely to abuse drugs or alcohol. Fuller said that intervention does help, and if there is help for children, they are less likely to repeat the pattern in their adult life. Blazer spoke about how the percentage of the elderly will increase greatly in the United States as the Baby Boomers get older. This generation has borne a great burden of mental illness, in fact, each succeeding generation is carrying an increased burden. Mental health care for the elderly is very expensive (including care resulting from Alzheimer's disease), although Medicare pays for very little while Medicaid pays for much more. Family members must spend considerable time taking care of older persons at the expense of their own families. The elderly population is unusual in that, 1) you can't separate general health care concerns and mental health care; 2) mental health care for the 4 Mental Health: It Affeets All Ages elderly can not be separated from issues of housing; 3) you also can't separate out the continuum of care. Blazer said that funding for services will be "absolutely critical." Strobul's book, Creating a Circle of Caring, is a curriculum to open up churches and lay people to be concerned and involved in the welcoming of the mentally ill. Her experience with her schizophrenic son who has suffered for 24 years led to her stressing that some people need significant long -term care and not just medication. People like her son become institutionalized to rest homes and hospitals, and need early intervention so that they can lead more normal lives. Good crisis teams are needed desperately and special assistance money should be shared with case management and not only rest homes, so that the mentally ill can live in apartments with assistance. MENTAL HEALTH ISSUES Forum participants separated into five working lunch sessions to begin the afternoon session. Each group concentrated on improving access to services for the Hispanic /Latino Community. Young Children's (Birth — Eight Years Old) Facilitator: Sue Russell ➢ Equity of access to services (poor, working poor, bi- lingual, geographic, communication skills, transportation, insured and uninsured). ➢ Ensure an early collaborative effort between schools, Mental Health, DSS, and Health Dept. ➢ Quality, availability and continuum of mental health services. ➢ Increase schools capacity to deal w/ mental health issues. ➢ Automatic mental health treatment services for children involved in domestic violence and child abuse. Adolescents Facilitator: Rebecca Young ➢ After - school services * Coordinate school and agency services to provide after- school services for older students (after - school is defined as all non - school hours, including summer). ➢ Services for youth growing up in violence * Provide comprehensive services for youth growing up in violence. * Provide support to children, families and the community regarding family violence. ➢ Out -of -home placements * Expand options for appropriate out -of -home placements. ➢ Crises services * Provide crises services. ➢ Adolescent substance abuse * Respond to the rate of adolescent substance abuse. * Provide services for adolescents growing up in homes where their parents are substance abusers. ➢ Strong partnerships between schools and mental health services * Develop strong partnerships between schools and mental health agencies /services. * Provide mental health services in the schools. 5 2000 HSAC Toruin .1.) 1 i .:1 F, I., 0 Young Adults Facilitator: David Thompson ➢ Need for affordable housing, including single room occupancy housing. ➢ Improvement of flexibility in which County administers services and increases local funding. ➢ Support services for mentally -ill young adults who want to live independently. ➢ Educate community about what it can do to help. ➢ Education and publicity about available services (especially for newcomers to the system). Mid -Life Facilitator: Dee Gamble Some clipart on this page ➢ Increase in supportive, safe, and affordable housing, including single room occupancy housing. ➢ Need for an increase in unrestricted funding. ➢ There should be a full range of mental health services for domestic violence and sexual assault survivors and their children. ➢ Improve transportation alternatives for the mentally ill. ➢ Need for developing community crisis teams. Elderly Facilitator: Debbie Kinert ➢ Sufficiency and accessibility of Mental Health Services. ➢ Respite care for the caregivers. ➢ Availability of resources that are not "means tested" (need for Universal Coverage). ➢ Fragmentation of services in County Senior Centers, i.e., need to use an interdisciplinary wellness model. ➢ Inequality of Orange County Services in the different regions of the County (i.e., northern Orange versus Chapel Hill). CONCLUSION