NAMI NC Heard in the Halls

Heard in the Halls #13 Special Edition on Health Care Reform

2010-04-16T08:27:00.001-07:00

NAMI North Carolina's

Heard in the Halls

Special Edition: Health Care Reform:

What it means for those affected by mental illness

March 24, 2010

Issue 13

Quick Links

NAMI NC
NAMI National

NAMI North Carolina aims to bring you comprehensive information on a variety of current topics.

This edition is devoted to updating you on the landmark legislation passed on Sunday March 21, 2010 on health care reform. This entire mailing consists of Andrew Sperling's synopsis of what the law changes means for our constituency, reprinted in its entirety. Andrew is national's expert in this area.

Deby Dihoff, MA

Executive Director

Forward email

This email was sent to skingcope@naminc.org by ddihoff@naminc.org.

Update Profile/Email Address | Instant removal with SafeUnsubscribe™ | Privacy Policy.

Email Marketing by

National Alliance on Mental Illness North Carolina | 309 W. Millbrook Rd. | Ste. 121 | Raleigh | NC | 27609

Heard in the Halls #13 March 2, 2010

2010-04-16T08:26:00.001-07:00

NAMI North Carolina's

Heard in the Halls

News from the Commission of MHDDSAS

March 2, 2010

Issue 13

Quick Links

NAMI NC
NAMI National

NAMI North Carolina aims to bring you comprehensive information on a variety of current topics.

Deby Dihoff, MA

Executive Director

Report from the Division At the Commission of MHDDSAS Meeting February 25, 2010

Sometimes it is good to take a break and hear some good news!

Institute of Medicine - Congress established the national Institutes of Medicine (IOM) to conduct scientific research to inform their decision making; we have an active IOM in NC- last year they completed a report on Addicitons, and DD transitional issues. This year we have three studies in process:

IOM/Military and Behavioral Health - We have the fourth largest military presence of all of the states, and we constitute 25% of those deployed in the whole USA as well. This study was ordered by the General Assembly, with the final report due during the next long session. I have been very fortunate to serve on our behalf on this committee and have made many excellent contacts. We've already used one of those contacts as a speaker at our eastern regional conference. We will expand our marketing/outreach efforts to the military, including the national guard- so this is an excellent way to build your membership and share our programs to those who may return with PTSD, for example. We are actively working to expand F2F and other programs to the VA hospitals- so far that is happening in Durham, Fayetteville, and we are working on Asheville and Salisbury.

IOM/Access Study- This report will really focus on the implementation of parity rules and health insurance issues in general

ION Adult Care Homes- impact of adults with mental illnesses in those settings - Mike Weaver, head of our consumer council represents NAMI NC on this committee; we will hear more from him on this very important topic

With revenues coming in short, the Department is considering stronger measures to cut costs in a way that would once again potentially be harmful to people living with mental illnesses. NC is one of 23 states that exempts mental health medications from requirements that make it harder to access the drugs that are needed- like a prior authorization, where someone must first approve that medication. We need to maintain this exemption, not remove it. Chances are, if it is an expensive medication, they might authorize one that costs less and might not work as well. Even if the state operates from a grandfathering in proviso-any extra step in getting meds is a barrier- and research shows those barriers in fact are harmful; resulting in more ER trips and worse. People living with mental illness have been through a ten year struggle- with horrific cuts last year. Don't make more cuts like restriction of access - Speak up now!

Call Your Legislators Today

Time is short. Call or email today. Let them know that you are counting on them to reject any changes to eliminate open access to medications in NC. Click here to contact your legislator

Call or Write to the Department of Health and Human Services and the NC Division of Medical Assistance Today

The comment period for the preferred drug list is open until March 12, 2010. Go to this link to see a copy of the proposed list: http://www.ncdhhs.gov/dma/mpproposed/index.htm

Talking points:

The NC Division of Medical Assistance posted on their website the proposed Preferred Drug List (PDL) - this is the first step in limiting access -
The HIV/AIDS group continues to have an exemption from controls- why not the group with mental health disorders?
Medications work differently on every single person- the choice should remain with the doctor and the patient
This adds more strain to an already burdened system- people have lost community support, and now, will they be required to try drugs that may now work as well for them on top of that?
Prior authorization adds a burden to the doctors too- more time making calls, getting approval. Our worry is that there aren't even enough psychiatrists in the system to go around right now- will this drive them away from this important work?

Other ways to save money:

1. NC already has mandatory generic substitution for NC medicaid, - this saves

money unless the prescriber says the brand name is medically necessary

2. Use science, and data to understand prescribing problems and address those

problems specifically, rather than adding layers of bureacracy for everyone.

more letters to doctors who prescribe expensive drugs for off label use like sleep

aids- solve those problems, don't penalize everyone

3. Use the Prescription Advantage List- which helps physicians know what the drugs they prescribe actually cost

Medications truly do work differently on everybody. While we must spend the public dollar wisely, to stretch it to serve so many needs, following what may be decades of trial and error to find the right medication, no one needs to be forced to change to a cheaper form of the medication. Too much research has shown that any barrier can be a reason to simply not take medications. Medication compliance is already an issue- and for many good reasons; the side effects can be devastating. But we know medications in combination with supports and therapies really work- let's let them work by maintaining open access.

Plan to attend and speak out about this issue at one of the Town Hall meetings coming up in March and April:

Town Hall Meeting

Mental Health, Developmental Disability, and Substance Abuse Services

Heard in the Halls #12 February l6, 2010

2010-04-16T08:25:00.001-07:00

NAMI North Carolina's

Heard in the Halls

Action Alert: Act now to Protect access to the medications of your choice

February l6, 2010

Issue 12

Quick Links

NAMI NC
NAMI National

NAMI North Carolina aims to bring you comprehensive information on a variety of current topics.

This edition is devoted to updating you on a threat to maintaining your ability to choose medications that work for you - this is dedicated to open access

Deby Dihoff, MA

Executive Director

Act Now to Protect Open Access to Medications

Call Your Legislators Today

Time is short. Call or email today. Let them know that you are counting on them to reject any changes to eliminate open access to medications in NC. Click here to contact your legislator

Call or Write to the Department of Health and Human Services and the NC Division of Medical Assistance Today

The comment period for the preferred drug list is open until March 12, 2010. Go to this link to see a copy of the proposed list: http://www.ncdhhs.gov/dma/mpproposed/index.htm

Talking points:

The NC Division of Medical Assistance posted on their website the proposed Preferred Drug List (PDL) - this is the first step in limiting access -
The HIV/AIDS group continues to have an exemption from controls- why not the group with mental health disorders?
Medications work differently on every single person- the choice should remain with the doctor and the patient
This adds more strain to an already burdened system- people have lost community support, and now, will they be required to try drugs that may now work as well for them on top of that?
Prior authorization adds a burden to the doctors too- more time making calls, getting approval. Our worry is that there aren't even enough psychiatrists in the system to go around right now- will this drive them away from this important work?

Other ways to save money:

1. NC already has mandatory generic substitution for NC medicaid, - this saves

money unless the prescriber says the brand name is medically necessary

2. Use science, and data to understand prescribing problems and address those

problems specifically, rather than adding layers of bureacracy for everyone.

more letters to doctors who prescribe expensive drugs for off label use like sleep

aids- solve those problems, don't penalize everyone

3. Use the Prescription Advantage List- which helps physicians know what the drugs they prescribe actually cost

Medications truly do work differently on everybody. While we must spend the public dollar wisely, to stretch it to serve so many needs, following what may be decades of trial and error to find the right medication, no one needs to be forced to change to a cheaper form of the medication. Too much research has shown that any barrier can be a reason to simply not take medications. Medication compliance is already an issue- and for many good reasons; the side effects can be devastating. But we know medications in combination with supports and therapies really work- let's let them work by maintaining open access.

Plan to attend and speak out about this issue at one of the Town Hall meetings coming up in March and April:

Town Hall Meeting

Mental Health, Developmental Disability, and Substance Abuse Services

September 2009: Heard in the Halls Special Edition #1

2010-04-16T08:22:00.001-07:00

NAMI North Carolina's

Heard in the Halls

September 2009

Special Edition Number 1

Quick Links

NAMI NC

NAMI National

CMT

NAMI North Carolina aims to bring you comprehensive information on a variety of current topics. We have a wonderful opportunity to share with our membership this information written by Care Management Technologies (CMT) a wholly owned subsidiary of Comprehensive NeuroScience.

While specific questions about materials presented should be directed to CMT, NAMI North Carolina is happy to discuss the topic further.

Generic Drugs and Bioequivalence
Are Brand Name Drugs Worth the Extra Cost?

Marketers work hard to create "brand loyalty." We all have our favorite brands of
cars, clothing, or breakfast cereal. Whether brand loyalty is really in the
consumer's interest is another matter. It may not matter much for most consumer
choices, because these are mostly low-risk decisions where the main hazard is
whether the consumer gets the best value for the money.

This is not the case with brand loyalty to medications. Brand-name medications
almost always are more expensive. A major cause of skyrocketing health care
costs is prescribing more expensive medications when cheaper ones would be just
as effective. And this is an arena where prescribers and patients can make
individual choices to insist on better value for the money.

But how do we know that generic versions of a drug are just as good as the brand
name? Much marketing, and extensive past discussion in the literature, has
focused on this very question. This Newsletter describes the facts behind generic
medications, and why choosing generic forms of a drug is usually a very cost-
effectiveness decision for prescribers and patients.

Generic Drugs - Guaranteed Bioequivalence

A very rigorous, successful program has been established by the US Food and
Drug Administration (FDA) and its European and Canadian counterparts to insure
that every marketed form of the same medication has the same biological effect.
That means that generic drugs are for all practical purposes the same as the
brand name drug -- no better and no worse.

In general, new medications are eligible for a 20-year patent. Because drugs are
usually patented long before the manufacturer's New Drug Application (NDA)
goes to the FDA, the manufacturer can often extend the patent for up to 5 years.
But, with few exceptions, under current US law no drug's patent lasts longer than
14 years after its FDA approval.

Once the patent on a drug expires, generic manufacturers are free to try to
develop a generic equivalent. The approval process for generics does not require
repeating all of the animal and clinical efficacy studies already done and filed by
the original manufacturer. Rather, the generic developer must prove that the new
generic drug has exactly the same active ingredients at exactly the same strength
in exactly the same dosage strengths as the original brand name version. FDA
inspects the facilities used to manufacture each new generic drug to make sure
that all the raw materials, manufacturing steps, and quality control measures are
the same as those used for the brand name drug.

This is the first way that the FDA guarantees that generic and branded versions of
the same drug are, for all clinical purposes, identical. In addition, as the FDA
states (http://www.fda.gov), "the generic version must deliver the same amount
of active ingredients into a patient's bloodstream in the same amount of time as
the pioneer drug." This means that the generic drug must be bioequivalent to the
brand-name version.

Understanding Bioequivalence

The key to marketing brand name drugs after the patent expires is to challenge the
validity of the generic's bioequivalence. This can involve misrepresenting the
scientific process used by the FDA to assess bioequivalence.

To prove bioequivalence to the FDA, the generic manufacturer performs a study in
which around 12 to 36 healthy, normal volunteers are each given a single dose of
one version of the drug, followed a few hours later by a single dose of the other
version (the studies are designed that half the group takes the brand-name first,
then the generic while the other half takes the medications in reverse order). This is
called a single-dose, two-way crossover study, and for immediate release drugs is
usually done under fasting conditions. (A third arm is usually added for extended
release medications in which the effects of food on drug concentration are also
determined.)

The concentration of each version of the drug in the blood is then measured at
regular intervals and pharmacokinetic (PK) methods are used to quantify how much
drug is absorbed into the circulation; the peak concentration of the drug; and the
time needed to reach that peak. The values for the generic and brand name drugs
are then compared.

The FDA uses a statistical test to determine bioequivalence. In technical terms,
bioequivalence exists only when the 90% confidence interval for the percentage
ratio of generic to brand drug formulations falls within the interval of 0.80 to 1.25,
based on log-transformed data.

This has been represented as meaning that generic drugs are anywhere from 20%
less potent to 25% more powerful (and therefore more likely to cause adverse side
effects) than the original drug. And there are clinical anecdotes of patients who
experienced clinical deterioration or toxic side effects when they were switched
from a brand to a generic drug.

But that is not valid. First, it is well known that if anyone takes a medication on two
different days, the pharmacokinetic data-the blood levels- will be different. This is
intra-individual variation, a well-known biological phenomenon, and is caused by a
host of factors including differences in gastrointestinal motility, level of hydration and
even, in the case of psychoactive medication, emotional state. There is normal
variation in biological measures, such as heart rate, temperature, respiratory rate, or
blood pressure, from day to day and even hour to hour. Similarly, the biology of
drug concentrations, which is affected by how the GI tract and liver are working at
a particular time, is subject to normal biological fluctuations.

This is why the FDA -- and Canadian and European regulatory agencies --have
adopted the bioequivalence tests described above. This means that a person
switching from brand name drug to a generic drug should experience about the
same difference in blood levels as he or she will taking the same brand-name drug
on two different days because of normal biological fluctuation.

Second, patients may clinically deteriorate or experience side-effects when
switched from one form of a drug to another. That can also happen when they
have not been switched, as part of the clinical course of the underlying disease.
While clinicians are strongly influenced by their particular experience, when well
controlled studies have been done, the anecdotes turn out to be just that. The
data tell us that bioequivalence means clinical equivalence.

Some Considerations To Keep in Mind

There are a few exceptions to the above discussion. More stringent requirements are
in place for drugs with a Narrow Therapeutic Index (NTI), meaning there is a very
small difference between the plasma concentration of effective and toxic doses.
Examples of NTI drugs are amikacin, gentamicin, digoxin, theophylline, phenytoin,
and quinidine. (Note that none of these are behavioral pharmacy medications.)

Although lithium requires blood level monitoring, bioequivalence has never been an
issue among the various generic versions of lithium that have been available since
lithium was first approved by the FDA in 1970.

Finally, the FDA grades generic drugs for bioequivalence with either an A or B. B
grades are given generic drugs that were approved before FDA started requiring
that bioequivalence be established by actual human, in vivo testing. Only three
psychiatric drugs are on the B list-amitriptyline hydrochloride/perphenazine tablets,
chlorpromazine hydrochloride tablets, and nortriptyline hydrochloride capsules. (You
can access the complete list of A and B-rated generic drugs at
http://www.fda.gov/cder/orange/default.htm)

The FDA's Therapeutic Inequivalency Action Coordinating Committee (TIACC).
Investigates reports that a generic drug isn't as good as its brand name originator.
According to TIACC, it has often been unable to find any scientific support even for
some published cases of supposed lack of bioequivalence.

Take Home Message - and CMT's Commitment

In the overwhelming number of cases - and for all psychotropic medications -
generic drugs are bioequivalent and clinically equivalent to the brand name
version. As a prescriber, you can often help your patient's ability to afford medical
care by prescribing generic versions of medications whose patents have expired
without sacrificing clinical effectiveness.

CMT recognizes the importance of bringing scientific information to the clinician so
that cost-effective prescribing decisions are based on empirical evidence. Before
recommending any generic version of a drug, CMT queries the FDA database to
insure that the generic version has received an A rating and that no special
considerations have been attached to generic form. In this way, we can be sure
that a specific chemical entity, whether it comes with a brand or generic name,
works the same.

And, all other things being equal, we are all better off if we can spend less money to
achieve the same clinical effect.

Forward email

This email was sent to skingcope@naminc.org by ddihoff@naminc.org.

Update Profile/Email Address | Instant removal with SafeUnsubscribe™ | Privacy Policy.

Email Marketing by

National Alliance on Mental Illness North Carolina | 309 W. Millbrook Rd. | Ste. 121 | Raleigh | NC | 27609

Heard in the Halls #11 January 2010

2010-04-16T08:20:00.001-07:00

NAMI North Carolina's

Heard in the Halls

January 2010

Quick Links

NAMI NC

NAMI National

CMT

NAMI North Carolina aims to bring you comprehensive information on a variety of current topics. In this edition I will touch upon the CABHA requirements, the status of peer support in North Carolina, Gap analysis for the General Assembly, Coalition Stories, and updates from the Legislative Oversight Committee

Deby Dihoff, MA

Executive Director

Gap Analysis completed for The Division of MHDDSAS

Feedback to the Division of MHDDSAS regarding service gaps and needs for report to the General Assembly March 2010 (prepared by public policy committee with input from the consumer council)

Need for a functional crisis response system that is embedded within a system defined by continuity of care for those most in need.

Certainly NC has made a tremendous effort to intensify the services necessary in times of crisis to fill the gaps created through system upheaval in reform. We believe a return to inpatient services available locally (these used to be required in rule) is a great step in the right direction, as is the addition of additional models such as CIT, mobile crisis, facility based crisis options, etc. However, individuals continue to cycle in and out of state institutions, sometimes as many as 4-5 cycles per year, with no clear plan upon discharge about what will change. It is time to get timely discharge plans into the hands of the providers who will pick up the care for the person, time to examine more closely the person centered plans and why the crisis plans embedded therein are not working. We must address more clearly accountability and responsibility- are LMEs allowed to require crisis plans from their providers? Can they insist that a copy be sent to the local inpatient facility and as well to the LME so they can get it to the right people at the right time? Minimally the LME should have the document on file electronically, and it should be shared with the treating providers, and with the applicable hospital. And the quality of the crisis plans needs to improve through robust review and monitoring and a system of consequences for those who are not complying with good care. As we move towards the inclusion of paid peer support, the crisis plans should include a linkage with a paid peer support upon discharge from any state or local inpatient bed. With that support, from someone with lived experience, we may see this turn around.

Discharges to homeless shelters has improved in NC, but largely for those who have been hospitalized 30 days or longer, which is a very small number of the total admissions. We need to look at the length of time people are receiving necessary hospitalization to ensure that they are stable before discharge. And perhaps we need a temporary housing situation, perhaps a small specialty waiver, so that absolutely no one gets discharged from our state hospitals to a homeless shelter. In FY 2009 there were 459 discharges to shelters, while in FY 08 there were 1192; a great improvement, but still 459 too many.

Housing

NAMI NC has a fear that with so much funding going towards crisis service development that there simply won't be enough left for housing. After all, people are only in crisis for a fraction of their life in any given year, the rest of the time they need safe, affordable, decent housing.

Individuals with mental illness often have difficulty securing housing, primarily due to very limited incomes. Studies show that providing affordable housing for people with mental illness helps with long term recovery and reduces incidents of crisis, including hospitalization. North Carolina has a history of strong partnerships in providing long term housing to individuals with disabilities, including the recent "Housing 400" initiatives that have leveraged state, local and federal funds to add more than 1000 units of housing .The problem is that 1000 units isn't nearly enough to meet the demand: there are 5,000 people with mental illness in adult care homes who could live more independently and while discharges from state hospitals to homeless shelters have decreased by half, even one discharge is too many. We need to have l000 more funded next year

A second area of housing needing attention is that of people with mental illness who have been placed in family care/adult care facilities not intended to serve their particular illness. The Supreme Court in NY recently found that this type of wholesale placement is not only inappropriate, it is a violation of federal law. An expansion of the options provided through the "Housing 400" program would meet the needs of many of these individuals who are inappropriately placed and may in fact present dangers to themselves and the older population living in these facilities.

With more than 5,000 people with mental illness in family care and adult care facilities, the state needs to invest in solutions for residential services that support independent living: supported housing (housing with services built in or connected ), group homes for people with mental illness, and independent living with service dollars tied to the housing and person so those without Medicare or insurance can qualify for safe stable housing that meets their unique needs. These needs go beyond the 10m for "Housing 400" and require the long term support of additional service funds of 7 million per year to begin reducing the number of people with mental illness in adult care home/family care homes.

The right treatments available at the right time, throughout NC

North Carolina has certainly struggled with getting the right treatment mix, with marked lack of success in the Community Support debacle. Years ago, there were requirements that all public programs ensure the availability of a continuum of services in their catchment areas. That requirement went away with reform, and it is time to bring it back. No matter where you live in NC, you should have access to ACTT for example, one of six SAMSHA recognized evidenced based practices (EBP). Also, people should have available within a reasonable drive access to a good psychiatric inpatient bed. We need to make sure that we provide what works, not just what providers, or others advocate for. An example is Integrated Dual Diagnosis Treatment (IDDT) - another one of the six EBP approved by SAMSHA. While you can conceivably figure out a way to bill for this, it is very hard, and therefore it simply doesn't happen.

Another example - NAMI NC provides natural supports in the form of family psycho education - another SAMSHA EBP that is not included on our menu of billable services. We believe it would not be a good fit for fee-for-service, but we also believe it is one of the most effective, and inexpensive (think volunteer) services out there- but we need more funding for getting it everywhere in NC . We advocate the old principle of "if you build it, they will come" - the way to get these treatments readily available is to make them a clear service definition, get it a rate, and make it available for billing. Then you need to reward those who get good results from providing the right treatments, by giving rate differentials for achieving certain outcomes - like keeping people out of jail, helping with employment, decreasing hospitalizations, aiding in recovery.

A lesson learned to accompany making sure the right treatments are accessible is that we must do better to train providers consistently, in an ongoing manner, to provide those services in the right way. Our training model does not work. Let's create what is called in other states Centers of Excellence, where linkages between universities and the Division of MHDDSAS connects research with practice through regional centers. These are small, inexpensive, but work to motivate providers to use treatments that work, trains them to do the work with a fidelity to the model, and monitors them in their work.

Employment is an EBP for which we have a service definition, but it is not working as well for those with mental illness as it could and should. Perhaps with a focus through the Centers of Excellence, NC can begin to experience much greater success with supported employment for those living with mental illness.

The introduction of paid peer supports is an excellent advance in North Carolina, but it must be accompanied by a system of care that really values recovery, and aids in people's recovery by having access to training, support, and services that are targeted towards illness management and wellness/recovery. People with mental illnesses truly have modest needs- let's make recovery a centerpiece of our system, not an afterthought. It should be woven into all rules, laws, practices, etc.

Decriminalization

We are so proud of the excellent work done around the state in training police officers to recognize mental illness and take people to treatment rather than jail (CIT- pre jail diversion). But the problem remains: all police departments must buy in and be trained. Those who were incarcerated before that program existed all too often still remain incarceration. We must advance our reform of the prison rules that process has taken far too long. Rule making needs to be re-examined and streamlined so necessary reforms can take place when problems are recognized. Transition planning from prison and jails must be improved according to newer findings on what works. People must have access to the medications that work while they are imprisoned; and they should not be forced to change medications without a consult with their primary psychiatrist. We must figure out a way for providers to become involved in the transition planning and get paid for that work - through forensic case management or forensic peer support.

Access to Medications

Medications truly do work differently on everybody. While we must spend the public dollar wisely, to stretch it to serve so many needs, following what may be decades of trial and error to find the right medication, no one needs to be forced to change to a cheaper form of the medication. NAMI NC believes that we should look at cost, the doctor and the patient alike, in making a truly informed decision on medication. We also believe that if someone is new to the diagnosis, and just trying medications, that is a good time to try a generic. But we are opposed to further barriers being established, such as prior authorization requirements, between the person needing medications, and getting their needs met. Too much research has shown that any barrier can be a reason to simply not take medications. Medication compliance is already an issue- and for many good reasons; the side effects can be devastating. But we know medications in combination with supports and therapies really work- let's let them work by maintaining open access.

A second area of concern is just having the money to buy needed medications. Compared to the cost of a day in an institution, even the most expensive of meds becomes small in comparison. Yet our public support for funded medications for indigent groups has declined with the economy. This is a perfect example of pound foolish, penny wise. Let's rebuild our psychiatric medication assistance fund, and help people stay out of the more expensive hospital setting.

Note: NAMI NC is a member of the Coalition for Persons Disabled by Mental Illness and also contributed to their gap document which can be found at the following link: http://capwiz.com/cpdmi/issues/alert/?alertid=14547521

A Thousand Stories Project: the impact of cuts on those living with mental illnesses

Some months back the Coalition had a very successful press conference describing the impact of cuts on real people, living real lives. This gained a lot of media attention and put the focus where it should be: no more cuts to mental health! A follow up strategy is to collect stories documenting the impact of budget cuts on those receiving services who may be cut back or may lose services entirely. We are also looking to document the impact on the loss of jobs and the potential closure of providers- all signs of disarray in an already chaotic system.

Please take the time to fill out the survey- you can fill it out multiple times if you find your circumstances continue to change and deteriorate. There are three surveys: for those individuals who are receiving (or losing) services, for employees and for providers. This survey will be active between December l and June 30, 2010. To tell your story, simply click here:

http://www.surveymonkey.com/s.aspx?sm+FtqhlyR35b3AZF4BtjcnNg_3d_3d

We will use these stories to reach decision makers and the medica and legislators - they need to hear the impact of the legislative decisions to cut our service system so severely. Remember, when we last made a call to action at the time of the cuts- the Governor actually rescinded l5M in cuts to mental health; so your voices, your stories, are effective. I head at the last Legislative Oversight Committee that the Governor is asking for more cut scenarios- 3-5-7M- this is the last thing we need. Help make sure this doesn't happen - tell your story- jump on the survey monkey.

CABHA

The Critical Access Behavioral Health Agency (CABHA) is a movement toward quality providers, with a range of services within their organization that can facilitate some one stop shopping by those who may have needs that change over time. Like any major change, the devil will be in the details and the unintended consequences- especially for small providers, in rural areas that have an absence of larger providers. Each provider (whether it be non profit or for profit) must provide the following services:

comprehensive assessments

medication management

outpatient therapy

In addition they must provide two additional enhanced benefit services in a sensible array

(say for children, or a range crisis services for adults)

Peer Support and Case Management may only be provided by CABHAs. The move to improve quality is on the heels of the many problems plaguing community support- fraud, misuse, overspending, too many providers - many more than were actually needed- and too many pour outcomes. To enforce quality, there are requirements for psychiatry time, clinical director time, and training director/quality improvement staffers. If you have more than 750 cases, the provider would have to have full time staff in these areas.

What are the worries with CABHAS?

Many small, specialized but excellent providers will not be able to stay in business if all the referrals stay with the CABHAS
How will referrals flow from CABHAS to non CABHA providers
Many clubhouses offer enhanced services now- this won't be allowed, so a good network of support for those being currently served will once again be disrupted
CABHAS may keep all the referrals for themselves; there is a conflict of interest in that they do the assessments, it has been shown that in the past those who do the assessments determine that those assessed need the services they provide.
Many people with mental illnesses have coexisting substance abuse disorders: it may be hard to get integrated care because one CABHA may specialize in one disorder, and another in the other.

It's complicated, and it is an issue that probably needs more time. Yet, the financial difficulties with the old way of having so many small providers did not work either and needs some sort of fix. Here is a link to a story produced by WUNC just today on the CABHAS:

http://wunc.org/programs/news/archive/NRH0120.mp3/view

Peer Support Progress

Yesterday Mike Weaver and I met with Mike Watson, Tara Larson and Flo Stein regarding concerns about training capacity for peer support, and issues with the definition. We are recommending formation of a task force comprised largely of peer support specialists to guide the state's efforts in rolling out this important new service. We are incredibly excited about this new billable service and know that it will be an important part of the continuum. It values the role that those in recovery who want to work in human services can play; lived experiences mean a lot to someone else who is just beginning to face that the helper has weathered and survived.

NAMI Representation on State Committees

Long a sore spot, I am happy to report that things are improving! Our voices are beginning to be heard. Here are some of our recent appointments:

Commission of MHDDSAS
State Medication Committee
Institute of Medicine Committees (Michael Weaver- adult care homes; Deby- veterans issues)
Stakeholder issues on Community Support and on Residential Committee
We're working to appoint someone to the Medical Care Advisory Committee (MCAC)
Always looking for those interested in serving on LIfe Plan Trust Board (meets in Chapel Hill quarterly)

We're always looking for volunteers to serve on statewide committees ; let Deby know if you are interested in this!

Don't forget - the Eastern Regional Conference (open to all) is February 27 in Greenville- register on our web page; the $l0.00 registration includes lunch - what a deal!

Deby Dihoff

Executive Director

Forward email

This email was sent to skingcope@naminc.org by ddihoff@naminc.org.

Update Profile/Email Address | Instant removal with SafeUnsubscribe™ | Privacy Policy.

Email Marketing by

National Alliance on Mental Illness North Carolina | 309 W. Millbrook Rd. | Ste. 121 | Raleigh | NC | 27609

Heard in the Halls July 22, 2009 - #10

2009-08-10T09:26:00.001-07:00

NAMI North Carolina's

Heard in the Halls

House and Senate Adopt Budget

August 7 2009
Number 10

Quick Links

NAMI NC

NAMI National

North Carolina General Assembly

It's been a very long and painful legislative session, with many highs and lows. Those will be the focus in the edition of Heard in the Halls

I also remind you to submit nominations for our annual awards (due August l5) and for Heroes in the Fight (August 27)

Thanks to all of you for the advocacy work you've done this session - it has paid off for our cause.

How did Mental Health fare in this year's budget?

Open Access to Medication - a victory, but the jury's still out...

There was a huge threat this year to eliminate the "carve out" to the prior authorization requirements for medicaid funded drugs. In effect, we continue to be an exception to the rule that people must get approval before getting a particular drug. Research indicates that any barrier to getting medications can result in adverse effects, It was all driven of course by money, and a need to balance the state budget in hard times. Many advocates banded together- the grassroots were engaged, and we won! The exemption remains but there will be closer scrutiny to what medications work, and cost with the following requirements:

The Dept may develop guidelines and measures to ensure appropriate usage of medications, including dosages
The Dept may require retrospective clinical justification for the use of multiple psychotropics
For those l8 or under who have 3 or more psychotropics, edits with target inefficient, ineffective, or potentially harmful patterns. When that is identified, a peer to peer consultation will be required
There will be an emphasis on using the Prescription Advantage List (meds that work and are cost effective) , using more generics, and enhancing rebate collections

Medication committees will adopt policies and procedures on the preferred drugs as follows:

guidelines for review of drugs for inclusion
manner and frequency of audits of the list for appropriateness, cost effectiveness
an appeals process
all classes of drugs will be included

Additional changes will result if the Department cannot demonstrate by June l, 2010 savings of $25 Million

Peer Support and Community Support

Definitely a good news, bad news report

First, Community support will be ending on or before June 30, 2010. The Division is working hard on discharge planning and transitions, when appropriate, to other services.

The Department shall submit to the federal government revised service definitions that separate case management from the Community Support Definition, and they will submit a new service definition for peer support services for adults with mental illness and/or substance abuse disorders. This is HUGE news- and a very big victory for NAMI NC. This was one of our high priorities on our legislative agenda. It will take a long time to build the infrastructure, but individuals in recovery will be able to have paid positions to help others - particularly as they transition out of corrections, institutions, crises, etc.

Other stipulations:

no new admissions will be allowed during this transition unless the Department determines appropriate alternate services are not available
Authorizations currently in effect remain valid
No CS will be provided in conjunction with other enhanced services (note- it may be used to help with discharge planning for level II I and IV group home transitions for children
Moratorium continues on endorsing new CS providers
Paraprofessional level will be eliminated in 60 days of enactment
65M in 2010 will be cut 97.5 M in 2011

A stakeholder committee has been established to help with the transitioning of people (14,107 adults, 23,523 children) and NAMI NC is at the table. A subgroup of this group will also help with the review/development of a peer support definition. NAMI NC has facilitated a group working on that task for over a year so all that work will be submitted to the Department.

We are absolutely thrilled to be moving on peer support!!

Capital Sentencing Bill HB 137 (anti death penalty bill for those severely mentally ill at the time of the commission of the crime)

What an effort was made this year to have our state become the second in the nation to have such an enlightened piece of legislation...but in the final moments of the session, it was not to be. Politics got in the way- too many controversial bills- too many re-elections. But the good news is that we had the votes!! We will try to intervene with the Governor if they do restart executions and there is someone with a mental illness in that group. Our other ideas is to wait for the spring short session. We will need your help in working on those legislators who were a "yes" but might need more education back at home. We have a wonderful session on this at our annual conference. Thank you so much for all your work in lining up the votes. Be looking for news on progress next year.

More to come: a special edition focusing on children's changes in residential group homes (level 3 and 4 cuts in funding) and alternatives.

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

Deby Dihoff, MA

Executive Director

Forward email

This email was sent to naminc01.raleigh@blogger.com by ddihoff@naminc.org.

Update Profile/Email Address | Instant removal with SafeUnsubscribe™ | Privacy Policy.

Email Marketing by

National Alliance on Mental Illness North Carolina | 309 W. Millbrook Rd. | Ste. 121 | Raleigh | NC | 27609

Heard in the Halls July 22, 2009 - #9

2009-07-22T11:09:00.001-07:00

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!

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

Forward email

This email was sent to naminc01.raleigh@blogger.com by ddihoff@naminc.org.

Update Profile/Email Address | Instant removal with SafeUnsubscribe™ | Privacy Policy.

Email Marketing by

National Alliance on Mental Illness North Carolina | 309 W. Millbrook Rd. | Ste. 121 | Raleigh | NC | 27609

Heard in the Halls July 15, 2009 #8

2009-07-15T06:04:00.000-07:00

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

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

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

2009-07-08T16:56:00.000-07:00

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

2009-07-08T16:54:00.001-07:00

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

2009-07-08T14:38:00.000-07:00

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

2009-07-08T14:33:00.001-07:00

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

Heard in the Halls June 2009 #3

2009-07-08T14:31:00.001-07:00

NAMI North Carolina's

Heard in the Halls

Take action to oppose major budget cuts that will decimate services for our consumers

June 2009
Number 3

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

UNPRECEDENTED BUDGET CUTS PROPOSED!!! take action IMMEDIATELY

We must act now to prevent a complete breakdown of the services that we rely on in the community like local inpatient beds, community support, and residential subsidies. Take action - call and email your legislator and tell them the impact this will have on your life and the lives of your family members. Let's protect PEOPLE FIRST

Let's run the numbers

Why are these cuts happening?

The Health and Human Services (HHS) Subcommittee of Appropriations met yesterday, and they made another $255 M in cuts to bring the HHS budget cuts to nearly $4 Billion over the next two years. They had left out the costs of the medicaid county share that is transferring from the county to the state. Our current budget in NC adopted last year is $21.35 Billion, but next year's revenues are only expected to be $l7.6 Billion; thus the shortfall. Also, with increased costs of education, health care, and other expenses, the lawmakers needed to come up with another $4Billion in cuts

Is it fair? A point was made that Health and Human Services is making up 50% of the cut, while they constitute 23% of the total budget- THESE CUTS ARE NOT FAIR. The budget for the Division of MHDDSAS has been reduced by 74M in 2010 and $91M in 2011

The specifics (with an emphasis on the services that will most impact consumers)

$4.5M each year of the biennium in state operated services(hospitals)
$4 M in community service reductions each year of the biennium
#66 - $l.l5M reduction (nonrecurring) in funds for rental subsidies (310 rental units up for occupancy in 2010)
#121 Reduce community Support by $59 M in year one, $116 M in year two (no replacement for this service is proposed)
#118 - Provider rate reductions (5.5% in 2010, 6% in 2011 - may destabilize service system)
Loss of 8M in inpatient hospital local build up (just when it was starting to take hold)
#125 Implement a preferred drug list to save $40 M year one, $50 M year two (restricts access)
#128 Dental Coverage- reduces tihs optional medicaid service by $l6 M first year, $20M second year
#133 Increase co pays on services (another barrier) by $2 per co pya ($3 M in 2010, $3.7 M in 2011)
#122 Eliminate PT/OT/Speech $2.7 M as optional medicaid service
#143 Eliminate MH Residential services, therapeutic camps for kids $l.5 M year one, $2.2 M year two)
#85 - Reduce State/county special assistance rates effective October l, 2009 ($3M year one, $4.3 M year two)
#120 Reduce Personal Care Services in Adult Care Homes ($l0M both years) and modify to reduce utilization ($49 M year one, $62M year two)

Note: There is no bill number, this is from a proposed money report dated June 2 put out by the HHS Subcommittee on appropriations. Full details to eventually be posted on line and on NAMI NC web site

The Timing

June 4, Thursday- vote expected at the HHS Subcommittee of appropriations (that's right, tomorrow!!)

Next week (week of June 8th) - Goes to full appropriations for consideration on the House side

Week of June 15 - Will probably proceed to the full House

Conferees- will look at negotiating a version acceptable to the House and to the Senate

It's not over till the final gavel drops!!

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)
Our hospitals will decline again through staffing cuts, and we'll be at risk of losing accreditation (more expensive)
Economic stressors lead to an increased demand for help and services- this is not the time to cut those very things people need more now than ever
Tie in your personal story and how it will impact your life
Consumers need access to a full range of medications- they are uniquely vulnerable, the drugs are uniquely important to their recovery, and the lack of access to drugs has been found to be costly (more expensive) The costs include data showing that over 50% of people in one state had trouble getting their drugs, one in 5 had an increase in adverse reqctions, and 3% actually became homeless! All this does is achieve poorer health outcomes
NAMI NC supports revenue improvements to preserve services for our most vulnerable services. We have signed on to Together NC which advocates for removal of corporate loopholes, an addition couple of tiers on our progressive income tax, and consideration of service taxes. Preserve NC as the positive place to live for families by protecting our infrastructure of services.

Who do I call, What do I do?

Consider a trip to Raleigh, or contact your legislator at home
Act NOW- they vote tomorrow at HHS subcommittee- send an email to the leadership of HHS Appropriations
Contact your local legislator because it will get to the full house floor, even if they don't serve on the HHS Appropriations subcommittee
If you legislator serves on the full appropriations call AND write them to oppose these cuts
Use the link above to contact info on your legislator
INitiate a telephone tree within your affiliate to get EVERYONE to call and write
If you have an affiliate meeting, write letters while you are there
Send me personal stories that I can use
Work both sides, Senate and House. They must eventually agree on one budget

Full House Appropriations leadership:

Michaux (Durham), Adams, Alexander (Mecklenburg), Crawford (Granville)(, Haire, Jeffus, Tolson, Yongue

Vice Chairs: Bordsen, Cole, Earle (MEck), England, Fisher, Glazier, Goforth, Harrison, Insko, Love, Martin, McLawhorn, Owens, Pierce, Rapp, Underhill, E Warren and Womble

HHS Subcommittee on Appropriations

Chairs: Earle (Meck), England, Insko (orange)

Members: Barnharet, Farmer-Butterfield, Brisson, Burr, Burris-Floyud, Dollar, Neumann, Stewart

MH is taking far too great a share of the cuts being proposed

Take Action Make a Difference. Do it Today

.Deby Dihoff, MA, Executive Director

Balancing the Budget- it will take more than cuts

Did you know that North Carolina's tax code last received an overhaul at the time of the Depression? Well, it's that time again. And let's make it fair and sufficient to maintain the great services and infrastructure that makes this state such a great place to call home. At this time of crisis, it is essential that lawmakers do all within their power to preserve key public services - especially those that are of direct benefit to people in need and that help rebuild our economy.

We simply can't balance the budget with service cuts alone -- The huge state budget shortfall makes some painful service cuts inevitable. It is critical that the House follow the lead of the Governor and the Senate and raise some new revenues to help plug the shortfall.

Spending is not our problem. - "The reality is that spending per person is actually down from nine years. This is a fiscally conservative state, and we don't go on spending sprees.
Taxes on the wealthy are better than cuts to essential services - When it comes to stimulating the economy (and preserving economic activity) during a recession, economists confirm that while new taxes should be used sparingly, they are better than cuts to essential services. These economists also confirm that to the extent that new taxes are a part of the equation, they should target those with the greatest ability to payl
Avoid quick fixes that only postpone the pain - To the extent lawmakers make new revenues a part of the solution, it is important to make them progressive revenues that will grow with the economy as it recovers. Simply relying upon regressive sources that tend to shrink over time (like tobacco and alcohol taxes) will just put us back in the same place in a couple of years.
Build on the Senate's recent action - The Senate has done a good job of jumpstarting a long overdue discussion over North Carolina's tax system. Its basic approach - broadening the base and lowering rates - makes good sense. The House should build on the Senate's proposal by closing corporate loopholes and improving the progressivity of the personal income tax. The proposed revenue plan of the N.C. Budget and Tax Center ought to be the model.

Heard in the Halls April 2009 #2

2009-07-08T14:28:00.002-07:00

NAMI North Carolina's

Heard in the Halls

Make your Voices Heard..Public Hearing on NC Budget Tuesday April 28 2009..Protect Free Access/Choice on Medications

April 2009

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

Action Alert - public hearing tomorrow April 28, 2009

The Appropriations Committee of the North Carolina House of Representatives will hold a public hearing on Tuesday, April 28, to receive comments about the state budget. The hearing will be held from 6-9 p.m. in the auditorium of the North Carolina Museum of History in Raleigh on Fayetteville Street.

Check this link for more information:
http://www.ncleg.net/sessions/2009/budget/2009/BudgetPublicHearing.html Ten community colleges across the state will host interactive broadcasts of the hearing and it will also be streamed live on the Internet.

Committee members would like to invite members of the public to offer suggestions and comments about the budget. Each speaker will have three minutes to share information. Information about how to submit written comments and how to access the online broadcast will also be available at the site.

The community colleges that will serve as host sites are:
Johnston Community College, Smithfield
Bladen Community College, Dublin
Central Piedmont Community College, Charlotte
Fayetteville Technical Community College, Fayetteville
Forsyth Technical Community College, Winston-Salem
Pamlico Community College, Grantsboro
Southwestern Community College, Sylva
Surry Community College, Dobson
Vance-Granville Community College, Henderson
Martin Community College, Williamston

Visit www.nccommunitycolleges.edu/colleges_map.aspx for contact information and driving directions to each campus.

WHO: Appropriations Committee of NC House of Representatives
WHAT: State budget public hearing
WHERE: NC Museum of History and 10 community colleges
WHEN: 6-9 p.m., Tuesday, April 28, 2009

Now is the time - do NOT delay- call your legislator and tell them what you think of some of the recommendations contained within the budget. Here are some suggested talking points for you to use.

Please CALL or email your legislator- go to the web site link above for quick access to numbers and emails and names! It is already in the Governor's Budget, and in the Senate Budget. It is time to fight this with your members of the House.

Restore the protections for choice and access to medications in the budget. Do not require prior authorization for medications for schizophrenia and bipolar
The Kaiser Commission recommends against this; providers may end up spending twice the time they actually spend with patients on paperwork
A study in Maine found that adherence issues resulted when prior authorization was used; resulting ultimately in cost shifts to ERs and increased visits to the doctor
Instead, let's use generics where they exist and are effective
Let's expand the use of behavioral pharmacy management quality indicators that support the use of evidence based practices
Let's expand peer consultation after mailings to doctors who prescribe outside of best practice guidelines
Let's provide financial incentives to reward patients who receive appropriate care resulting in good outcomes, not by volume of prior authorizations
Let's involve the users in policy decisions- add families and consumers to the state medicaid pharma committees
Let the doctor make the best decision medically based on individual circumstances

Deby Dihoff, MA, Executive Director

Balancing the Budget- it will take more than cuts

Spending is not our problem. - "The reality is that spending per person is actually down from nine years. This is a fiscally conservative state, and we don't go on spending sprees.
Taxes on the wealthy are better than cuts to essential services - When it comes to stimulating the economy (and preserving economic activity) during a recession, economists confirm that while new taxes should be used sparingly, they are better than cuts to essential services. These economists also confirm that to the extent that new taxes are a part of the equation, they should target those with the greatest ability to payl
Avoid quick fixes that only postpone the pain - To the extent lawmakers make new revenues a part of the solution, it is important to make them progressive revenues that will grow with the economy as it recovers. Simply relying upon regressive sources that tend to shrink over time (like tobacco and alcohol taxes) will just put us back in the same place in a couple of years.
Build on the Senate's recent action - The Senate has done a good job of jumpstarting a long overdue discussion over North Carolina's tax system. Its basic approach - broadening the base and lowering rates - makes good sense. The House should build on the Senate's proposal by closing corporate loopholes and improving the progressivity of the personal income tax. The proposed revenue plan of the N.C. Budget and Tax Center ought to be the model.

Heard in the Halls April 2009 #1

2009-07-08T14:28:00.001-07:00

NAMI North Carolina's

Heard in the Halls

April 2009

Quick Links

NAMI NC

NAMI National

North Carolina General Assembly

Welcome to the first edition in many years of the 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

This week in the General Assembly

Exciting news- this week in Senate Appropriations Senator Kinnaird put forward SB 354 that will help an estimated 9000 people maintain their Medicaid eligibility despite a cost of living increase that may have put them a dollar or two over the income restrictions. Here's how our complicated government system works: every January people who live on social security get a cost of living increase, then in February, the poverty level is set for federal programs. In April, NC sets its own eligibility limits. This year was a bigger than usual cost of living increase, which ironically kicks people out of eligibility for Medicaid. And of course Medicaid is their insurance program that pays for their health care and their services as well. When they lose this, they lose their ability to live on their own, must meet large deductibles in order to apply again. Many may have to go to nursing home level of care. If you have a story like this- please call your legislator and ask them to support the An Act to Direct the DHHS to Adopt a Policy Allowing a Certain Income Disregard under the Medicaid Program. And call Senator Kinnaird and the cosponsors Atwater, D Berger, Foriest, McKissick, and Stevens, and Nesbitt to say thank you as well. Because it passed Senate Base Budget/Appropriations, There is a long ways to go till it is law, but we're on our way. Please activate your telephone trees or just call your legislator and ask them to support SB 354.

National Family-to-Family Leadership Award recognizes Brenda Piper, NAMI North Carolina Program Director

Each year, the Family-to-Family Education Program recognizes a state Family-to-Family program director for outstanding statewide Family-to-Family program coordination. Brenda Piper, for the past three years, has been making steady progress in fortifying the NAMI North Carolina Family-to-Family program infrastructure. Of her many accomplishments, she has successfully secured local management entity (LME) contracts which provide funding for the state and local affiliates. She has worked effectively to promote statewide communication regarding program development via regular contacts with affiliate presidents and quarterly calls with Family-to-Family teachers.

North Carolina compares very favorably with the 49 total states engaged in the family to family program Based on information gathered during year-end calls to the states from national, covering 46 of our 49 F2F program states, North Carolina falls in our top tier of program states which have:
1) funding in excess of 50,000 earmarked for F2F;
2) annual F2F classes held in excess of 25;
3) annual F2F graduates in excess of 250;
4) full time/paid program coordinator;
5) solid communication links with local program sites;
6) local affiliate program support;
7) solid core of state F2F trainers; and
8) strong state board and executive director support of program expansion

Brenda will be recognized at the 2009 conference in San Francisco.