What Counts? And is Anybody Counting?

(Posted on FB, NC CANSO EMPOWERS page)

While the public mental health system isn’t the only source of help and support for people with mental health challenges, they are to ensure that citizens with no private means–and that is so many of us!–are given the help they need when they may need it. Are the outputs of your MCO reflected by people living higher quality lives and personal growth or is your area still having growing numbers of citizens appearing in EDs when in personal crises or because they simply do not know where to go?

If you are on a CFAC (consumer and family advisory committee), please ask about the numbers of individuals utilizing Emergency Departments and psychiatric emergency centers, where they exist. Because these numbers are the best indicators of 2) how well people are accessing services before they reach the point of crisis, 2) the service culture and quality with which they are met, and 3) the coordination of the local mental health system, including relationships with community assets that may be best able to help and individual, depending on need.

If you are an advocate serving on a CFAC or not, this is such important information for us to have! We can hardly ask for specific changes to ensure progress in our communities with out such data.

Is no one keeping this data? Then we as caring citizens must ask the legislature and the Department of Health and Human Services to put a focus on these aspects of service.   Because we may be spending way too much money on too few good or lasting results if such things are not regularly considered!



We won’t have a citizen-worthy system unless citizen stakeholders–including those who have histories with these mental health, substance use, and developmental challenges, are engaged and included 
in ensuring that dollars are buying quality for the people served!


Legislative Alert!
Call on the NC Legislative Oversight Committee on Health and Human Services’ newly established 
SUBCOMMITTEE ON BEHAVIORAL HEALTH/DEVELOPMENTAL DISABILITIES  was to have convened in the weeks ahead of the opening of this spring session (March 2).
  1. One of the VERY important aims of this subcommittee is to address the development of a comprehensive plan that would include outcome based measures, clear definitions of the roles and responsibilities of DMA, DMH, and the LME/MCOs.
  2. It would also address how to ensure that our public service systems become TRULY informed by community stakeholders, including CONSUMERS and FAMILY MEMBERS!  
  3. Further, this committee could be the legislative forum that introduces lasting recovery-promoting policies in North Carolina’s public mental health and substance use services system!
Without our voices, North Carolina will have industrialized mental health care that reflects productivity, but NOT VALUE!  Help ensure that our dollars are purchasing life-improving outcomes through better informed systems at every level!
Please help now!  Time is essential!
Email or call these Committee Members and interested others.  Tell them that you are concerned about the future of mental health services and the futures of their recipients, and ask them to CONSIDER OUR ADVOCACY EVEN NOW AND BEGIN SUBCOMMITTEE MEETINGS AS SOON AS THE SESSION IS OVER!  
BOTTOM  LINE:  We NEED their efforts!  CALL OR EMAIL Committee members and chairs:
From the Senate:
Tamara.Barringer@ncleg.net                       919-733-5653
Louis.Pate@ncleg.net                                     919-733-5621
Tommy.Tucker@ncleg.net                            919-733-7659
From the House:
Josh.Dobson@ncleg.net                                 919-733-5862
Nelson.Dollar@ncleg.net                               919-715-0795
Donnie.Lambeth@ncleg.net                          919-733-5862
Chris.Malone@ncleg.net                                 919-715-3010
Thank you for your
very important advocacy!

DOJ Frustrated About Slow Progress Supporting Transitions out of Assisted Living Facilities

The article below linked was published in Raleigh yesterday, January 19.  This is at least the second time the federal government has expressed concern about our insufficient effort re: the initiative.  For mental health consumers, this is a social justice and civil rights issue.  People in area homes have been placed here from all over the state while the legislature let us develop one of the largest “assisted living” industries in the country.    It takes guts to live in these and more guts to leave after one has become accustomed to custodial care.  

From the Raleigh News And Observer:

Federal government says NC is shirking its agreement to help mentally ill people with housing and jobs

“The state agreed in August 2012 to provide housing for 3,000 mentally ill people by 2020, and supported employment for 2,500 by 2019. The state entered into the legal agreement with the U.S. Department of Justice to avoid getting sued for violations of federal laws that require states to provide services to disabled people in the least restrictive settings. A federal investigation found that the state was segregating people with serious mental illnesses in adult care homes when they were capable of living independently with mental health services and help finding and keeping jobs.

“The federal Justice Department filed the motion on Jan. 9 in U.S. District Court, asking the court to enforce the agreement.”

NC CANSO’s Letter to the Secretary Brajer: Time to Invest in Recovery Through Peer Activity

Dear Secretary Brajer, Interim Director Vogler, Consumer Policy Advisor Ken Schuesselin, Susan Robinson and other leaders:

NC CANSO (North Carolina Consumer Advocacy, Networking, and Support Organization) is a consumer-operated non-profit organization that has been active in our state since August of 2009.  With its limited resources, we have continued to advocate, educate, and developed a vocal network of persons who have lived with consequence of mental ill-being and/or with co-occurring substance use problems.   We move forward on the principle of hopefulness because we know that so many of our fellow North Carolinians—even with severe life struggles or symptoms—can have better lives because of mutual support through peers and other factors, some of which are strengths of our mental health system.

Needs Not Captured by the State                                                                                                     The Board of Directors of NC CANSO is concerned that so few resources are dedicated to developing easily accessible, multi-functioning peer led efforts.  This includes an active, engaged state-wide peer organization that empowers others to recover and contribute to their communities.   This state-wide organization should be engaged with and supportive of the development of peer operated support centers across our state that are “safety nets” to our safety nets, offering supports not reimbursable by Medicaid but essential to the community while helping people to reclaim a social life, gaining self-help guidance and support through easily accessed centers.

Other states have funded such state wide organizations as well as such peer operated supports for many years and find them as a real complement to the formal system of services.  Peer support centers impact individual participants, the local community, and the larger mental health system.  This is evident in the noted reduction of hospitalizations among peer center participants when assessed annually.

For years, consumer advocates have met with officials to urge them to support more consumer engagement in system change and more consumer input into vital issues that may be larger than system developments (such as recovery and rights).  State staff are generally friendly, but there are years of little or usually no follow up to our concerns.  The lack of responsiveness by staff when well-meaning individuals share concerns must make us wonder if we share the same values.  Does the State honestly share the same hope for recovery that so many recovery advocates do?  Why, then, has it taken literally years of discussions and seeming dismissals of ideas with no communication with us?

Our state must address the disparity between the planning and implementation culture of our public human services system and the recovery culture which has continued to grow out in our communities—often outside of the public system.  Certainly, this requires allocation of funding toward new activity, and the one source especially made available to our state for funding such efforts is the Community Mental Health Block Grant.  In fact, in other states, (Georgia, Tennessee, Ohio, e.g.) much of what we discuss here are funded with the MHGB.

The Mental Health Block Grant in North Carolina                                                                  About five years ago, a group of consumer advocates who met regularly with the Division of Mental Health about system issues—a routine that should now be resurrected—inquired about how the Block Grant was used because we felt that new solutions could be funded with some of those dollars.  To our dismay, we learned that 88 per cent of the block grant was giving to the MCOs and 12 percent was used for other specific initiatives.  We were not satisfied with this fact then, and would be far less so now, if those numbers have not changed.  This is because while the system is still very focused on the medical model as the driving approach to services, we need Block Grant dollars to support the less clinical, more psycho-socially oriented supports to recovery, such as peer-operated services.

But additionally, we know that the MCOs under waiver management have put aside enough funds to draw on to serve the underserved through the provider system.  We trust that someone in the state will ensure that they do use these funds accordingly for client care rather than investing them to grow more money.  Anyway, we must challenge the state to put more funding toward progress-yielding solutions instead of putting more dollars toward less effective yields.

But our biggest motivation for the years of advocacy about block grant utilization is that the Federal Government has intended for these dollars to be utilized in ways that promote rehabilitation and functional recovery to the point that there is less utilization of hospitals and other facility based settings.  (United States Code Title 42, Chapter 6A, Subchapter XVII Part B.  See section on criteria for grant on page 1101 of this link:  https://www.gpo.gov/fdsys/pkg/USCODE-2010-title42/pdf/USCODE-2010-title42-chap6A-subchapXVII-partB.pdf )  Can we really make the case that the current service array and how they are managed and administered is resulting in decreasing inpatient and facility care?  Articles in the past two years suggest we need new assets applied to our problems, and we feel that the Block Grant is on source for funding some of these solutions!

The language of the above section addresses service or support needs where peers can serve and can bring expertise to bear which will have improved outcomes while costing less.  The citizens of our state deserve this!  They can bring the hope-based, strengths-oriented philosophy while also utilizing rehabilitative technique and mutuality to support progress in individual lives.  Peer specialists serve well to link their peers to other resources that may be true assets at lower cost to the system—saving costs in the long run.

A Partnership for Progress:  State Leaders and Consumer/Peer Leaders                Additionally, in the states where state-wide peer organizations and consumer operated services are flourishing, it is because of the partnering relationship between state administrations and the lead consumer organizations.  It is evident, given the demise of the past consumer organization, that there has not been the collaboration around ideas, efforts, and outcomes of the organization’s work.  There has apparently been insufficient mutual accountability between the organization and state staff, which would be required for a strong state organization to help lead peers to improved health and mental health.  The absence of such collaboration calls system culture to question.

We cannot improve our shared system without a culture shift toward consumer inclusion and recovery as defined by outcomes.  An enlivened, supported consumer movement is imperative for this to happen!   We must work together to make recovery happen!  Lip service cheapens what this word really means to individuals and their communities!  The peer community wants to work with the state, not tiptoe around and murmur or just dream.  We must engage each other toward shared goals and there must be financial and shared social support before we can truly move toward being a system that focuses on recovery for the citizens of North Carolina.

The efforts of people with personal understanding of illness and how to get well cannot be underestimated as our state seeks to preserve a person-centered foundation during a time when the system is becoming more commercial and industrial.  The industry voice in our state is louder than ever while the stakeholders to be served or those who are their peers and families and who wish to support them are weaker than before.  People are finding themselves feeling even more powerless against such big bureaucracies and even have a difficult time accessing the help they need from such large and often technology-based systems.

Our Ask                                                                                                                                                      We are aware that North Carolina is to submit its MHBG Application in September, and that it has asked for a reiteration of the previous year’s funding objectives.   We ask you to consider that in light of our changing system, the growth of the peer movement, and the need to empower people not just to have symptoms treated but to find wellness and recovery—the application should be altered.

We request that you:

  • Propose to fund a state-wide peer organization with a budget of $190,000.00 or more (I can supply bare bones numbers) with the plan to issue an RFA to include specific objectives and measurable outcomes to be reported. We have already supplied helpful information on objectives and outcomes to Dr. Vogler and other lead staff.
  • Propose the funding of five peer-operated support centers (peer support centers) at $95,000.00 each (I can supply budget information). We currently have several with no sustaining funding but great outcomes.  We can begin with them, because a shortage of peer support volunteers is threatening sustainability.  Foundations wish to help but will not until someone else is a sustaining funder.  We can have a training network as these five refine their operations and show competency in financial management.  Vogler retained a copy of a budget prepared for operating a peer support center recently.

Please, empower us to empower YOU to help our system better serve our communities!


Laurie Coker, Director of NC CANSO

Ed Rothstein, Board Chair and the Board of Directors of NC CANSO

Better Services, Not Forced Outpatient Treatment the Answer

“In this environment, court mandates alone are unlikely to be embraced and acted upon by resource-strapped mental health providers. Meaningful changes in community mental health outcomes will require attention to the intensity and quality of care as well as to its patient centeredness and recovery orientation.”
Dr. Joseph P. Morrissey at the Sheps Center in Chapel Hill
Published in Psychiatric Services, a national online journal

On the President’s Executive Order

Commentary worth reading . . . 

“I hasten to point out, however, and we must emphasize repeatedly, these two actions—gun background checks and mental health funding–are quite separate from each other, and they are not causally related. It would be a very definite mistake to link them too closely. To do so runs the risk of further stigmatizing the population of persons who suffer from mental health and substance use conditions. As has been stated very frequently, persons with these conditions are far, far more likely to be the victims of crime than the perpetrators.”

– Ron Manderscheid HERE

Ron Manderscheid Says It Best . . .

From an article written last August titled, “THE ISSUE IS GUN CONTROL”

“Last Thursday, Representative Tim Murphy (R-Pa.) asserted that we have a “failed mental health system.” He should have said we have a “failed Congress for not addressing gun control.” He was using last Wednesday’s Virginia shootings to promote passage of his own mental health bill, which has serious, if not fatal, deficiencies.

“We need to question Murphy’s logic and motivation very closely. Persons with mental health conditions, just like all individuals, deserve dignity and respect; they should not become the whipping boys for the unwillingness or inability of the Congress to pass national gun control legislation. Neither should the mental health system.

“As many of us have stated repeatedly in broadly diverse venues, the vast, vast majority of people who shoot others are not mentally ill. They may have malicious agendas, and they may be violent and angry, but they are not mentally ill. To assert otherwise simply is incorrect: Violence must not be confused with mental illness. This mislabeling inappropriately assaults the dignity and promotes the stigmatization of those who actually do have mental illness.”


Dr. Ron Manderscheid is one of the most brilliant thinkers on mental health systems I have met.  I have read his work for years, learning about his when he was working with SAMHSA.  He writes about the need to develop recovery-focused services and systems, about the role peers can plan in mental health and in integrated health care systems, about how we should be thinking about all the changes coming so fast to our system, about the civil rights of citizens who deserve better treatment access and approaches instead of forced outpatient care . . . I could go on.

He is brainy.  He is the Director of the National Association of County Behavioral Health and Developmental Disabilities Directors.  He is a leader of the College of Behavioral Health Leadership whose annual summit is a think tank where people from across the country who work in many capacities as well as people who have recovered from severe mental health challenges work hard to collaborate for solutions.  This group recently fostered research on peer support compensation but publishes other very timely reports in our field.  He loves research and quotes it easily when making his points in presentation.   Besides all this, he teaches at Johns Hopkins University!

Dr. Manderscheid is a scholar of the things that matter so much to us who wish to see our fellow citizens offered services that help them heal from their mental health challenges.  Yet he is not all brains.  He uses his knowledge with heart.  He seems to lay out paths with his knowledge to consumer leaders across states, to hospital administrators, to policy makers, to so many in this extremely diverse network of advocate-workers.  He is trusted and respected as a comrade whose values are what weave us all together.

To read the rest of this well-reasoned article on the issue of gun violence and mental health politics, check THIS out.