IF YOU WANT TO BROADEN THE MENTAL HEALTH AND SUBSTANCE USE  RECOVERY CULTURE IN POLICY AND PRACTICE IN OUR STATE,                                          HELP US ADVOCATE FOR THIS BILL!

How can you help?   TARGET THESE GENERAL ASSEMBLY MEMBERS and tell them we need the Peer Wellness Center Pilot Program in our state!  (Bill number to be assigned mid-week after Easter)

Health and Human Services Appropriations Committee Chairs:  Click on Senators Bishop and Krawiec to get contact information.  Phone calls are best.  Many legislators are reading fewer emails these days.  If you send an email, copy it to their assistants and ask that they ensure their bosses get the message.

Leadership in the House of Representatives:  Please advocate to any on the list who may represent your area.  Focus may be more necessary on Republicans as they may be less informed about community level innovations and peer support and that these reduce need for hospitalization and would help NC become more successful at supporting integration for members of the Transitions to Community Living Initiative.

BACKGROUND

After targeted education and advocacy about the need for peer operated wellness centers as part of the community array of supports in our state, Representative Verla Insko is soon to introduce a billed called Peer Wellness Center Pilot Program.  The bill spells out the purposes for these centers, objectives to be met and measured, and the fact that the bill calls for funding one rural and one urban pilot for two years.  Pending the success of these two sites, our hope as advocates is that these will be expanded through time across many North Carolina communities.  There are more than 45 such sites in Tennessee as well as many in Georgia.  In Georgia, these sites have been the foundation to the development of peer respite centers as a logical second tier in peer support based wellness center expansion.

In North Carolina, there have been at least two strong mental health supporting centers developed by peer specialists and aimed at mental health recovery, which is similar but of necessity different from the more familiar substance use recovery models.  One is Promise Resource Network in Charlotte, which has operated upward of 10 years.  The other, GreenTree Peer Center, has operated almost 7 years.  Each of these is funded by different means and operated in capacities according to their funding (while a strong and active presence in Winston-Salem, for instance, GreenTree can only be opened in the afternoons).

While these centers do serve people with dual recovery needs of mental health AND substance use, peer facilitators are prepared to work with people who may have extreme experiences (psychosis) with support that helps people adapt to some mental phenomena that do not respond to their medications.  The centers are trauma-informed in approach and focus on harm reduction and safety promotion, which supplements the  12 Step recovery support model, many of which are already offered in communities, even in rural ones.  (Many of our participants at GreenTree are also a part of the 12 step community in Winston-Salem).

THe funds for this pilot may come from the Mental Health Block Grant in order to ensure that the Mental Health population receives more focus and funding than it has, historically.  (Note, the Substance Use Block Grant has funded community based initiatives that are independent of the formal provider system for several years.  This would be a step into a brighter future where mental health recovery is truly recognized and valued and where its integration with physical health care is prioritized.)  In many states, peer operated centers are a strong component of an integrated system.

 

 

 

Summary by Sarah Potter and Laurie Coker

The Consumer Caucus at this year’s annual conference at Pinehurst was certainly lively, with most of its participants being actively vocal.  We thank the I2I Center for hosting this annual consumer-led discussion. It is one of the rare spaces that consumers and family members can speak about shared hopes and concerns in an open forum.  About 25 consumers and family members from across the state, many of whom represented local or state level Consumer and Family Advisory Committees (CFACs), came together to discuss changes under Medicaid Transformation.  

There was no pre-set agenda, but Laurie Coker of NC CANSO (North Carolina Consumer Advocacy, Networking, and Support Organization) graciously volunteered to lead the discussion, beginning by sharing some history of consumer engagement in our public mental health system.  (She has been a strong advocate for fifteen years and has witnessed system changes. She currently runs GreenTree Peer Center in Forsyth County).

The key theme that emerged was the need to ensure a vibrant role for the voices of consumers and families in ensuring higher quality services and supports during this time of Medicaid Transformation in our state.  The following are some highlights from the discussion:

1)  The role of CFACs is unclear and even uncertain in the future of Medicaid funded service delivery and administration.  

• We need new language in State statute 122C to reflect today’s operational environment and to ensure that there is meaningful and integrated advisory input from system users, families, and those who have recovered health and understand how best to serve people through the system.
• To better identify gaps in service, CFACs should work to be better connected to their communities, possibly through hosting regular listening sessions so they can hear the needs from those who most experience them or who have ideas to contribute toward improvement.  
• Local CFACs should work more closely and collaboratively with State CFAC.  Development of unifying principles that promote this collaboration will help.

2)  Consumer inclusion should be a defining characteristic of our Transformation process with consumers being engaged at every table to provide input and guidance and not just as tokens.  

• Their roles, through CFACs and otherwise, should be supported by policy and contractual language that puts teeth in their efforts so that advisory input is seriously considered and integrated into local or state system change.  CFACs must not simply be a presence to offer opinions.  
• With the Standard Plan being currently rolled out, a statewide MH/SUD Advisory should be formed and guaranteed an active part in developing and overseeing changes to healthcare delivery in NC.  The concern is that in these dimensions of the system, there is too little engagement of consumers and families, which is illogical and does not even make good business sense if we want a sustainable system with good outcomes.

Current Actions Planned

• The group agreed to focus on educating especially new legislative members through personal stories and introducing ourselves to new members on the Legislative Oversight Committee.  Martha Brock is working on another Legislative Advocacy Day for the spring through SCFAC.   (Addendum: Ms. Brock has since clarified that SCFAC Subcommittee on Legislation is being engaged to help with planning).
• There is a Legislative Breakfast scheduled for February 2 at the Friday Center in Chapel Hill.  SCFAC will have a table there, and everyone was encouraged to attend.
• A statewide CFAC meeting is in the planning for the spring as well.  It was agreed that we need to do a better job of informing families and consumers about what’s going on, more clearly define the role of CFAC members, and be active in soliciting input from our community members about what they need and want.  

Wrapping up the discussion, one family member participant who has worked in health care bureaucracies challenged the group and the state staff who were in participation.  As a current member of an MCO board of directors, she stated that boards and officials needed to hear what we want and not just what has already been decided by administrations then passively approved by consumers and families!   She states, with many agreeing, that CFAC members should be far better informed by those they are to advise so that they can do their work effectively!  She stated that her experience has been that too often people working in bureaucracies give lip service to consumer involvement and we must see this change in our state if Medicaid Transformation is to work.

This meeting was a great opportunity to see old friends, meet new advocates, and to voice what needs to be done going forward.  There is a lot of work to be done, and we will need to strengthen our collective voice to ensure future success!

From Elana Kravitz, Director of the New York Association of Psychiatric Rehabilitation Services, and friend of NC CANSO

See the link to Hayes’ article below.

NYAPRS Note: In the following timely piece, Slate’s Laura Hayes explores what we know about those who commit violent crimes and asks how can we recognize them and take the right actions to avoid future violent acts. 

She concludes that these crimes are actually committed by “violent people, almost always men, who are lonely, isolated, blame others for their problems, and (who) lack the skills to manage anger,” thereby inhibiting their own ability to socialize and integrate into networks of friends and companions.

Because of a general lack of understanding of “mental illness”, we see troubling stereotyping is not just wrong but that it gets in the way of finding a real solution to our violence problem.  People who are violently angry are not mentally ill by our current standards.  Instead of treating them, we call them names, we avoid them. Can we do better than that?

One of the most challenging reasons that we lack a system for intervention, is the very nature of the problem. “Violent angry people do not go looking for help on their own. Because they live in a state of perpetually feeling under threat, they trust no one and do not seek out support.”

Where are the answers?  Since so many mass shooters, for example, are young school aged men, we can look to thoseschools that are on the cutting edge of dealing with crisis.  For example, Peace of Mind in D.C.,https://teachpeaceofmind.org/, and Mindful Schools in California, www.mindfulschools.org, each offer a curriculum for mindfulness; PassageWorks, http://passageworks.org/, a Colorado program for teachers and staff to integrate mindfulness into their work; Mindful Teachers, http://www.mindfulteachers.org/ a website of resources for teachers; and Peace In Schools, www.peaceinschools.org/, which provides programs for teens and training for teachers. Each of these programs provide much needed skills for coping with emotion and stress reduction for all kids, they can also serve to identify kids who are struggling the most with these skills. 

Too often, hostile kids identified as “a problem” get a mental health referral, but are quickly dumped because they fit no diagnosis and are difficult to work with.

Criminalizing emotional distress is not the goal. We should be seeking to heal the individual while protecting the public. This requires a response of compassion to those who frighten or anger us…..and that is no small thing.

https://slate.com/technology/2018/04/anger-isnt-a-mental-illness-but-we-should-still-treat-it.html

 

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.

Jason Helgerson has been hired by several states by now to lead major transformations in how states have utilized Medicaid.  His most recent stint was in New York where articulate mental health leaders/advocates for improved health and “behavioral” health outcomes have been very engaged in ensuring user-informed and practical system changes that would result in better outcomes in people’s lives.  Helgerson has announced his resignation after doing great work in New York and we want to share with you the letter he sent out to stakeholders across the state.  It is shared with us by Mr. Harvey Rosenthal, a person whose mental health history has informed his own excellent work for many years.  (Harvey is the Director of the New York Association of Psychiatric Rehabilitation Services.)   Mr. Helgerson, whose letter follows, has been the state’s Medicaid Director for several years now.

Dear Stakeholder Community:

 Happy Friday.  As you may have heard, I have decided to resign from my position effective April 6^th.  It has been a tremendous honor to help lead New York’s effort to fundamentally transform Medicaid and health care.  Together we have made the world a better place through innovation and hard work.  While much has been accomplished there is still much left to do!  I want to make clear that my departure will have NO impact on this important mission.  The Department of Health and its leadership remains 100% committed to the causes of MRT, DSRIP and VBP. 

 While I am sad to go, I am so bullish about our state’s collective future.  Delivery systems across our state are changing and health outcomes are measurably improved.  Organizations are working together as never before and as a result the system is really starting to work like a seamless, patient-centered delivery system focused on results.  I can’t wait to see what the future has in store for your collective work.  Know that I will be cheering you on as you show the world that collaborative, accountable care that meaningfully addresses the social determinants of health, improves health care outcomes as well as community health. 

 I wish you all the very best.

 Jason Helgerson,

NYS Medicaid Director

Fellow advocate, let us not expect any less here in our state than what New York has accomplished through its inclusive and collaborative effort!

Complaints alone are not advocacy.  To be effective, we need to identify some potential solutions that can be offered to decision-makers.  In advocating for Ideas to strengthen inclusion of consumers and families in system development, oversight, and quality improvement, here are three ideas that perhaps our State Consumer and Family Advisory Committee and other advocates can consider as part of our advocacy strategy:

• Recommend that actions are taken to ensure that the Consumer Policy Advisory is empowered to undertake functions as defined in the position posting from February 12, 2015:
  • “The selected candidate will work with LME-MCOs, applicable DHHS Divisions, county agencies, citizen groups, consumers, and consumer family members to guarantee that disability populations are adequately represented at all levels and in all phases of Department and Division efforts. The selected candidate will initiate and participate in system improvement and citizen involvement and ensure that the community-based system remains compliant with legal rights protections for recipients of supports and services.”  

If the functions described were supported to be done with optimal result, the Consumer Policy Advisor would definitely                   strengthen the position of the consumer and family voice at the Division of Mental Health.

 

• Recommend that consumer and family inclusion are leveraged through MCO Contracts: Create language for the contract between MCOs and DHHS that ensures that consumers and families are engaged in an integral (integrated) way in advising MCO process, practices, culture.  Tie funding incentives to meaningful and measurable consumer engagement as is done in public health systems.

 

• Recommend that the development of independent statewide consumer advocacy organizations be supported to 1) empower citizens toward recovery or personal goal advancement, 2)  facilitate collaboration with area and state CFACS to ensure more stakeholder engagement with these advisor bodies, and 3) foster shared visioning for system and service innovation and quality improvement.  Commitment to the effectiveness of these organizations should be shared between leadership of these organizations and Division leadership and liaisons.  The aim is to collaboratively shift system culture toward  participatory change/participant driven progress and family support.
  • Funds from community mental health and substance use block grants can be accessed for this.  Funds should be identified for individuals with intellectual and developmental disabilities.

WHAT other recommendations do YOU have in mind?  Please share them with us!