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Overview

2001-2008 Reform Crisis

Most of this information comes from the N&O articles linked below. Overall, the article sounds like it could easily be cherry-picking a relatively simple, clear-cut story from what must in reality be much more complicated; information is needed from other sources.

In 2001, the North Carolina mental health care system underwent sweeping changes designed to decrease costs overall, but with the opposite actual effect; the cost has now (as of 2008-02-24) more than doubled, to $1.5 billion a year. The N&O theorizes that this is because standards are being applied with extreme unevenness: some people are receiving services they don't really need, while others who desperately need service are receiving nothing, or the wrong services. (The example they cite, however, may make sense in context; the article doesn't give enough details to tell for sure – but the pay rate of $61/hour was clearly much too high for the type of service.) Too much money went to "community support", it says, and not enough to critical services.

The 2001 reform apparently planned to shift care responsibility away from centralized institutions and out to community facilities; unfortunately, the counties were told to unload their responsibilities before the funding for the local groups was approved by the federal government. Federal approval finally arrived in late December 2005, and the new services were launched 2006-03-20.

In February 2007, the Health and Human Services (DHHS) accountability team started an audit; in November, DHHS declared a moratorium on new services. On 2007-04-04, the "community support" rate was slashed to $40/hour and then raised back to $51 on 2007-04-26.

Many new service providers were formed to take advantage of the restructured funding; Dominion Health Services, a Raleigh-based company with about 1000 employees which went door to door looking for customers for the new "community support" services, was among those – and has now been asked to return $1.5 million (of a total of $59 million from companies which DHHS says broke the rules).

Related Pages

• state government entities:
  • NC DHHS: Department of Health and Human Services
  • NC MHDDSAS
• local management entities:
  • The Durham Center
• service providers:
  • Alpha Management Community Services‎
  • Annas Resources
  • Comprehensive Community Care (Durham, NC)‎
  • Coordinated Health Services, Inc.‎
  • Touchstone Residential Services
• terminology
  • CAP-MR/DD
  • developmental therapy
  • local management entity

Links

News

• 2008.02.26 - 03.03 Mental Disorder: The Failure of Reform:
  • Part 1: Reform wastes millions, fails mentally ill "Mental-health changes in North Carolina were intended to improve community treatment and give taxpayers good value, but they have done neither. Providers took clients shopping, swimming and to movies for $61 an hour. And the cost of the community support program was more than 10 times what the state expected."
  • Part 2: Companies cash in on new service "Community support is lucrative for providers, but reviews say many clients don't need the mental-health service. Now the state wants its money back."
  • Part 3: Serious mental therapy fades "North Carolina's 2001 mental-health reforms aimed to make its mental hospitals places of last resort and to have as many people as possible seek treatment near their homes. But now people with severe needs are left without care."
  • Part 4: Caregivers abuse patients, and usually get away with it "Charges are filed in just 13 percent of cases. The lowest-paid, least-trained workers spend the most time with patients."
  • Part 5: Patients die from poor care; families don't hear full story "Since December 2000, at least 82 patients in the state's mental institutions have died in ways that raise questions, including homicides and suicides."
  • Q: How can N.C. fix a broken mental health system? "In 2001, state legislators and Gov. Mike Easley's administration set out to reform the public mental health system with a sledgehammer." This was apparently intended to lead into a reader-driven discussion, but it's not clear where any reader comments might have ended up.

Organizations - Autism

• Autism Society of NC (links)
• TEACCH Treatment and Education of Autistic and related Communication-handicapped CHildren: "an evidence-based service, training, and research program for individuals of all ages and skill levels with autism spectrum disorders. Established in the early 1970s by Eric Schopler and colleagues"
  • Carolina Living & Learning Center: an integrated vocational and residential program for adults with autism; located in Pittsboro

Organizations - Other

• Family Support Network of NC: "to promote and provide support for families with children who have special needs"
• NAMI NC: National Alliance on Mental Health, NC Chapter
• NC Health Policy Gateway, a project of Duke University and NC Blue Cross Blue Shield