Commissioners educated on role in mental health

by Amy Kingsley

Mary Annecelli isn’t crazy about the way mental health reforms authorized in 2001 have turned out, and she wants the Forsyth County Commission to know about it.

So every week starting in November, she’s chaperoned a small group of advocates to every county commission meeting and briefing. That’s one pilgrimage every week, including the second week of April.

“We’ve become those people,” she said. “But we do it for the young people. [Mental health] disorders claim more young lives than heart disease and cancer. They affect more brilliant people.”

Annecelli knew one such young person last October, a so-called “red flag case” who committed suicide before his family could get treatment for his mental illness. His death triggered these regular, not-so-silent vigils in the commissioners’ meeting room.

“There was no excuse for his death,” she said. “All these excuses we keep hearing are just more young lives.”

On April 10, Annecelli’s persistence paid off. The county commissioners invited a professor from the UNC School of Government to explain the commission’s role within a mental health system that has handed off most of its clinical functions to private providers. Mark Botts, who specializes in mental health policy, took them step by step through their regulatory role.

Regional mental health agencies are governed by advisory boards made up of representatives from the counties they serve. Commissioners from each of the counties sit on the advisory board along with other citizens and mental health professionals. The commission also receives annual reports and approves a business plan for the agency every three years.

The NC Health and Human Services Department requires all counties served by an agency to approve its three-year plan before it does business. The Forsyth County Commission did that last spring for CenterPoint, the mental health agency it shares with Stokes and Davie counties.

Thing is, they don’t remember doing it.

“If we did not participate in the three-year plan, does it mean it’s null and void?” asked Commissioner Walter Marshall.

That’s not unusual, Botts said.

“County commissioners and county governments are significantly removed from the mental health system,” Botts said. “Because they don’t have direct involvement and direct control, generally it’s not a priority for them, given all the things they have to worry about. And for commissioners who are interested, it’s hard to know what their role is.”

That only contributes to the turmoil surrounding these agencies, which are also caught between competing executive and legislative visions and mounting criticism of service gaps that have opened in the wake of privatization. Annecelli wasn’t shocked by the commissioners’ ignorance of their regulatory role.

“You saw how that works,” she said. “They were a little surprised, weren’t they?”

Commissioner Beaufort Bailey serves as the commission’s representative to the CenterPoint advisory board. He said the commission did hear a presentation by the mental health service provider’s leadership when it approved the three-year plan last year.

Client advocates like Annecelli have been airing their concerns in the wrong venue, he said. Instead of taking their complaints to CenterPoint’s advisory board, they’ve been going to the county commission, even though representatives from three different counties govern the center.

“The county commissioners are there to hear their complaints,” Bailey said. “We’re not going to sit up there and debate with them in public. Forsyth County can’t control everything.”

The mental health system might not be done changing either. A week before the briefing, the state released the Mercer Report, a study compiled by consultants that recommended consolidating the 25 management agencies into three to five regional administrations.

During the course of its research, the Mercer company ranked all the state’s existing mental health agencies into three tiers based on financial, clinical and record-keeping performance. Both CenterPoint and the Guilford Center in Greensboro ranked in the second tier.

CenterPoint received high marks for its financial and clinical performance, but was docked for deficiencies in record keeping.

“CenterPoint got great grades for its services,” Bailey said. “We’re doing the best we can.”

Annecelli disagrees. She said the services at CenterPoint have already suffered enough. She said the agency is treating only half as many people as it was before reform.

Botts, who aided the General Assembly attorneys who wrote the 2001 statute, said the controversy has given politicians an opportunity to reevaluate reform.

“I think there’s been enough dissatisfaction,” he said. “Things have been stirred up enough that there’s an opportunity to look at the system and ask, ‘Is this the system that we want?'”

To Annecelli, the answer is obvious.

“It was working better before 2001,” she said.

Mental health agencies like CenterPoint serve populations affected by substance abuse, developmental disabilities and mental illness. Since reform, their function has changed from a treatment center to a referral hub for private groups that receive reimbursement from the state.

Some services have been easier to replace in the private sector than others. The News & Observer of Raleigh published a multi-part series on mental health reform that showed support services for the less afflicted consumed much more of the budget than services for those with serious, chronic mental illness.

“We need to ask if it makes sense to private all direct services,” Botts said. “Things like crisis services and services for the severely mentally ill. Is trying to privatize that a good idea?”

When legislators first started debating privatization of mental health services, they were taken by the idea that private providers with a wide array of services could replace a single, central mental health provider, Botts said.

“Unfortunately that promise just hasn’t come to be,” he said.

Services like crisis care and treatment of the chronically mentally ill tend to be less lucrative for private providers, Botts said, so agencies have had a harder time finding takers for those patients.

Annecelli, who volunteers for a mental health help line, encounters the kind of people who are struggling to find services in the new system every day. She said she worries that the government is not listening to the people most affected by mental health reform. She and her fellow advocates plan to attend a public meeting on the issue at Behavioral Health Plaza in Winston-Salem on April 21.

“When you deal with diseases like this,” Annecelli said, “it becomes your mission.”

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