Mental Health in North Carolina: A system in flux - WRBL

Mental Health in North Carolina: A system in flux

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North Carolina's mental health system is riddled with problems.
And while most players in the system do what they can to make it work, it's clearly in need of major attention.
There are too many players with their hands in the pot.
And as soon as a wrinkle gets ironed out, the state drops another change and it starts all over again.

It's a changing system that leaves many between rocks and hard places, looking for a solution yet "unrevealed."

"The system is a mess.  A big mess," said Carol Cannon, a member of NAMI.

When it comes to North Carolina's mental health system, families with mentally-ill loved ones usually have an opinion.

 "It's so fragmented and things change so quickly," she added.

 "They just get ready to do one thing and the system is all set up and then they come up with another obstacle," said Larry Hagler, parent.

It's a frustration also felt by many professionals treating people living with mental illness.

It's like an insurance company, making most of the important choices, which providers are in the network, who's out, will they get reimbursed, will a claim be denied, managing a network of hundreds of providers, social workers, psychiatrists, therapists, crisis response teams.

Local management entity.

These people won't talk about the issues in the system. They're afraid it'll upset the relationship with the LME.

But one provider no longer with the system agreed to speak with 9 On Your Side as long as we protected his identity. We spoke on the phone.

"Um, I find the system oppressive for both the client and the clinician," the caller said. "The barriers that LME's at the state level set up in order to achieve that goal make that a very difficult thing to do."

Those hoops, providers said, range from appeals processes to paperwork, a lot of it forcing the provider to spend hours answering the same questions over and over.

"It's a complete waste of time and a barrier to treatment. It would be a very strong word for me to use but," the caller said. "Frankly, it's unethical."

"It's something that we really do want to work on at ECBH," said Leza Wainwright. She's the executive director of East Carolina Behavioral Health or ECBH, as it's known. It's the LME responsible for the providers in the east's 19 counties, studying ways to improve the system.
 "Mental health is also a little different in that you don't see the appendectomy scar. The doctor can't prove what he did because there's some physical manifestation you can see," said Wainwright. "Sso some of the paperwork is necessary just to document what was the intervention that was done for the consumer."
Nowadays, somebody starts with a service and they get started and they start getting better.  You start getting better, so you don't need the service anymore.  So you take the service away, so now they're back in the hospital and you're spending more and more money on hospitalization.
Who takes the service away? The local LME.
"Not true. First of all we don't treat anybody except on care coordination so if we don't have providers, people aren't getting services and we'd have no reason for being here," Wainwright said. "I wouldn't put all the blame on the LME. The LME is also working within the system that's given to them. They are staffed by extremely competent, well-intentioned clinicians wanting to do the right thing. And in my dealings with LME, they've done a good job."

"Who's fault is it," 9 On Your Side asked.

"I think when there is a system there is so many players and if we all don't work together with a common goal at that point, it's all of our fault," said Wainwright.

While different providers point fingers in different directions, at the end of the day, it's our state lawmakers who make the call.
They change this system so often, it's almost impossible for anyone to grasp not only what's going on, but where to find services for a loved one.

In part two of our report "Unrevealed," 9 On Your Side looks at a system that's biggest issue is change.

"The state has changed the system that they started so many times. The system is not working today because the state continually changes," said Larry Hagler, father.

Family members of those living with mental illness know our state's mental health system well.

"It's so fragmented and things change so quickly," said Carol Cannon. She lives with mental illness. "As soon as get use to one thing being in place then we get something else coming down from Raleigh that changes everything all over again."

So do providers, our therapists, psychiatrists, and crisis teams.

"Um, I find the system oppressive for both the client and the clinician," said one anonymous caller. He asked that we protect his identity. "The state makes the decisions and the cost to the taxpayer explodes and they change it. And these decisions are made by people who are either not clinicians at all or not qualified to make the decision."

"Well, I mean clearly they get an awful lot of advice from a lot of people," said Leza Wainwright. She's the executive director of East Coast Behavioral Health, the system's management entity covering the east's 19 counties. "We send those 170 men and women to Raleigh to represent us, and we expect them to be experts on everything from mental health to how to pave a road."

The North Carolina Center for Public Policy Research's 2012 assessment of the system found one of its biggest problems is a lack of consistency in our General Assembly.

A new crop of representatives and senators come in, they have their own ideas, and something new comes down the pike, rippling down to families living with mental illness.

"They are not staying with it long enough to find out what works and what doesn't. That is just my opinion as a consumer in the system somebody with lived experience," said Cannon.

"Are they focused you think more on money? Not so much sick people but saving money," asked 9 On Your Side.

"Unquestionably the budget is a driver," said Wainwright. "But there really are, most of the members of the General Assembly that I have spoken to really also do care about people and families and want to balance."

"Do you think they understand what families with mental health issues deal with," asked 9 On Your Side.

"Certainly not all of them and to the depth that the family understands their situation. But I think they are clearly open to learning more and want to have that understanding," said Wainwright.

And let's hope they do. Because Governor Pat McCrory just weeks ago announced yet another major shift.

"While we are currently providing services to these individuals and the families we are spending a lot of money doing it," said McCrory. "And yet the system does not focus on improving the overall results and delivering better health outcomes."

He introduced a proposal for a restructure they say will change Medicaid, stabilize costs, and serve the whole person.

"I don't think there's anybody who would disagree with the broad outlines of that proposal," said Wainwright.

But right now, it's just that, a proposal, sending the mentally ill and their families toward another unknown.

"There was so much confusion before because of all the changes and now all of a sudden there's another change. Does that make the situation worse," asked 9 On Your Side.

"Yeah, I mean we certainly worry about instability," said Wainwright. "And that's a big challenge for consumers and families. If it's changed and it's for the better, then sometimes you just have to put up with some instability. "

And change is what we'll get.

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