N.C. Center for Public Policy Research

1. N.C. Center for Public Policy Research Sustaining Hope for Mental Health Care in North Carolina Mebane Rash and Aisander Duda January 22, 2011

3. Part II of the Center’s Study Mental Health, Developmental Disabilities, and Substance Abuse Services in North Carolina: A Look at the System and Who It Serves One Man’s Journey Through Tolstoy’s A Confession and Out of Depression Buying Local Hospital Beds for Short-Term Inpatient Psychiatric Care The North Carolina Mental Health Study Commission: A Better Model Because of Stakeholder Inclusion, Independent Staffing, and Strong Leadership North Carolina’s Mental Health Work Force Mental Health and Medicaid in North Carolina: Services and Support Under Federal Law The Privatization of Mental Health Services in North Carolina The Genesis of Community-Based Mental Health Services in North Carolina: The History, Structure, and Accountability of Local Management Entities

4. Part III of the Center’s Study 50-State Research We will examine mental health reform in other states – looking for successful efforts in complying with the U.S. Supreme Court’s decision. We want to compare the experiences in three states where mental health reform has worked (Kansas, Massachusetts, and Minnesota) with three states where it hasn’t worked (Georgia, Michigan, and Nevada). Survey of the Mental Health Work Force In 2008, the Workforce Development Initiative released their report on the mental health work force situation in North Carolina. The report notes that information about the current work force is not available, and therefore the initiative was unable to compare the work force needs against the currently available staff and their skills. The report states: “Ideally, the following information would be available for staff of service providers, of LMEs, and the state-operated facilities and central office of the Division: the number of positions by title, number of vacancies, wage range, turnover rate, education/training and experience, and demographics of managerial, administrative, clinical, and direct support staff.” This information still is not available in North Carolina. In early 2011, the Center will survey all providers of mental health services to gather this important information. The Architecture of the System This article looks at the structure of the system and whether the system can meet the state’s needs going forward.

5. Persons in Need, 2009

6. Persons Served in the Public System of Care, 2010

8. The Budget • FY 2009-10, MH/DD/SA Division’s budget cut from $820 million to $664 million, a 19% cut • FY 2010-11 • $40 million restored for community services provided through LMEs • Save $41 million using rate and utilization management • Save $7.7 million using independent assessments • Save $50 million on in-home personal care services • FY 2011-12 • Projected state budget deficit of $3.7 billion • Enhanced federal match for Medicaid ends. North Carolina’s share goes from 25% to 35%.

9. The Budget for MH/DD/SAS

10. Why Medicaid Matters in Mental Health: Mental Health Services Funded by Medicaid • Intermediate care facility services for the mentally retarded (ICF-MR) • Inpatient hospital and nursing facility services for individuals 60 years of age or over in an institution for mental diseases • Inpatient psychiatric services for individuals under age 21 • Outpatient prescription drugs • Physical therapy and related services • Personal care services • Diagnostic, screening, preventive, and rehabilitative services • Case management services • Other medical or remedial care • Home and community-based services to individuals with mental retardation or developmental disabilities

11. The National Mental Health Picture:A Look at Six States

12. Secretary of NC DHHS, Lanier Cansler “Mental health reform is over. Now we are about building a mental health system and doing the things that we need to do to build a strong system across the state.”

13. NCCPPR’s 50-State Study Six States Researched More Thoroughly: 3 States Where MH Reform Has Worked Well • Kansas • Massachusetts • Minnesota 3 States Where MH Reform Has Not Worked Well • Georgia • Michigan • Nevada

14. Four Factors to Evaluate State Mental Health Systems • Governance – Which level of government is responsible for the care of the mentally ill and how do they perform that task? • Coverage – Who gets coverage in the public system? • Work Force – Is there an adequate supply of workers to provide MH services? • Funding – How will services be paid for?

15. Trend 1: Funding • North Carolina is currently expanding the Federal 1915(b)(c) Combined Waiver for our Medicaid program. • Waiver has been in operation by Piedmont Behavioral Health LME since 2005. • Michigan – has statewide 1915(b)(c) Combined Medicaid Waiver with mixed results: • Michigan has been able to save money and increase provider and service quality. • Michigan has struggled to match federal dollars with state dollars and has seen consumers forced into dire situations to get services.

16. Trend 2: Consumers • States are giving consumers a voice in both their treatment and in the governance of the system. • Georgia – Peer Support and Wellness Center – Offers consumer run programs focusing on recovery and community resources. • Massachusetts – Genesis Club is an International leader in offering training and vocational programs to help their MH consumers work in the community.

17. Trend 3: Prisons • States can choose to fund corrections as the service provider or the community mental health system. • Georgia – Has chosen to fund Dept. of Corrections and now 1 in 13 Georgians are currently incarcerated or paroled. An estimated 60 to 70 percent of inmates need MH or SA services. • Minnesota – Has chosen to fund the community MH system, and has lowered the burden on local Sheriff’s departments. Rivers State Prison – Milledgeville, GA

18. For More Information: Mebane Rash Attorney & Editor, North Carolina Insight N.C. Center for Public Policy Research 5 West Hargett Street, Suite 701 PO Box 430 Raleigh, NC 27602 (919) 832-2839 mrash@nccppr.org www.nccppr.org