Mental Health Association in North Carolina

Public Policy Update

January 4, 2008

This special update features information about yesterday’s press conference with NC Department of Health and Human Services Secretary Benton regarding the state psychiatric hospitals. The announcement about the press conference billed it as a “plan to fix the mental health system.” However, much of the statement was focused on state hospitals and the relationships of local crisis services to hospital utilization. Highlights include:

• The State Operated Services section of the Division of MH/DD/SAS will report directly to the Secretary.

• A new website has been created to improve understanding of the state operated facilities.

• Dorothea Dix will remain open an additional 60 days to ensure the new Central Regional Hospital is up and running and to take pressure off of Broughton during its reorganization.

• Workgroups have been put together to work on 1) state hospital issues 2) the implementation of crisis services and impatient care across the state and 3) construction and operational questions about the new Central Regional Hospital.

The Mental Health Association in North Carolina will be participating in the group that will work on “issues that involve coordination between LMEs and public/private hospitals in crisis services, strategies for hospitals to provide inpatient services, and the requisite financial/management structure to facilitate implementation” (for more information see the Secretary’s statement below). We look forward to working together to develop solutions that will improve the lives of persons with mental illness in North Carolina . 

Included in this update is a copy of Secretary Benton’s prepared remarks, as well as notes from the press conference. Thank you to Erin McLaughlin , MHA-NC Policy Specialist, and Julia Leggett, ARC NC Policy Coordinator, for their notes and these documents. If you have any questions about these, or other mental health policy issues please contact Jennifer Mahan, MHA-NC Director of Policy and Advocacy Initiatives, at 919-981-0740 x270 or This e-mail address is being protected from spam bots, you need JavaScript enabled to view it .

Link to the new state operated services site, as well as the NC DHHS press release from January 3^rd can be found at http://www.ncdhhs.gov/

You can view the press conference on WRAL.com at http://www.wral.com/news/video/2248452/

Or view reports on the press conference at News 14  http://news14.com/content/top_stories/591391/benton-announces-plan-to-fix-mental-health-system/Default.aspx

and NBC17 http://www.nbc17.com/midatlantic/ncn/search.apx.-content-articles-NCN-2008-01-03-0010.html

NC DHHS Secretary Dempsey Benton’s Statement from January 3, 2008

As you know, Gov. Easley gave me clear marching orders back in September- fix the state’s public mental health, developmental disabilities and substance abuse services system.  In the short time I have been here as secretary I have noticed too often people were “talking past each other” not “to each other.”  I am going to change that starting today.

Every year, 25,000 people are served through our 14 state facilities.  We owe those folks and their families the best possible service.  Every dollar wasted is cheating the folks who count on us and the taxpayers.

The system is in a state of transformation.  That is very apparent in our psychiatric hospitals.  In the past 6 months, inspections by federal and national accreditation organizations have identified operational problems in the hospitals which require the department’s attention. 

We have to restore the public’s faith in our facilities.  These actions I’m announcing today will:

·        Assure the facilities meet their on-going responsibilities for providing safe and effective patient care to those being served;

·        Assure the public that quality services will be provided and share with them a continuing report of activities at the facilities;

·        Support current services that are effective and facilitate the development of cost effective community based services.

We will fix the problems that confront these services and here’s how:

The DHHS staff that is responsible for running our states institutions will be moved into my office, reporting directly to me rather than being part of the division of Mental Health, Developmental Disabilities and Substance Abuse Services.

The Hospital Management and Operations work group will be convened to work with the State Hospital Directors.  The Committee will be comprised of individuals external to the department and will include members from:

• UNC School of Medicine , Department of Psychiatry
• NC Hospital Association
• Former State Facility Managers
• Representative from National Alliance on Mental Illness
• Private Providers

Areas of review will include protocols for violence management, for placement of restraints, and administrative guidelines that can be consistently implemented throughout the state hospital system.  A thorough review of current operational challenges will be undertaken including adequacy of qualified staffing.

A work group will be established to review the implementation of the state’s Crisis Service System, and the state’s overall strategy for providing inpatient services (beds) across the state.

In the crisis services area, the group will review the current implementation activities and refine the definition of the core level of crisis services which should exist in all areas of the state.  The group will review current inpatient bed capacity (used and unused) and operational factors which are associated with successful LME crisis services and how to enhances these efforts across the state.

The Inpatient services area will involve a review of current and programmed capacities at both state and community level.  It would then involve crafting a strategy for “delivery” of the requisite levels of capacity.  This would be a results driven strategy to guide state hospital construction as well as the community systems.

This group will work on issues that involve coordination between LMEs and public/private hospitals in crisis services, strategies for hospitals to provide inpatient services, and the requisite financial/management structure to facilitate implementation.

That committee will include:

            UNC School of Medicine , Department of Psychiatry

            NC Hospital Association

            Local Management Entities

            NC County Commissioners Association

            NC Mental Health Association

            NC Psychiatric Association

            Dr. Marvin Swartz, Mental Health Commission

            A private provider

We also will be as transparent as possible to improve public understanding of the activities in the state operated facilities.  We will develop an improved web site, at ncdhhs.gov.  It will be fully operational by the end of January and eventually will include:

• Admissions/discharge data
• Admissions/delay data
• Inspections survey results and reports as well as notice when they are ongoing
• Death-actual and trends
• Significant injuries
• Staff injuries
• New programs
• Volunteer work
• Staff training

We want to be open about our hospitals, so we are going to post all of the news-bad and good-on this site.  One thing that I do know is that we have many fine staff at our institutions.  We want to do everything we can to make the hospitals a good environment for our employees as well as our patients.  To that end, effective immediately we are implementing a five percent increase in salaries for psychiatrists at all of our institutions.  We are also undertaking a study to see if there is a similar need to increase pay for our nurses and health care techs in all of our institutions.

The closing of Dorothea Dix and Umstead Hospitals will be delayed for 60 days to allow for the new Broughton management to improve operations and to assure sufficient time to address any remaining construction issues with the new hospital.

Regarding the new Central hospital, an external work group will be convened to assess the construction and operational questions associated with opening of the hospital.  The group will meet with the architect and project manager to review these questioned areas. 

In addition, the group will review the plan for the transition of services from Dorothea Dix Hospital and John Umstead Hospital to the new hospital.  Experts from both Duke and Carolina have agreed to serve on this group.

Notes from Secretary Benton News Conference Reporter Q&A:

(NOTE: These notes were taken as the news conference was progressing. Not all questions from reporters are listed but the majority of the questions and responses are included).

Matt:

Do you need to ask legislature in next session for approval of money in proposed pay raise?

Secretary Benton:

Pay raise is 1.2 million annually, this year ½ that 600,000 have made budget and in this year in the for this fiscal year and will be part of the request for the next fiscal year

Matt

Can do this without GA approval

Sec B

Yes

Bonner

Are you doing this (pay raise) due to problems in Broughton?

Sec B

Due to overall hospital situation and make sure we have a good environment for our hospital situation. Broughton has a history of being more challenging.

REP

Fed funding affect on decisions?

Sec

One factor Broughton reduced our admission cap by 10% to focus staff more directly and address special problems

All the hospitals we need to keep that amount of capacity unutilized, while we wait until not until Broughton is fully operational

REP
Looking strategy to deliver required levels of capacity last years report said we need more capacity how to determine capacity.

Sec

Role of the committee to review reports that have been developed and the three new hospital programs. The data is three years old and will be looking at all of that data.

Local and state major hospital to see if we are on target with the program and make amore definitive answer on what we can truly expect from the community system

More realistic on what can be delivered

REP
What it the timeline for this committee?

SEC
Crisis Service: begin next few weeks, work over next few months, wait see how they feel when they get together.

SEC

Not prejudge what committee will do what they can do now in terms of inpatient beds and capacity they are providing in state facility

Do not want to preclude in any particular area

REP

Can there be an additional delay again?

SEC

Have not precluded that option we are currently focusing on 60 days then see how committees feel when they get there

REP

How can you succeed were your predecessors failed?

SEC

Have a pretty strong sense of getting these issues addressed how that attitude exist before they really want to push hard and work on these issues and get program developed to address these issues

These committees are comprised of people who come to table with great deal of knowledge

Guide us to a better result

REP

Will you be asking GA (general assembly) for more funding/?

SEC

Not sure of that answer

REP

Additional 60 days to address construction issues at new hospitals?

SEC

Construction punch list items and report developed by safety officer identifying needs.

Don’t know of additional hazards, 

Do want to occupy that facility that it is ready with a minimum (MISSED)

Don’t think there are other major problems just want to clear up lingering problems and concerns.

REP

Orders to fix the MH DD SAS System how would you describe the state of system reform?

SEC

Undergoing transformation on many levels and we have challenges in many areas. We are not where people think we need to be regarding the level of quality of services across the state in the privatization effort.

Do not have crisis service and programs available across the state. That is a front door when we need behavioral health services

Mixed bag capacity patient services on a community service level.

Sandhills area good stories but not state consistency.

We need to get to state consistency.

REP

Describe system as being broken?

SEC

Not willing to say it is broken. 

REP
What would you call it?

SEC
Work in progress.

REP
Umstead patients being abused

Satisfied with Umstead right now?

SEC
Specific reference to Umstead several external perspectives brought to us over the past six months or so report from another expert looking at four hospitals over the last year

His report said Umstead operating in reasonably good standards.

His report had a concern with Broughton.

We want to have external group review those reports, set of activities to address all of the issues.

SEC
All reports we are getting is part of the reason we are taking these steps to reduce situations in the future

Part of what we are doing today is for me to be more directly involved with our facility operations

REP

The group most involved in reform was the legislature.  What is the GA involvement if they are not a part of this process?

SEC

This process is developing actions that might very well be brought to the legislature in the upcoming session and executive should do and propose solutions then take those to the governor and legislature for their consideration.

REP

Did you ask if a lawmaker or two should be in on these workgroups?

SEC
No

REP
Places to send people to once they leave the hospital? Next care providers?

SEC

See what the committees come up with MH transformation has multiple components.

Hospitals are a safety net.

Crisis services-legislature made clear is a top priority.

Legislature said to me get to the table major players that can make the change happen.

LME and major hospitals that have existing institutional standing have ability to bring this to implementation.

This does not address every part of the MH transformation.

REP

Committee comes back and says we do not think hospital should close do you have the authority to keep them open.

SEC

That would take more then just myself.

We work on a biennial budget; second year assumes the hospital will close.

If they (workgroup) come back with a decision to keep hospitals open then we will have to take that to legislature.

SEC

Group has had a lot of work; we are not where we should be with facility management.

Make sure 6 months from now we are in a better position.

People in Division have hands full with the community service right now.

REP

Do you see changes at top of the Division?

SEC

Not at this time.

REP

What does transformation mean?

SEC

That is the term most in use during my tenure here.

REP

You stated you are not an expert.  You have spent last several months in your position so what surprises you the most?

SEC

Not expert in behavioral health services but I have worked in public management.

Concern: Lack of clarity in responsibility, lack of consistency on how we deliver services

Privatization have the right standard set for providers big part of program is around privatization of services, observation we need to have standards set as a higher level to ensure quality of services and work more with LME for consistency of services across the state

Hope that community service would come forward at the community level and it did not, we need to work on that.

Short on the specificity of how to do that and need to be more specific on what it will take to do it

REP

Is the 60 day extension enough?

SEC

Don’t know could be. We will need to make the adjustments.  60 days could be successful.

Substantial construction on the hospital should be completed by mid January.

REP

Mike Moseley in the last MH DD SAS Oversight meeting stated that if we will have three hospitals open and that cost a lot of money what will this cost?

SEC

Senior budget folks have given that they see impact as fairly minimal.  (Getting central facility finished then having it ready without people in it for 60 days is minimal cost)

REP

Do you think transition was aggressive?

SEC

Folks were well intentioned when they developed that schedule

SEC

Current proposal have patients transition first of March

Called for beginning the patient move feb12 finish 1^st March that whole process would move 60 days.

60 days from March 1, transition from 1^st of May

Planning to proceed with negotiations with Wake County at appropriate time.

REP
Promises you can make to patients or families about the care they will get either in their old facility or transitioning to new facility?

SEC

Give highest possible quality of care regardless of what facility they are in.

REP
Clear lines of authority from local level clear up the state?

SEC

We will have that as a major part of our work over the next several months, comprehensive review of LMES functions and services providing to us recommendations and observations concerning our standards and level of service and consistency and areas where we should modify structure and how we can work together see that report and create a proposal for the governor.

SEC
LMEs have had a major challenge from going from provider of services to a manager of private services that is a major transition of responsibility.

Mixed story based on LME.

Change was focused on LMEs being key part.

Maybe too much expected of them during this effort need to revisit that.

Privatization LMEs have had to take on overseeing of all the private providers

They are getting their arms around it now and we are developing a new relationship with the LMEs.

Dollars spending in not most effective way can be channeled to services.

Bonner

Predecessors suggested have state take over an LME what do you think?

SEC

We will look at that.  Looking at places where we can facilitate mergers of LMEs.  We have a wide range of LME sizes we probably do need additional mergers to occur to get more balanced.

REP

LME’s directors have said they had not as much authority?

SEC

That is a tough one to wrestle with, comprehensive arrangement to handle UR process, state is doing it now and as I look at it we have grown into that role, not where it should have been, getting better on managing it.

If we send it to multiple organizations will we have again a more fragmented approach?

Private providers that are part of the system now and when you divide UR to multiple LMEs there is a concern about fragmenting the process it is an issue.