WE NEVER STOP learning because we must do so to survive in our ever changing world.  As a lead advocate, a peer specialist, and a systems thinker–even to consider community level solutions,  I am finding that sometimes language can become a barrier to how we learn and respond to change.  And when walls are formed by how we use language, we can get backed up against them.  This makes responsive local community efforts even tougher!

As a person who tends her own mental wellness and who has lost a son to the overuse of alcohol coupled with his own mental ill-being, I so much want to help bring our community together around solutions that can reduce suicides and accidental overdoses and crisis needs and improve people’s opportunities to choose health and personal growth! Yet I am finding that our communities are informed by trends that keep our suffering siloed.

Yet suffering is not in a silo, and mental suffering can look like something with a psychiatric label or with a substance use label–or both.   But truly, our shared concern, then, is on mental suffering, patterns of it, how our wills are involved in making it worse, and therefore our choices–AND the patterns of a community’s response to it.

So if we in our local community begin to form a “Recovery Community,” as it has become defined only as those with substance use histories and their allies, it is not enough. I have looked up the language. I have hoped to read fact that a recovery community is actually one that supports recovery of people with mental suffering or “dis-ease”  whether or not it is related to addiction.  But clearly, it is not.  Yet for years, I have had a broader perspective on what a recovery community is and who recovery allies are.  Am I just short sited, or far-sighted?  I would hope I can assume eventually communities will support recovery for all, and that society will learn that substance use is in its purest sense a response to mental pain, as is mental ill-being.  Both of these are biological, psychological, social/relational, and spiritual in nature.

Currently, opioid use is governing so much of what is being funded, what is being seen in our emergency departments, and what is becoming the center of so many local community efforts across our state. This is a good thing, but does in go far enough? If we focus so much on solutions that mostly meet the needs of opiate users without regard for their mental wellness otherwise, is it enough?

And what about the role of peer support in our communities? Across the state, do we have the breadth of experiences being attracted into peer support work so that a person who is comfortable understanding the needs and thinking of a person who has a substance use problem also understands how to support someone who may be having extreme mental states, even psychosis, without dismissing this as merely a symptom? Because it is not. Our mental experiences, including intoxication for alteration with substances, are so often how our tender minds respond to traumas that are simply mind-blowing. Research supports this.

So how do we stop separating our potential to recover a full and meaningful life after ill-being, including substance mis-use? It starts with a discussion, and it needs to start now, because otherwise we will have lopsided community responses funded and operating while some go without the support they deserve to reclaim a meaningful life.

AS for our local community in Winston-Salem, I would like to see and strive to have a formal Recovery Community.  However, I wonder what that work to form such a community would look like. Until all of our local citizens who suffer from mental ill-health--INCLUDING those whose dis-ease with life have led them to tragic opioid incidents–are valued as deserving our earnest support, then we cannot truly have a “recovery community” in its sincerest of meanings.

 

The following analysis is shared by Martha Brock, long-time advocate for better services in our state:

LEGISLATIVE OVERSIGHT and MEDICAID TRANSFORMATION:  Some thoughts to share with you

I have learned some things recently, as I attended the Legislative Oversight Committee on DHHS in December and January and the Medicaid Behavioral Health Subcommittee this past Wednesday, February 28.  I have the advantage of living in the City of Raleigh and being able to more easily meet and talk with (and listen to) legislators that are tasked with making the laws that affect DHHS beneficiaries.

See NC Health News web site and Rose Hoban’s story titled “Behavioral Health Plan Still Needs Refining” published this week.  I was one of three consumer disability advocates who addressed the Subcommittee and commented on The Behavioral Health Plan dated February 1, 2018.

Here some things I have learned.

1. Dave Richard, Deputy Secretary of NC DHHS and leader of NC DMA, has an extremely tough and thankless role to play. The Cooper Administration is meeting resistance fueled both by policy differences and by the partisanship of legislators.  Sometimes it is hard to separate the two motivations so as to be able to come up with proposed compromise.
2. We, as advocates, have to cease clinging to the MCO system now in place—and even to the current Consumer and Family Advisory Committee (CFAC) model. I prefer to discuss the concept of “inclusion” of ALL Stakeholders at all levels of governing:  both local and state.  This means as a new infrastructure is created after the federal authorities approve North Carolina’s plans for Transformation, we will have to urge continued roles for advisory bodies.  These should be modeled on the CFAC statute and to be included in statutes and rules.
3. While the new advisory committees or Boards and Councils may be modeled on CFAC, we may have to advise NC DHHS on a different model or re-named system of advisory bodies for the state and local Managed Care system. These bodies will of necessity reflect the new realities of the newly implemented Medicaid and non-Medicaid delivery of services for DHHS beneficiaries.

Here are some issues for you and your CFAC to consider as Transformation moves quickly forward.

1. What can you do as a CFAC memberor community advocate  as the NC General Assembly addresses Medicaid Transformation?  Who should you talk to as you advocate for improved services?

•       Talk to your own representatives in the legislature in Raleigh while they are at home in your area or by phone.  If you do not know your legislators (in the State Senate and House of Representatives), go to ncleg.net and then to “Who Represents Me” tab.  It is important to look up their contact information and to note which committees they are on.  Look in particular for the DHHS Appropriations Committee members and those on the Legislative Oversight Committees on DHHS and on Medicaid.

2. What are some of the key issues being looked at by the NCGA Committees, particularly the Legislative Oversight Committee (LOC) on DHHS and the LOC on Medicaid and its two disability focused Sub-Committees?

•       First, the single best source of reporting on what is happening in Raleigh is NC Health News edited by Rose Haban(referenced above). There are other reporters including Richard Craver at the Winston-Salem Journal who write on MCO issues, but few who cover legislative activities.  Unfortunately political publications like the ones edited by John Hood or by NC Policy Watch are NOT addressing the important developments, as Transformation is discussed at the NCGA.  Nor are many associations or trade groups including the NC Assn. of County Commissioners.  com and their Capitol reporter, Laura Leslie, sometimes cover these issues.
•       It is important to remember bigger is not always better. We need to continue to support a dual system of Medicaid Managed Care that supports smaller providers as well as the larger ones. How many of you recall CABHAs?  Those entities and the demands the model placed on small groups and solo providers put many out of business.  And, those providers are still gone, as reflected in pressures on workforce availability in NC.

We cannot have a successful model of care in North Carolina in two years, if one is put in place through trial and error.  As the plan Secretary Cohen submitted to the NC Legislature states, we need to learn from NC’s previous errors and from what has worked in other states.  It is essential that the plan put in place also reflects the experience and knowledge of those served by the old county system and the current LME-MCO system, and only through our assertive advocacy will that happen.

3. QUALITY MATTERS.

As Laurie Coker asked at the Sub-Committee meeting Wednesday, “How will quality be measured?”  Will consumers and family input be included NOW in the design stage ahead of full implementation and final federal approval?  Will the quality improvement processes be designed with our input and will measures include consumer and family survey instrument reports?  Will our opinions really matter?

What are your ideas on these or any other issues on Medicaid Transformation and on advocacy on the issues affecting us and our families?  Now is the time to raise these issues and speak up to your legislators and to the leadership of NC DHHS.