news-record.com

RALEIGH — Some of the most pressing problems afflicting North Carolina's mental health system can be fixed with stronger oversight from state officials, Gov. Mike Easley said Tuesday.

Should state officials get additional power to manage the mental health system? Join the discussion at the Debatables blog.

"We need dramatic change, and we need it quick," Easley said.

He called on legislators to give the Secretary of Health and Human Services the power to hire and fire the directors of local mental health agencies. That power now rests with appointed local boards that have minimal requirements to report on their work to either state or local elected leaders.

Although legislators have yet to hear details of Easley's plans, they agree that changes are needed in the state's mental health system.

"I've been very troubled by this for some time," said Rep. Pricey Harrison, a Greensboro Democrat. She said that although some legislators, such as Rep. Verla Insko of Orange County, have been working hard on mental health issues, it has not been a focus for others.

"We're not doing right by the patients, and we're not doing right by the tax payers," she said.

Easley has presided over mental health reform, an effort begun by the General Assembly in 2001 to remake the state safety net of mental hospitals and treatment options for those who could not afford services on their own.

Under the old system, most services for the poor were provided by local governments agencies that hired psychiatrists, counselors and other professionals.

After the changes, those local agencies have gotten rid of their treatment arms and become the managers of a network of private providers.

Those private agencies — some large and some staffed by no more than a five or six people — provide care under the supervision of the state and so-called Local Management Entities.

This new system has allowed for abuses documented in news reports during the past four years, including in the News & Record. Most recently, the News & Observer of Raleigh published a series that illustrated many of the system's problems, and Tuesday's news conference in part seemed to be a response to those stories.

Although some providers have given excellent care, others have been cited for shoddy service and overbilling the state.

"Essentially, what you have is privatization with no accountability," Easley said.

Speaking alongside Health and Human Services Secretary Dempsey Benton, Easley outlined three broad steps he said the state should take:

lGiving Benton and future health secretaries the ability to take decisive action, such as removing providers who don't follow the rules from the system and more authority to manage local agencies. Easley also said that the 25 local agencies that run the state's mental health system — such as the Guilford Center in Guilford County — should be consolidated into fewer entities in order to save on administrative costs.

lRenegotiating contracts with providers so that unskilled health care attendants are not paid at the same rate as doctors and psychiatrists. The state, he said, is renegotiating its Medicaid agreement with the federal government so this can happen.

l Reducing stays in state mental hospitals. Reform efforts were supposed to reduce the number of patients flowing into state hospitals, but the number of patients has actually increased since reform efforts began. Easley also proposed making some extra beds available, at least temporarily, to handle the influx of new patients.

It is unclear what effect, if any, these changes would have on the Guilford Center, the mental health agency that serves Greensboro, High Point and the rest of the county.

Already, the agency has developed partnerships with mental health agencies in Mecklenburg County and some western counties to share workloads and administrative costs.

Billie Martin-Pierce, the Guilford Center's director, said she was due to meet with Benton twice this month and would find out then whether that consortium agreement would stand or whether the state would require more radical changes.

Although the Guilford Center has not been immune from problems, it has had fewer serious issues than some other local mental health agencies, Martin-Pierce said.

"At the end of the day, the work here on the ground is the same. It doesn't matter who the governor is, who the legislators are, it doesn't matter who I am," she said. "There are clients, and they need to be served and served well. And that has not happened on all fronts."

Contact Mark Binker at (919) 832-5549 or mark.binker@news-record.com