Ashe Mountain Times

North Carolina's Speaker of the House believes finding answers for the mental health services of Ashe County and the state isn't likely to happen until the effects of President Barack Obama's health-care plan are known.

Rep. Thom Tillis, R-Mecklenburg, made the comments after a Tuesday luncheon at Shatley Springs Restaurant, where he was invited to address a gathering organized by Rep. Jonathan Jordan, R-Ashe.

Ashe is one of five counties that formerly used New River Behavioral HealthCare, which was dissolved following an unexplained financial crisis that is currently under investigation.

Tillis took five questions from the Ashe Mountain Times related to mental health services:

 

Q: In Ashe County now, one of the biggest issues is the mental health situation. What is your take on what has happened?

A: I think its just another example of one of several across the state where we've got some LMEs (local management entity) that are in trouble. This one has gone to the point where the counties are having to step up and try to step in and help. A part of our appropriations strategy was to take a look at LMEs structures, do some consolidation, take a look at even in the future the relationship between the DSS (Department of Social Services) and the county, and the county commission, and oversight. And I think all of that is going to have to be put in the mix because I don't see how we're going to really be able to drive out a lot of cost and make some of the improvements we want to make with case management and other things without even taking a look at some of the other structures, like the Department of Social Services and other provider agencies across the state.

 

Q: Is there any legislation, or bills, that are swirling now related to mental health?

A: You know, most of what we did this year was in the budget around consolidation. Mental health is still an area that we're pretty far behind, the nation as a whole is. But North Carolina has got some serious capacity issues. We also have some issues with just how to deal with people with profound mental health problems, and more generally, people with intellectual disabilities. The whole underlying support infrastructure has serious problems. One of the things we have to do is figure out how to create more capacity in institutions that have close supervision. One of the ways you're going to be able to do that is for other people in systems that either have mental health capacity or could — we have facilities that can be freed up and be dedicated to mental health patients — is how we free up some of that institutional capacity with more options for people at home. When I think of the full HHS (Health and Human Services) problem, you have people with profound mental health problems; you have people with intellectual and developmental disabilities, the total of people that are using the lion's share of our health services. There is a company up in Asheville called Simply Home — and they are actually headquartered in Asheville but not legally allowed to use their technology and get Medicaid reimbursement here — which basically allows people who could be largely independent without human supervision, if they have the right sort of technology at home to where people could be alerted. If you were able to provide more in-home solutions for people who are not profoundly disabled with intellectual or developmental disabilities, then that kind of shifts all the resources downward to an area that most people want. I mean, most people who can live independently want to if it can be done safely. That frees up some of the brick and mortar capacity we need to deal with the mental health problem. Then you still have got to have more resources focused on it, people that actually have a specialty in it. And you also have to figure out how to get them. There are a lot of people who have mental health issues that we don't even know about. We see problems based on the known population, but I'm convinced there's a significant unknown population that we've got to figure out how to reach out to, and a lot of those are imbedded in prison right now, or in other facilities.

 

Q: You mentioned there are other LMEs across the state that are having the same problem?

A: I don't know that any of them have risen to the level that has occurred here. But there are a number. A part of what we're trying to do is we're trying to drive out some efficiencies, but also make sure that we have good governance models in place to avoid situations you all are dealing with here. And there are problems throughout. There are a lot of structural problems that we have to go look at and see if we need to do things differently. I haven't necessarily bought into just the LME consolidation and a different way for case work. We need to look at the total picture, health and human services strategy of North Carolina, and see if we should even re-organize. And we need to have that on the table. It won't be next year because it's a short session, but I do think true HHS reform needs to get legs because it will save money and improve outcomes.

 

Q: That's a long-term going from where we are at now to getting it fixed?

A: Right.

 

Q: We're talking years?

A: I think you could start seeing pretty substantial change over the next couple of years. But there's a great unknown. We need to find out what national healthcare, if it's going to go into place, how that affects the way that we deliver healthcare here. If we're going to have somewhere between 400,000 and 800,000 more people on Medicaid rolls who are largely healthy people, or not healthier, but not in a profound mental health or intellectual developmental disabilities, we're going to have that inflow of people at the same time we're still trying to deal with the backlog of people with profound health problems that we need to deal with. That is the biggest risk to actually doing anything meaningful with that unknown out there and particularly in 2014 when it starts getting implemented in earnest. So along the way, you hit singles and doubles, and you have got to figure out what if any national healthcare provisions come in and then craft a change around whatever that reality is. I for one hope it's not there. I hope the state is in a mode where we're building our own state healthcare reform strategy and the other states are doing their thing. But yes, it's a multi-year process, because you've got state, county and in some cases city involvement in health and human services initiatives. You've got a provider network you have to deal with. You have a lot of nonprofits you have to deal with. It's pretty complicated.