Heard in the Halls July 22, 2009 - #9

NAMI North Carolina's Heard in the Halls Budget Breakthroughs? H 137 - passed Appropriations  July 22 2009 Number 9 Quick Links NAMI NC   NAMI National   North Carolina General Assembly   While Deby is out of the office - I will be sending periodic emails to help keep our constituents up-to-date with legislative issues.  Thank you so much for your continued advocacy efforts - keep calling your legislators - your calls are making a difference.  Our legislators need to continue to hear from our NAMI members "North Carolina's Voice on Mental Illness." Susan King Cope Development and Special Events Director National Alliance on Mental Illness NC The Legislature has reached a tentative agreement on a revenue package that would raise $990 million. The package would raise the sales tax by ¾ of a cent or 1 cent, add a 2% surcharge to the income tax, and increase the cigarette and alcohol tax. House and Senate leaders will work out the details over the next several days. It appears that we're approaching the end, though a meltdown is always possible.   This inclusion of additional revenue in the final budget package is a big victory, and we should feel great about what we've accomplished this legislative session. Just a few months ago legislative leaders were saying that raising additional revenue wasn't necessary and wasn't a possibility - now they are ready to raise nearly ONE BILLION dollars to mitigate the worst cuts to critical public investments like education, health care, and job training just to name a few.  The final budget won't be pretty, but it could have been a lot worse. While leaders in both chambers have reached an agreement, it still might be necessary to put some pressure on rank and file members to pass a budget with the revenue package, so keep your eyes and ears open for a final call to action. What can you do to help? Time is short. Legislators need to hear from you today.   Email your legislators and tell them to say "NO" to devastating budget cuts and "YES" to a balanced solution for the state budget that enacts smart cuts and raises new revenue. If we pull together, we can get through this budget crisis. Keep up the great work!    Susan King Cope Development and Special Events Director NAMI North Carolina On Wednesday, July 22nd members of the Education Appropriations Committee voted 7:4 in favor of HB 137:  Capital Procedure/Severe Mental Disability which would exclude individuals with mental illness from from the death penalty if they had a severe disability at the time the crime was committed.  This bill would also allow defendants a "guilty" verdict - whereas currently, they must enter a plea of not guilty and move into full court proceedings. There was much discussion about the bill and confusion regarding what and when the bill would be applied.  There was also much discussion about the proposed "savings" the bill would provide the judicial system.  In the end - members across party lines determined that the bill would protect those with mental illness and moved for a favorable vote.   This is a great step on the progression of this bill and it is because of the many calls from NAMI NC membership that helped the HB 137 make it through Committee.  The bill will now move on to the House for a vote! Don't forget to nominate someone that has made a difference in your life!  Right now, NAMI North Carolina members have 2 opportunities to give recognition to those who go the extra mile for individuals and family members with mental illness: 1)  NAMI North Carolina Awards - to be presented at the 2009 Annual Conference go to the NAMI North Carolina website for application:  Due August 15th 2)  Heroes in the Fight - a partnership with Eli Lily and other mental health organizations in North Carolina - and across the country for more information, go the the Heroes in the Fight website and download application or get it off of the NAMI North Carolina site:  Due August 27th

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Heard in the Halls July 15, 2009 #8

NAMI North Carolina's Heard in the Halls Budget still not passed HB 137 - passed committee Nominations for NAMI Award and Heroes in the Fight July 15 2009 Number 8 Quick Links NAMI NC   NAMI National   North Carolina General Assembly   While Deby is out of the office - I will be sending periodic emails to help keep our constituents up-to-date with legislative issues.  Thank you so much for your continued advocacy efforts - keep calling your legislators - your calls are making a difference.  Our legislators need to continue to hear from our NAMI members "North Carolina's Voice on Mental Illness." Susan King Cope Development and Special Events Director National Alliance on Mental Illness NC On Tuesday, July 14th members of the J1 Committee voted in favor of HB 137:  Capital Procedure/Severe Mental Disability which would exclude individuals with mental illness from from the death penalty if they had a severe disability at the time the crime was committed. This bill would also allow defendants a "guilty" verdict - whereas currently, they must enter a plea of not guilty and move into full court proceedings. This is a great step on the progression of this bill and it is because of the many calls from NAMI NC membership that helped the HB 137 make it through Committee.  The bill will now move on to Appropriations and then to House. Today, July 15th, the Continuing Resolution allowing legislators to continue budget negotiations will expire. Unfortunately, they have still not come to agreement on the budget and don't seem any closer to an agreement then they were two weeks ago. It's almost certain that they will pass another Continuing Resolution before Wednesday, so that negotiations can continue.   The Governor also released a tax plan last week that represents a combination of the House and Senate plans. The plan adds up to $1.6 billion in new revenue this fiscal year and $1.7 billion next fiscal year. It's unclear what impact the Governor's announcement will have on negotiations between the House and the Senate.   While it's obviously important for the Legislature to create the best budget possible, functioning without a permanent budget for a long period of time can be very damaging. It puts local governments and state departments (like HHS) in a difficult holding pattern during which they must make large discretionary cuts that will invariably change once the Legislature passes its more specific budget.   Furthermore, everyday we fail to pass a revenue package, we lose millions of dollars. If we had passed a budget by the July 1 deadline, the state would be collecting new revenues right now. The only way to make up for this lost time is to increase tax rates more than we're already going to. Our state leaders must take a balanced approach to the current budget shortfall, and that means raising revenues. Without new revenues, legislators will be forced to make massive cuts that will cause tremendous pain in the short-term, and jeopardize our long-term prosperity. The Governor, the Senate, and the House have all proposed budgets that include new revenues, and that's progress. The Governor has called on the House and Senate to raise $1.5 billion in new revenues.  Now it's time for our state leaders to come together and agree on a budget that's good for all North Carolinians. What can you do to help? Time is short. Legislators need to hear from you today.   Email your legislators and tell them to say "NO" to devastating budget cuts and "YES" to a balanced solution for the state budget that enacts smart cuts and raises new revenue. If we pull together, we can get through this budget crisis. Let's get to work!   Susan King Cope Development and Special Events Director NAMI North Carolina Don't forget to nominate someone that has made a difference in your life!  Right now, NAMI North Carolina members have 2 opportunities to give recognition to those who go the extra mile for individuals and family members with mental illness: 1)  NAMI North Carolina Awards - to be presented at the 2009 Annual Conference go to the NAMI North Carolina website for application:  Due August 15th 2)  Heroes in the Fight - a partnership with Eli Lily and other mental health organizations in North Carolina - and across the country for more information, go the the Heroes in the Fight website and download application or get it off of the NAMI North Carolina site:  Due August 27th

Heard in the Halls July 8, 2009 #7

NAMI North Carolina's Heard in the Halls Update on budget cuts- community support, open access to medications July 8 2009 Number 7  Quick Links NAMI NC   NAMI National   North Carolina General Assembly   While Deby is at our National Convention in San Francisco - I will be providing short updates about what is happening at the NC General Assembly.  Many thanks to Coalition Members for forwarding timely information to me for use.   Susan King Cope Development DIrector National Alliance on Mental Illness North Carolina Budget Update:   Yesterday the Governor sent a letter to the members of the North Carolina General Assembly urging them to raise revenue to protect vital services in our state including education, public safety and healthcare.  Included in the letter was a specific proposal to for revenue that would raise $1.6 billion in the first year and $1.7 billion in the second year through modernization of our tax code, temporary taxes and targeted tax relief. The Governor's office has stated that the proposal, combined with $3.8 billion in budget cuts and $2.4 billion funds form the federal government would balance the budget while still ensuring we meet the most critical needs of NC citizens.   This letter comes at a critical time: House and Senate Conferees are still at odds over cuts and cannot agree on tax revenue packages. The Senate has been pushing for increases that would total $15 billion, while the House is reluctant to extend revenue increases beyond $1 billion, nor can they agree on the kind of revenue changes that would make up the compromise package. Without agreement on the sources and amounts of new revenue, budget negotiations must continue based on an assumption of around $900 million being added back into the budget. The Senate passed an open ended continuing budget resolution that would keep the state operating at 85% of its current funding; the House amended the Senate resolution but limited it to July 15.   The state cannot continue to operate with a temporary budget that cuts 15% of state funding; In HHS some programs such as state institutions cannot operate at 85% of funding so a greater percentage of funds are being withheld from state funded services and supports to people with disabilities. We need the Legislature to pass a reasonable revenue package and prevent devastating cuts to services and supports to people with addictive disease, mental illness and developmental disabilities. These cuts, as they stand, without additional revenue, will result in the closure of programs, the loss of tens of thousands of jobs, and leave people without the services they need and are currently receiving.         ACTION:   Call your State Senator and your State House Representative and tell them you support the Governor's proposal for increasing revenue, and ask that part of these new revenues go to support services and supports in MH/DD/SA, including Medicaid. You can find contact information for your NC General Assembly representatives at www.ncleg.net  under "Representation" or http://www.ncleg.net/GIS/RandR07/Home.html.   Please personalize your message with information about the reason these services are so important to you, those you serve, and your community.     Message:   I support the Governor's proposal for increased revenue. Part of any increased revenue needs to go to mental health, developmental disability, and addictive disease services, including those in Medicaid. The state budget cuts are still too deep and will devastate services and supports and result in the loss of thousands of jobs. Thank you for your continued support!   Susan King Cope, NAMI North Carolina

Heard in the Halls July 3, 2009 #6

NAMI North Carolina's Heard in the Halls Update on budget cuts- community support, open access to medications July 3 2009 Number 6 Quick Links NAMI NC NAMI National North Carolina General Assembly Welcome back to NAMI NC Heard in the Halls. I hope to bring you direct information on what is happening in the general assembly regarding issues that touch you and your family members. Deby Dihoff Executive Director National Alliance on Mental Illness NC When, oh when will we have a budget? And time just keeps passing ...with still no budget. Each day that passes with no budget means the amount of time to deal with the crisis has lessened, making the solutions harder. The continuing resoluton requires a l5% cut but who decides where, and when? There is no agreement on both sides of the general assembly; the Senate supports revenue packages of $l.5B (along with the Governor), but the House is not comfortable with that amount. And the role of the Governor right now is not clear either. Ask your legislators to get a budget adopted, and to put revenue increases if adopted towards restoring some services for people with mental illnesses- like community support and access to medications. PLease ask them to consider long overdue modifications to our outdated tax codes as part of the overall solution. What are the latest cuts in Community Support (CS)? Your advocacy efforts are working, because the previous across the board cuts (over two years) to Community Support have been scaled back. Still huge cuts, but a little more flexibility. Please remember that these cuts are a moving target until both the House and Senate come up with an agreed upon budget. Which means you can still make a difference. The latest shows CS with a cut of $65M year one, and $97M year two. The second year represents 80% of the previously allocated service dollars - so still a huge, sweeping cut to CS, and remember: this affects perhaps 37000 people, with 75% of them being children. We're hoping many of these children can receive a higher level of service like intensive in home, which they probably need. Yet another consequence of the massive curtailment of services in medicaid is it probably will eventually mean a rollback in the medicaid block grants which are tied by formula to medicaid spending. When our state elects to discontinue a service, or radically curtail a service- for each dollar we put in, the feds put in 3 dollars. So you can see the other consequences- not only people not getting services they need, but jobs are lost, economies worsen, communities suffer. Ask your legislators to: 1. Restore matching state funding to earn us $l.45 B in federally funded services. Don't be penny wise, pound foolish! 2. Restore adequate funding to CS - that has to be more than 20% of the current level. 3. Question the wisdom of the consolidated Case Management and whether there will be sufficient resources to deal with the massive movement/transitions caused by these cuts- kids moving from group homes, adults and kids both losing community support. 4. Explain the domino effect of each of these separate cuts- loss of CS leads to loss of overall community stability- possible onset of crises, hospitalization. Ditto for loss of access to medications Capital Sentencing SB 309, HB 137 Let's not forget this very important bill! We have a chance to get this bill heard, and with luck, passed! You must call your legislators- anyone on Judiciary l, or anyone on appropriations- start with the House side! And you must do this by Tuesday of next week. We expect the committee, J-l, to hear this either Tuesday or Thursday of next week; we expect it to pass there, and go straight on to appropriations. That will be a struggle, and we need your calls. Open Access to medications It's not looking that good for maintaining open access to medications- the House is looking to save $40M by instituting a preferred drug list. For years those on medications treating mental illness have been exempt from these requirements - and bureaucratic managed care practices like prior authorizations, fail first, etc. There is good work going on to investigate other ways to save this money- like educating prescribers, starting wtih those inpatient settings where polypharmacy starts. Studies show those who have barriers to getting their drugs have 3.6 times as many adverse effects (ER visits, inpatient, even jail..) Action: Tell the House and Senate Budget and Finance Chairs, and the leadership that you oppose a preferred drug list for mental health, and share your personal stories of how long and arduous is the journey to finding the right mix of medications for your own recovery. Make a call to your legislator on Monday!! It works. Thanks for all those efforts. And have a happy fourth. Deby Dihoff, MA, Executive Director

Heard in the Halls July 1, 2009 #5

NAMI North Carolina's Heard in the Halls Report on planned cuts to children's group homes and other children's legislation July l 2009 Number 5  Quick Links NAMI NC   NAMI National   North Carolina General Assembly   Welcome back to NAMI NC Heard in the Halls.  I hope to bring you direct information on what is happening in the general assembly regarding issues that touch you and your family members.    Deby Dihoff Executive Director National Alliance on Mental Illness NC No Budget- Everyone's heard that we don't have an approved budget yet- we have a continuing resolution to keep paying for state services, with an overall cut of 15% in spending, while the Senate and House try to resolve their differences.  Much of the disagreement is around the increased revenue package- the Governor is pushing for $1.5 M, and the House is not in favor of that big of an increase.  All this is showing how much the advocacy for a balanced approach- both revenue increases, and spending cuts- is working! If we are successful in getting an increased revenue package we must still fight to see that these new revenues are applied directly to restore services that people living with mental illness need.    In the midst of that, we are still facing unprecedented cuts to services and supports for people with mental illnesses- particularly Community Support and Level 3 and 4 Group homes.  This addition will focus on the planning that is being done to transition children safely from these facilities to other treatment options.    Let's start with the good news- passage (by one vote!!) of the anti-bullying bill:    School Violence Prevention Bill Passed with a Vote of 58-57   The School Violence Prevention Bill was passed and sent to the Governor's desk on June 24th much to the excitement of many child and family advocates. To summarize, this bill protects any student or school employee who experiences an act of bullying or harassment on school grounds or during school sponsored activities. The bill defines bullying or harassing behavior as acts being motivated by actual or perceived differentiating characteristics such as race, religion, physical appearance, sexual orientation, mental, physical, developmental, or sensory disability, etc. A policy prohibiting this behavior should be adopted by each local school administrative unit before December 31, 2009. For more information on this bill, visit the General Assembly website at: www.ncleg.net/ and type in S526 in the "Find Bills by Number" area.  Please thank your legislators for supporting this bill (you can look up how they voted on the General Assembly site)   Level 3 and 4 Group Homes In the last Heard in the Halls, we talked about appointing a transition committee to help with the many details of such a huge change - well, that's been done!  And there are at least three people representing the needs of families and consumers living with mental illnesses, including myself.  This is a moving target- last week group homes were to be completely cut, this week, it has been modified so that the length of stay will cap out at 120 days total. (advocacy works!!)  The following changes will be made:   2010  15.8 M cut   (representing about 1/3 of the present funding level) 2011 22.5 M cut  (representing about 1/2 of the present funding level)   Therapeutic camps will be closed completely- due to federal issues Any setting with more than l6 beds (except psychiatric residential treatment facilities) will close due to federal compliance issues    Timeline:  October   What are the changes you can expect if you have a child in a level 3 or 4 group home? The Division will emphasize therapeutic family services in lieu of group homes, as well as services that support families - like intensive in home and multisystemic therapy The eligibility and continued stay criteria will be modified for level 3 and 4 homes During treatment at those homes, there must be parental involvement, and community involvement The homes must receive national accreditation within one year; those who have accreditation already will be "preferred providers" Before admission to a group home, there must be a step down plan- return to home, or alternatives, and a discharge plan Stays will not exceed 120 days Exceptions will require an independent assessment Why the Changes? Two things are driving this- the economic downturn with the need to make cuts, and the fact that group homes are not a best practice model- it is widely known that they don't really result in the best outcomes for kids and families.  What does work are excellent clinical services that bring help to the family - intensive in home and multisystemic therapy, and day treatment.   We must add to this support for families- crisis facilities, wraparound, and respite care.  The federal government is clamping down as well- they don't want to continue to fund practices that don't work, and the state has determined it is a matter of time- six months, twelve months max until these services are completely disallowed by the federal government.  But at the same time, we must make sure these 2000 or so kids in these homes experience a smooth transition to a more appropriate service.  Yet, there are no new funds to help businesses create more capacity for the things that work- intensive in home, multi systemic therapy.   What are the numbers? Day treatment capacity - 139 programs Intensive in home - 446 providers MST - 31 providers PRTF (Psychiatric residential treatment facilities ) - 325 beds Level III homes -2253 beds Level IV beds - 199 beds Level II family type (therapeutic foster) - 5553 beds   Implementation  Excellent planning is occurring involving many stakeholders, including family members and others representing those with mental illness.  Here's some of what will be done to attempt to have a smooth implementation:    Letters to all providers, and to families Protocols for planning for the child and family teams Some discussion of rate incentives to get people to provide what works, not to drift towards the group models of service Lists of how many kids are involved by county Work on assessing kids - to make sure safety is protected Lists of options - especially those accredited Tracking of movement- some level 3s moving to PRTF Getting new service definitions approved for therapeutic foster and for crisis centers for children   Big questions that remain: Children transitioning from a group home will need case managers to help them navigate to a new, more appropriate service.  And all of that is up for discussion with the severe cuts to community support.  Paraprofessional services is on the block for cutting completely from CS, which endangers the needed wraparound services.  The next Heard in the Halls will focus on that crisis.   Often, it takes a crisis to move systems to make the big changes that are necessary to move towards things that work, not just what is comfortable or has been done.  We must challenge our state to handle this correctly, to make the big changes necessary, but to protect every single child and family during what is bound to be a difficult process.  These children came to these programs because of their problems, but now it is a systems problem - not the children's problem- and we owe it to them to not compound their issues with traumatic change.    What can you do?   Contact the House and Senate Leadership - tell your story; ask that funding be provided to build up the services that work.   Keep up the advocacy - it works.   Deby Dihoff, MA, Executive Director

Heard in the Halls June 2009 #4

NAMI North Carolina's Heard in the Halls Budget goes to House Floor containing devastating cuts to mental health services June 2009 Number 4  Quick Links NAMI NC   NAMI National   North Carolina General Assembly     Welcome back to NAMI NC Heard in the Halls.  I hope to bring you direct information on what is happening in the general assembly regarding issues that touch you and your family members.    Deby Dihoff Executive Director National Alliance on Mental Illness NC The Cuts Just Keep Coming...  This week we saw some action in the House, with the Finance Committee at long last addressing revenue enhancements that would ultimately reduce the total volume of cuts to the Health and Human Services Budget by about $800 M.   We applaud the actions taken by the Finance Committee because the enhancements are more progressive than we had expected.  Please thank your legislators!  This budget cannot be balanced on cuts alone; we must look at taxes.  The changes would mean that tax breaks and loopholes for businesses and corporations would end, and there would be an expansion of sales tax to cover warranties, home repairs, and on line purchases.  Also, there is a l/4 percent increase in the overal sales tax.  The cigarette tax increase did not go through as proposed.   Please thank your legislators for this progressive movement on taxes, but also add that the revenue enhancements are simply not relieving enough of the cuts to mental health services.    While all that was happening, I was upstairs in the full House Appropriations seeing the latest rounds of cuts.  These  cuts would later be ammended by the increase in revenues by Finance.  That was all made public at yesterday's HHS subcommittee of appropriations meeting.  They passed the ammended SB 202 restoring some of the previously cut items. But the good news- the room was jammed with people wearing t-shirts saying No Budget Cuts to Mental Health!  I have never seen the room so full of supporters.  But it was passed, so it is onto the floor of the House today.      So how did things work out for the people in NC affected by mental illness?  Remember, we went into the session with a clear disadvantage:  Health and Human Services was making up 50% of the cut, while they constitute  only 23% of the total budget.  Overall, we did not fare that well in mental health.  Massive restorations were made to Smart Start, child care subsidies, and other items, and community support and group homes were not restored by even a penny.  Here are the figures:   Restored:   Division of Mental Health Stated Funded Services -  cut $50M; restored $50M In Home Personal Care Services                                cut $49 M, restored $34M Personal Care in Adult Care Homes                           cut $l0M, restored $8M Eliminates PT/OT/ST                                                 cut $l5M, restored $l5M Adult Optical                                                            fully restored (3.2M) Dental Coverage                                                        cut $l5M, restored $l5M Orthotics, ER co-pay, CCNS, Providers fees - fully restored   Other:   Provider rate cuts - moved back from 5.5% the first year and 6% the second year to 3.06% in the first year and 3.56% in the second year.   What else:   The big news is really what didn't get restored or addressed in any way.  And that is the cuts to Community Support and Level 3 and 4 Group home- these touch thousands of individuals, and it is not known how they will transition out of these.  To what, and where? - sensible questions given our system capacity issues.  33,000 people will no longer receive community support which includes training and case management services.   Nor did they change or restore the open access to medications for those with severe mental illnesses.    It is clear that advocacy has worked to restore provider rates, PT, OT, Speech, personal care.  Let's get going and ask that the following be addressed!  Eliminate cut to community Support by $59 M in year one, $116 M in year two (no replacement for this service is proposed  Keep the waiver for drugs for those with severe mental illness to not be subject to a preferred drug list to save $40 M year one, $50 M year two Eliminate the cuts to Level III and IV Group Homes What Can you Do?  Thank your legislators for their revenue enhancements, but make it clear we must not cut Community Support and LEvel III and IV group homes without substituting other services. Ask that they continue the "carve out" for psychiatric medications making them not subject to a preferred drug list A suggested replacement package for the Community Support is as follows: Immediately move to adopt a medicaid billable peer support definition Add a targeted case management definition Review caseloads of community support to determine who might benefit from either peer support or case management Appoint a transition committee including family members and consumers to work out the details.      4.  Mobilize your affiliate members; organize a letter to the editor What can I do? Listening to the news I learned that the budget is being debated on the floor of the House, and it is continuing through today and probably tomorrow as well.   So- there is a chance to influence your Representatives:  call, email, visit.   Attend the Together NC rally at 5:30 on Monday the l5th of June - show a groundswell of support   Talk to both your Senators and Representatives as the conferee process is next- where they try to resolve the differences   Talking points These cuts are a pipeline to prison, poverty, and patient deaths It will take people and programs decades to recover People will be harmed, and some will die These cuts bring with them hidden costs- when the local services aren't there for people, they all to often land in an emergency room (more expensive), jail or an institution (more expensive) Some good news:  Just this morning I had a call from the Governor's Office - Ann Bryan, who spoke at our annual conference.  She wanted input to share wtih the Governor and leadership about the impact of these proposed cuts.  I shared with her the replacement ideas for community support and residential services.   Those living with mental illnesses are taking too big a share of the cuts  Take Action  Make a Difference.  Do it Today   Deby Dihoff, MA, Executive Director