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MHA/NC Letters By John Tote
An Advocate's Perspective:
Is This the Tipping Point?
Released: Tuesday, September 23rd, 2008
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Welcome to another edition of an Advocate's Perspective for the Mental Health Association in N.C., Inc. (MHA/NC). In this series, MHA/NC explores various issues of note to the constituencies involved in
North Carolina 's mental health, developmental disabilities, and substance abuse system. In this Perspective, we examine the recent history at
Cherry
Hospital and the possible effects throughout the MH/DD/SA system. It seems we have hit a tipping point.
To begin, we must answer the question, "What is a tipping point?" We will define a tipping point as a point of irrevocable change - with no assignment of good or bad - simply a point that changes in either direction.
Next, we must look at the events at
Cherry
Hospital , both in isolation and as part of a broader whole.
Cherry
Hospital is one of
North Carolina 's four psychiatric hospitals. Eventually, it will be one of three along with
Central
Regional
Hospital and
Broughton
Hospital .
Cherry
Hospital has a long standing history within the mental health community, as well as within its own community in
Goldsboro . It has played an important part throughout its history of providing short-term and long-term care to many of eastern
North Carolina 's severely ill citizens. Recently,
Cherry
Hospital has gained notoriety in troubling ways.
Staffing issues have led to well documented cases of abuse and neglect. Indeed, one horrific and well publicized incident led to the death of a resident. Because of the events that have taken place at Cherry Hospital, the Federal government, in the form of the Centers for Medicare and Medicaid Services (CMS), which oversees the government health benefits programs Medicaid and Medicare, took notice and put the hospital "on watch", if you will. Cherry had plans to make corrections, all designed to ensure adequate and essential care and treatment for residents and patients at the facility.
Unfortunately, as is now well known, during the time that
Cherry
Hospital was under review by the Federal government, additional incidents occurred. As a result, CMS withdrew the Federal funding that
North Carolina receives for serving individuals at
Cherry
Hospital . This loss of funding equates to some $800,000 per month and approximately $10,000,000 per year. Now the question is, where will the money come from? Clearly,
North Carolina has a moral and legal obligation to the individuals who are served at
Cherry
Hospital , and we will continue to see individuals coming into the hospital system since community level services and supports have yet to be fully developed across the state. In this time of deep, deep economic concerns and a stagnant economy,
North Carolina does not have new or additional tax-based revenue to put towards this shortfall. The Department of Health and Human Services has emphatically stated that they will find the money to make up the difference, though many in the advocacy community are fearful that the money will come from community-based services. Thus, this creates the final link in a chain of events that brings us to the edge of precipice, known as the tipping point.
Within the confines of mental health system transformation, some local communities have done well in developing a range of needed and desired services for their mental health population. However, many of our communities continue to be underserved in this vital area of human services. The result, in many cases, is that while
North Carolina is going through a time of designed hospital downsizing, we have actually seen the highest admission rates to our state hospitals in history. There have been numerous days in the past year where
Cherry
Hospital and the others have been at a point of capacity and couldn't take additional individuals, creating back ups in Emergency Rooms and elsewhere across the state. There must be no doubt that the individuals that work at Cherry and our other state hospitals are dedicated men and women who often work for very low pay in extremely poor conditions. It must also be said that because of the state of our system, the stress on these men and women is increasingly significant. True, there is no excuse for the cases of abuse and neglect that we have seen in recent months; however, our state has not done enough to adequately serve the men and women who work everyday in the MH/DD/SA system. We have encountered the Perfect Storm! Everyone is a loser in this storm, but those most affected are our state's MH/DD/SA consumers and their families.
It is this advocate's perspective that if some $10,000,000 is shifted from community services to fill the financial gap of
Cherry
Hospital , and we see additional community cuts such as have been proposed by cutting the rate for Assertive Community Treatment Teams, we will be at an irrevocable point of change. It is also this advocate's perspective that if this tipping point is reached in this manner, this time of change will not only be a negative one, but will have disastrous consequences as a ripple effect turns into a tidal wave.
Currently,
North Carolina is attempting to increase additional local crisis services and local inpatient capacity. Moving beyond the point that this should have been done years ago, it still must be noted that there are, and will continue to be, significant basic community service gaps even with these new crisis services. These gaps will be exacerbated if providers are forced to abandon Assertive Community Treatment Teams if an absurd 8% cut is allowed to stand. With these potentially catastrophic losses, there will be a drastic increase in need for additional capacity at our state hospitals. However, considering the ramifications of the Olmstead Decision, intended to ensure people are served in a "least restrictive environment," and N.C.'s own downsizing initiative, this is a scenario that should not be allowed to play out. Best practice for mental health care does not start at the hospital level. Rather, that should the place of last resort.
North Carolina 's "pyramid" needs to be turned back on its right self. In other words, community services should be the base of the pyramid, the middle should be community crisis, inpatient and other high end psychiatric services, and the top of pyramid, which is also the smallest component, should be the state hospital system.
North Carolina must standardize practices at the state hospitals system rather than having multiple systems, making it more difficult to lead and administer. North Carolina must see hospitals as its place of last resort, and those in leadership must make mental health care a true priority in our state by seeing that the full array and continuum of community based services be put in place in each community of North Carolina. This should not be a luxury, but a right for all of our citizens.
So to answer the question, are we at a tipping point? Perhaps only history will provide the final answer. What we do know is that we must do a better job in serving those with mental illness. This is one advocate's perspective.
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