Leading from the Left

Thursday, May 31, 2007

Progress Delays Pursuit of Nuclear Power

Late yesterday afternoon I received the folllowing press release from Progress Energy. They've decided to "delay" their pursuit of nuclear power! Given the problems at Shearon Harris, and the GAO study that Congressmen Price has requested, delaying any future nuclear power is a good decision on the part of Progress.

Here's the press release in it's entirety.

Progress Energy Carolinas sets goal of doubling efficiency savings to 2,000 MW

Company announces deferral of potential construction for new nuclear plant in N.C.,
proposes 2-year moratorium on new coal plants while pursuing aggressive conservation

RALEIGH, N.C. (May 30, 2007) – With its service area expanding by 25,000 to 30,000 new homes and businesses each year, and facing increased costs to ensure continued reliable electricity to accommodate that growth, Progress Energy Carolinas today announced a goal of displacing 2,000 megawatts (MW) of power generation through demand-side management and energy-efficiency programs.

In meeting this goal, the company will double the approximate 1,000 MW currently being saved with existing programs. The additional 1,000 MW reduction would be equivalent to the capacity of more than six combustion-turbine power plants.

“We are at an energy crossroads in the Carolinas,” said Bob McGehee, chairman and CEO of Progress Energy. “The growth in our service area is equivalent to a fully built-out, medium-sized city each year. Our homes and businesses are more dependent on reliable electricity than ever before. And our world has become much more aware of global climate issues and the factors that affect climate change. These decisions will position our company to help shape climate-change policy as it is being developed.

“As a utility, we’re committed to making sure electricity remains available, reliable and affordable and that it is produced in an environmentally sound manner. There are two main ways to meet that increased demand – engage our customers in changing behaviors to use less electricity, and continue to invest in new ways to produce and deliver power so it’s there when needed to meet the demands of the region’s growth. The balance is critical.”

Progress Energy will aggressively implement its energy-efficiency programs and, over the next two years, evaluate their effectiveness and participation rates to determine their viability in reducing electricity demand further. Additional reductions in future electricity demand growth through energy efficiency could push the need for new power plants farther into the future.

Related to its efficiency initiative, the company has announced a commitment that it will not propose any new coal plants during this two-year evaluation period. In addition, Progress Energy has notified the Nuclear Regulatory Commission that if the company moves forward with plans for a new nuclear plant at the Harris site in Wake County (a decision that has not yet been made), the new plant would be online in 2018 or beyond, at least two years later than initial energy demand forecasts had indicated.

“Working with the communities we serve, we are developing programs that are a good fit for our customers’ lifestyles,” McGehee said. “And we want to actively engage citizens in a call to action to use energy more wisely and efficiently. This will reduce demand, save customers money and preserve the environment.”

Progress Energy will launch a three-pronged effort to encourage citizen participation:

First, the company is setting the conservation example by converting its buildings, plants and distribution and transmission systems to new technologies that ensure operational efficiency.

· The newest Progress Energy headquarters building in downtown Raleigh (Two Progress Plaza) participates in the company’s load-control program; it has “smart elevators” and programmable thermostats, among many other features that curtail energy use. In addition, the company is making a commitment to replace existing lighting in the older headquarters building on Fayetteville Street with compact fluorescent lighting (CFL). CFLs reduce energy use by 75 percent compared to traditional incandescent lighting, and the change will reduce emissions of carbon dioxide by more than 56 tons, the equivalent of taking 10 vehicles off the road for a year.

· The company is improving the way electricity is transported from power plants to homes and businesses, upgrading equipment on its transmission system and studying a real-time distribution system that would allow remote operation of switches and other equipment at substations. At full implementation, the company will have the ability to save approximately 100 MW by reducing voltage slightly during peak energy demand.

· Since 2001, Progress Energy has completed 311 MW of power uprates at its nuclear plants in the Carolinas. A power uprate increases the maximum power level at which a nuclear plant may operate and the amount of energy the plant produces.

Second, the company is partnering with commercial, industrial and government customers, including the military, to find ways to help them reduce their demand. Those customers accounted for nearly 63 percent of the energy used in Progress Energy Carolinas’ retail service area in 2006.

Third, Progress Energy will offer several new programs to help residential customers use energy more wisely. Since 1980, participating Progress Energy customers have saved the equivalent of 16 billion kilowatt-hours (kWh) through existing efficiency programs. New programs coming online this year will add to the approximately 1,000 MW of demand-side management and efficiency programs already in place:

· Installation of a new generation of programmable thermostats and water heater control devices to help regulate on-peak energy use in homes and businesses.

· Increased residential HVAC maintenance, as well as duct testing and repair.
· Large-scale replacement of incandescent light bulbs with energy-saving compact fluorescent bulbs.
· Increased energy education and awareness, including in-home energy assessments and the use of new digital displays that provide real-time energy use and cost information for homeowners.

· Research and investments in new, clean fuel-cell technology for home and business electrical generation.

“We are moving forward on a variety of fronts to increase efficiency and to give our customers options to do the same,” McGehee said. “Technological advances will continue to be important, but the most critical element for success is our customers’ willingness to understand and change energy behaviors. This is a shared responsibility and a challenge for all of us, not just in the Carolinas but throughout the country and world, and we believe our customers will help make this aggressive goal a reality. Our customers will determine how quickly we achieve and surpass this goal.”

Progress Energy is committed to a long-term, balanced solution to meeting growing energy needs – a solution that includes three main components: (1) increased energy efficiency, (2) investments in renewable energy sources and other emerging energy technologies, and (3) upgrading of existing power plants and investments in new plants when needed.

Progress Energy is investing between $1.1 billion and $1.4 billion to reduce emissions from its coal-fired power plants to meet the requirements of North Carolina’s Clean Smokestacks Act. The company also has invested $1 million in Microcell Corp., a Raleigh-based company working to bring commercially available fuel-cell applications to industrial, commercial and consumer markets, and is evaluating options for increasing electricity generation from other nontraditional and renewable sources, including hog waste and other biomass.

Last year, the company announced a potential nuclear plant expansion for the future to meet the demands of growth. Because it takes many years to site and build new power plants, the company is working to keep future power plant options open, including a plan announced in early 2006 to use the existing Harris Plant site southwest of Raleigh for nuclear expansion if the company decides to build a new nuclear plant. The existing nuclear unit at the Harris site came online in 1987 and has been helping to meet the growing region’s needs dependably and in an environmentally sound manner for 20 years. Progress Energy is continuing to move forward with preliminary activities to ensure nuclear power remains a viable alternative for meeting the region’s future energy needs. A final decision on building new nuclear plants in the Carolinas is still more than a year away.

Progress Energy (NYSE: PGN), headquartered in Raleigh, N.C., is a Fortune 250 diversified energy company with more than 23,000 megawatts of generation capacity and $10 billion in annual revenues. The company's holdings include two electric utilities serving approximately 3.1 million customers in North Carolina, South Carolina and Florida. Progress Energy's nonregulated operations include energy marketing. Progress Energy is the 2006 recipient of the Edison Electric Institute's Edison Award, the industry's highest honor, in recognition of its operational excellence. The company also is the first utility to receive the prestigious J.D. Power and Associates Founder's Award for dedication, commitment and sustained improvement in customer service. For more information about Progress Energy, visit the company's Web site at www.progress-energy.com.

Marty Clayton
Progress Energy
Manager - Community Relations

Wednesday, May 30, 2007

Guest Post to Wrap up Mental Health Month

We're coming to the end of Mental Health Month during which I devoted most of my posts here on this blog to mental health issues. I intend to continue my coverage of mental health issues, particularly this reform mess. Thanks for all your comments and suggestions this month....much appreciated.

Today, I'm honored to have a guest post from Linda Foxworth. Linda is a children's advocate and mental health advocate whom I first met years ago when we both served on the Board of the Childcare Services Network. She now heads up Kidscope, a local non-profit that works with children with mental health issues. Here is Linda's guest post:

Young Children’s Mental Health

I was very pleased to hear about the recent National Children’s Summit in Washington, DC, and to read Speaker Nancy Pelosi’s opening remarks, and I quote, “We take seriously our responsibility to America’s future – our children. As the brilliant author and activist Pearl S. Buck said: ‘If our American way of life fails the child, it fails us all.’ Today, we commit to ensuring our children are given the tools they need to succeed.” Nice rhetoric, but what tools is she referring to and who will give them to our children?
It seems as though the tide is turning toward a national interest in the well-being of our children and not a moment too soon. Locally, a group of early childhood professionals, family members and community leaders met on a Saturday morning to hear Dr. Betty Rintoul talk about mental health issues in young children. The group was small, but the information exchanged about the importance of early intervention and treatment of young children with mental health issues was invaluable and should be shared with everyone.
For many people it is hard to imagine that young children would be suffering from mental health issues. Good mental health is an important aspect of a family’s ability to grow and thrive. 70% of preschool teachers cite behavioral and social/emotional problems as the primary problem putting young children at risk. Recent research indicates that the quality of brain development is shaped by a child’s experiences. Children can develop in such a way that they see the world as safe, predictable and worth exploring and learning from, or as hostile, distrustful and frightening. Early environmental experiences, especially parenting, have a huge influence on emotional development and therefore on behavior. Children who've developed good brain functions by age five have advantages that accumulate through life. One thing that leaps out of all the brain literature is that emotion serves as a central organizing process within the brain. Children learn from people they love. If we want young people to develop the social and self-regulating skills they need to thrive, we need to establish stable long-term relationships between children and families and caregivers.
Mental Health reform in North Carolina has turned our focus away from the needs of young children and put it squarely on services for troubled adolescents, substance abusers and adults with severe mental health issues. All of them were once preschoolers, and although not all troubled preschoolers end up as adults in need of mental health services nearly all troubled adults could have been identified as problematic when they were preschoolers.
Whatever services are planned in the “reform of the reform” of mental health in North Carolina, services for the very young must be included. As the director of a KidSCope, local children’s mental health program that has been in existence for 20 years and served nearly 3000 young children and their families, I know that funding is scarce, and each community will need to make tough decisions about the services that they want available to their citizens. In Orange County, we appreciate our local officials who have always advocated for young children and families and prioritized their services. We must continue to do so. Not prioritizing mental health services for children birth to five will not serve us well and will cost us dearly in the future, not just in dollars, but in human resources as well. We must build a future that speaks to the health and well-being of even its youngest members. As Karl Menninger, a famous American psychiatrist said, "What is done to children, they will do to society."

For more information, you may contact Linda Foxworth at lfoxworth@kidscope.chtop.net.

Tuesday, May 29, 2007

Homeland Insecurity

I'll let this speak for itself.

Half of me wants to shout out "Thank God we're not Alabama!" The other half of me remembers some of the ignorant anti-gay rhetoric last week in the NC State House as they were debating the anti-bullying bill. We may not be as bad as Alabama, but....

Oh, and by the way, I know Howard Bayliss. Howard Bayliss is a friend of mine. And Howard Bayliss is NO terrorist!

Diversity is Threatened by High Costs

The Board of County Commissioners recently received a report on housing affordability in Orange County. At the time of the preparation of this report, the least expensive single family home listed on the MLS in Chapel Hill was in the neighborhood of $450,000. That was a bit of an anomoly; I checked today and the least expensive single family home in Chapel Hill city limits was in the mid-$200's. Carrboro prices are similar.

These high housing costs raise some important, and difficult, questions for our community I think. Do we really want to become the kind of place only the upper middle clase and rich can afford? How have we come to this point that Southern Orange housing is increasingly out of range for middle-class home buyers? What decisions have we made--or not made--that have contributed to the affordability problem?

And, really, aren't there some steps we can take to address it? Something concrete and practical?

There was an article in yesterday's Chapel Hill Herald about housing costs in OC. If you have a few minutes you might want to check it out. The article doesn't really break any new ground, but it does remind us where we've ended up in OC with regard to housing costs.

While Orange County has some excellent non-profits that work to address bits and pieces of housing affordability, it seems to me that the problem is larger than they can adequately address. Each of those organizations (Habitat, Empowerment, the Land Trust, for example) focus on important but narrow segments of the housing crisis. A broader vision is necessary if we're really serious about wrestling this beast to the ground.

Some nay-sayers claim that the there's nothing we can do. I don't buy that. Do you?

Sunday, May 27, 2007

We got Parity!

Good news this week from the General Assembly.

The State House approved the mental health parity bill...finally....on Thursday. The bill had been watered down in committee by removing substance abuse parity and was further watered down on the floor by with an amendment that exempts employers with fewer than 25 employees. Estimates are that, due to the exemption for small employers, the parity bill will now only apply to about 1/6 of NC's citizens. Passage of these amendments are very disappointing, and the bill's future in the Senate is unclear. There's more work to be done.

In other news, the State House gave final approval to HB 1366 "School Violence Prevention Act," commonly referred to as the anti-bullying bill. This bill was constroversial mainly because it included protections for gay and lesbian kids. Just including the words "sexual orientation" in the General Assembly is enough to kill a bill. The right-wing tried to strip out sexual orientation twice in committee, failing both times in party line votes. And their efforts to amend the bill continued on the floor of the state house on Wednesday. Minority Leader Paul "Skip" Stam offered the amendment again to strip out the "offending" words but it failed in a very close vote, 58-59. Several Republicans voted with a majority of Democrats to keep the inclusive language.

This is the first time in North Carolina history that a bill that includes protections for LGBT folks has passed either chamber. it's about damn time. As with the parity bill, this bill's chances are unclear in the Senate.

Wednesday, May 23, 2007

Good News from the General Assembly

On Tuesday, the House Insurance Committee finally voted on the Mental Health Equity bill. They stripped out coverage for substance abuse, which is disappointing, but passed the bill with a favorable recommendation. The bill will be heard on the House floor this afternoon, and we're cautiously optimistic. It's been a long time coming, but we might finally see mental health treatment handled just like any other medical condition. About time!

On another front, the House Judiciary I committee gave the HB 1366, the "School Violence Prevention Act," a favorable report. This bill is commonly referred to as the 'bullying' bill. It was vehemently opposed by conservatives in both the JI and Education Committees because the bill specifically protects LGBT kids from bullying and violence on school campuses. I'm keeping my fingers crossed that this bill passes tomorrow on the house floor.....if it does pass, it'll be the first time that a bill with the words "sexual orientation" has passed either chamber of the NC state legislature. It'll be an historic moment, if it passes.

I'll let you know tomorrow how both of these bills fared.

Finally, Speaker Joe Hackney used the power of his office to effectively kill the anti-gay, discriminatory "Defense of Marriage" Amendment. North Carolina already has a law against same-sex marriage but conservatives want to enshrine that ban in our state constitution. Treating one class of citizens differently than others has NO place in our constitution. Hackney was right to stand firm on this issue.

Monday, May 21, 2007

Lots to report today....

On Saturday morning I attended a meeting about mental health issues in very young children, 0-3 years old. We often don't think about mental health problems in kids that young, and I have to admit I learned alot about a subject that I wasn't at all familiar with.

There are very few programs set up to intervene and help in situations in which mental health issues can be identified at that age. But think about...if a child is being raised in an abusive, violent setting, then the effects are going to begin showing up at an early age. Proper early intervention and treatment could dramatically improve that child's future.

Later Saturday, I met with a group of mental health provider and advocates to talk about the effects of the mental health reform on service in Orange County. It was an excellent meeting, and--oh boy--did I get an ear full. We talked for over an hour and probably could have continued for another 3 or 4. Concerned about the mental health service cuts, they listed obstacle after obstacle: from cuts in reimbursement rates, to problems with medicaid, to lay-offs from private firms that now have contracts to provide service, to excessive and confusing paperwork. For example, one provider had to submit 5,000 pages of documents last week because of a random audit. It took 3 staff people 2-3 days to pull all the documentation together. That's time away from serving clients and away from providing much needed care.

We also talked about problems such as the situation with Caring Family Network which I posted on yesterday. These private for-profit entities, which are now responsible for providing care in most of our counties, are responsible to shareholders NOT patients. They're businesses, pure and simple. When these companies find they can't make money providing mental health care at the current levels, they have a fidicuary responsiblity to cut costs somehow. Those cuts come in the form of reduced staff and reduced hours. As I said yesterday, some services just shouldn't be privatized.

Another problem that came was the cuts in reimbursement rates for certain services. This has led to a number of problems, including a reduction in the quality of care. For example, some providers can only afford to pay highschool graduates to perform certain tasks. So, services that were once provided by master's level staff are now provided by folks with far less education. Don't get me wrong, there's nothing wrong with having a high school education. But some forms of care are best performed by trained staff with the education to back it up.

Saturday, May 19, 2007

Reform the Reform

You may have read that the Caring Family Network will be "consoildating" their operations at the end of the month. "Consolidation" is just a nice way of saying that they will be reducing their hours of operation at their Hillsborough clinic and reducing access to health care for people in our county.

North Carolina's mental health system is in near total collapse. The reduction of services that Family Care Networks has announced is only a symptom of a problem that is in fact much worse. As you know, several years ago the state embarked on what amounts to a privatization of mental health services. They called it reform.

There are some public services should not be privatized; the needs of our citizens in some cases are much better met by a well-managed government program. Mental Health services are, in my opinion, one area that should not ever have been privatized. Providing care to those with mental illness is not profitable--period. As someone said to me the other day, "It's just not a sustainable business."

So what happens when these private providers can't turn a profit? They cut back on services. And that's exactly what the Caring Family Network has done. The Hillsborough clinic that they now operate has been in operation for 38 years. CFN is reducing the clinic schedule from 5 days a week to 2.

What's the effect of this reduction? I've learned that somewhere in the neighborhood of 100 patients are now having to find care elsewhere. The state's reform was supposed to improve mental health care in NC, instead it's only hurting the people who need help the most. It's time to reform the reform.

Tuesday, May 15, 2007

Parity Vote Delayed Again

The Insurance Committee of the State House discussed Rep. Martha Alexander's mental health parity bill today. However, the debate lasted so long that the committee ran out of time and adjourned without voted. It is expected that the committee will meet again on Thursday and complete their discussion. The insurance industry is lobbying hard against this bill. It is unclear what the outcome will be.

Would You Lie for Your Country?

Well, would you lie for your country? Even if the reason for the lie was based on out-dated prejudice?

Today, I'm going to take a break from mental health to post about the US government's "Don't Ask, Don't Tell" policy.

Several years ago, gay sailor Jason Knight was booted out of the Navy under the rules of the "Don't Ask, Don't Tell (DADT)." Knight, a highly trained Hebrew linguist, was then brought back into the Navy last year even though the US military knew that he's gay. Seems they had a wartime need for linguists. Go figure.

And then, in a plot twist worthy of a daytime SOAP, Knight was booted out again last week after his story appeared in "Stars and Stripes." Here's a report on this turn of events.

There are several questions that beg to be addressed. First, what benefit does our society gain by encouraging Americans to lie? The only way Knight could keep his job was to lie. How does that make a better country, or make better military?

Second, why is the government firing personnel with highly desirable skills during a time of war? It's never right to fire someone because of an immutable characteristic, of course. But to do so at a time like this is just down right stupid.

Third, how was sailor Knight a threat to the military? Knight's own colleagues say that he was an asset to their organization. So much for the military's claim that openly gay soldiers and sailors are a threat to unit cohesion.

Finally, if he was good enough to invite back in, why fire him now?

It's time to end the "Don't Ask, Don't Tell" policy. It was always wrong, always useless, and now it's time to send it to the dustbin of history. No decent government purpose is served by requiring personnel to lie in order to keep a job.

Monday, May 14, 2007

Killing the Mentally Ill

Senator Ellie Kinnaird has introduced legislation to prevent the state from executing the mentally ill. This is an extremely important piece of legislation, and I'm thrilled Senator Kinnaird and others are pursuing it. I'm against the death penalty...period. But even if you're a supporter, does it really seem humane to execute folks who suffer from a mental illness? Does someone with schizophrenia have enough awareness that their actions are wrong to warrant execution?

Clearly, someone who commits a heinous crime should be punished, even if they have a mental illness. But the death penalty is not the appropriate punishment. Here's the N&O article on Senator Kinnaird's bill.

This, of course, begs the question: since NC's mental health system is in disarray, shouldn't we be concerned with the ramifications to our criminal justice system? If the severely mentally ill do not get the treatment they need, if they fall through the cracks, we may see more of them in the trouble with the law. The bottom line is this: as a society, we're going to pay either way so why not support mental health sytem that functions well and gets adequate treatment to those who need it?

Friday, May 11, 2007

No Vote Yet on Parity

The Insurance Committee in the state house did not take up the mental health parity bill as planned on Thursday. Debate on another bill lasted much longer than predicted, and the committee adjourned without hearing any other bills on their agenda.

We believe that the parity bill will be heard next week, but there are also rumors that support from Blue Cross Blue Shield might be softening. BCBS had indicated they would support parity legislation that covered mental health but not substance abuse. While those of us who want health care equity find that position frustrating (to say the least!), their support of parity for mental health services was crucial to the bill's passage.

I'll let you know how things go.

In the meantime, the State House passed a budget early this morning which included $100 million for Medicaid relief for North Carolina's counties. NC is one of only a handfull of states that requires counties to cover part of Medicaid costs. County governments have been screaming for relief from this burden for years and were hoping this would finally be the year that we got it.

While the $100 million in the house budget is better than nothing, it is still only a small portion of what's needed to help counties. Poorer counties are hit far harder than affluent counties like Orange; for example, some rural Eastern North Carolina counties spend more money on Medicaid than education. This is shameful.

There are indications that the State Senate may come up with a stronger plan that brings true relief to county governments on this issue.

Wednesday, May 09, 2007

Great Op-Ed piece from Patrick Kennedy on Mental Health Equity

Mark Sullivan from the Mental Health Association of Orange County sent along the link to this piece, co-written by Patrick Kennedy. I thought some of you might find it interesting.

Important Committee Vote on Equitable Coverage

Tomorrow morning at 11am the Insurance Committee of the State House of Representatives will debate and vote on a critical mental health reform bill. Please contact your legislator and ask him/her to support HB 973 "Mental Health Equitable Coverage." And if you live in her district, please thank Rep. Verla Insko (D-Chapel Hill) for being one of the four primary sponsors of this bill.

HB 973 would require that insurance companies provide equity in insurance coverage for mental health and substance abuse. Currently, there is no requirement to do so--some plans do and some plans don't. But mental health and substance abuse are diseases like any other and leaving them untreated leads to loss of work productivity, life expectancy, and so forth. Insurance companies have historically opposed equity legislation, arguing that it will raise costs. But it seems to me that there are significant long-term costs to our communities when mental health disease and substance abuse are left untreated.

It's unclear to me the chances for this bill to pass. The insurance industry has successfully killed similar legislation in past sessions. But this bill is at a critical stage, and your legislator needs to hear from you! Take a few minutes to contact your legislator and ask for him/her to support HB 973, "Mental Health Equitable Coverage."

Tuesday, May 08, 2007

If You Were Governor...

Now that Secretary Odom has resigned, I am planning on writing Governor Easley a letter encouraging him to appoint a replacement who 'gets it' when it comes to mental health reform in North Carolina. The Governor has an opportunity to appoint new leadership at the Department of Health and Human Services who will acknowledge that mistakes have been made and will work co-operatively with the mental health community to chart a new course.

I have my own thoughts, of course, about what to include in this letter. But I'd also like to hear from you all. What needs to be said the Governor as he considers who to appoint as Secretary of DHHS? What qualities should this individual have? What issues should they focus on first?

Email your thoughts to me at mikenelsonnc@aol.com. Thanks for the help!

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Monday, May 07, 2007

Did you know that people with serious mental illness die, on average, 25 years younger than people who don't have serious mental illness? This differential has increased, not decreased, in the past 15 years or so. In the early 1990's, the seriously mentally ill died on average 10-15 years younger than their peers. For some reason, the health of the mentally ill is getting worse, not better. Why? What's causing this? What can we do about it?

Here is an article from USATODAY about this issue.

Friday, May 04, 2007

Breaking News on Mental Health

Carmen Odom today announced her resignation as Secretary of the Department of Health and Human Services.

Odom is a very capable individual, but there is wide-spread belief that mental health reform in NC has been botched. I have the utmost respect for Ms. Odom and wish her well in her new position as President of the Milbank Memorial Fund, a health policy foundation based on New York.

Odom's departture gives Governor Easley an opportunity to shake the etch-a-sketch and start over. I was speaking to a county commissioner from the western part of the state yesterday who described the state's mental health system as being "in total collapse." I agree. There are many reasons for the current situation, and we shouldn't blame one or two people for what's gone wrong. But the change in leadership at DHHS gives us a chance to realistically address the problems with mental health reform.

Thursday, May 03, 2007

More from Mark "Drastic and Worse"

Below is a letter to the editor about mental health reform that Mark Sullivan wrote. I hadn't planned on running two guests in a row on mental health issues, but this letter does such an excellent job of summarizing the problem that I thought it deserved to be shared. For example, take note of Mark's comments about high school graduates being allowed to perform the same functions as trained practitioners. This is reform? Puh-lease.

The mental health reform debacle demonstrates one thing very clearly: blind adherence to the ideology of privatization is misguided. Some services and some programs should not be privatized at the expense of quality care. I'll save my rant about the Bush administration's ideology of privatization for another day, but suffice it to say that I believe Democrats, like Governor Easley, have been misguided in pursuing privatization programs --particularly for health care.

Drastic and worse (this one was printed on 4/22)

"In response to Health and Human Services Secretary Carmen Hooker Odom's April 14 letter:

Community Support was designed to be a key component of the new mental health system, replacing Case Management and Community Based Services. Under the new regimen, high school graduate workers can perform essentially the same functions as graduate-level practitioners, and their agencies can bill at the same rate.

Architects of the new system aimed to reduce dependence on state hospitals by strengthening the infrastructure of community-based services. One of their strategies was to bring market forces to bear. By untying reimbursement rates and credentials, allowing workers with GEDs to bill at the same rate as those with master's degrees, an obvious financial incentive to employ lower-skilled workers was created. Some of us pointed out this glaring problem when the original definitions and rates were introduced.

Now DHHS has confirmed the predictable outcome: Lower credentialed workers are providing the vast majority of these services.

Rather than taking a sensible approach like tying credentials to reimbursement rates, the department has taken drastic action, which only guarantees that the problem gets worse. By slashing reimbursement rates, it is ensuring that lower-skilled workers will increasingly provide this important service. It is pulling the rug out from under an already shaky and insufficient network of providers."

Mark D. Sullivan, MSW
Executive Director
Mental Health Association in Orange County, NC

Wednesday, May 02, 2007

Guest Post from Mark Sullivan

I'm honored to have a guest post today from Mark Sullivan, Executive Director of the Mental Health Association of Orange County. Here is Mark's post:

The most recent debacle in the now seven year old process of mental health reform involves billing for Community Support Services, the flagship service of the newly designed Mental Health, Substance Abuse, and Developmental Disability system. Headlines above the fold in the News and Observer in recent weeks included “Audit: mental health providers cheat.”

Health and Human Services Secretary Carmen Hooker Odom cited results of a recent audit of 172 service providers, and listed encouraging an individual to take his medicine, and taking a child swimming as examples of possible criminal abuses of the public system. With such little context, it is difficult to determine whether these are actual abuses, or are merely being drummed up to justify a radical slash of funding. It is very likely that in some of these cases the real explanation is that under-qualified, overworked employees did not adequately document their activities. The fact that these services were approved by Value Options, the managed care company designated by DHHS to perform authorization and utilization review under the new system, seems to have been omitted so that providers could be smeared.

Abuses may have occurred, and the system that Secretary Hooker Odom has signed off on is deeply flawed. However, the responsibility for this most recent development lies squarely on the shoulders of Secretary Hooker Odom and Governor Easley. They have developed a system that not only allows for the gaming of the system that has occurred, but systematically promotes it.

When the new definitions and rates were released, advocates charged that they were designed to insure that lower qualified workers were used to deliver services in order to save money. It appeared obvious that when high school graduate and masters prepared workers could perform essentially the same functions and bill at the same rate, lower qualified people would be used. Architects of the new system vociferously denied this. Now the worse case scenario has unfolded; the new model encourages the use of lower qualified workers, but is not saving money either.

By cutting reimbursement rates, Secretary Odom only confirms that the Department’s intention was to have these least qualified workers providing the bulk of this important service, despite the rhetoric. In a recent letter to the editor, Odom pointed out that high school graduates were providing services that, if provided by more qualified workers, would lead to better outcomes. Rather than designing a solution to this very real problem, the department has simply reduced the rates, insuring that the status quo is unchanged. This decision demonstrates either serious incompetence, or a real disinterest in developing an effective and efficient system.

Mark D. Sullivan, MSW
Executive Director
Mental Health Association in Orange County, NC

Tuesday, May 01, 2007

May Day! May Day!

Well, today is May 1st. I'd like to paraphrase a speech I heard today by Rep. Susan Fisher of Asheville:

"May Day. We often think of May Day as a quaint tradition that involves flowers, dancing and a pole. May Day can also be a distress signal. An SOS that's sent out when someone or something is in trouble."

Rep. Fisher was speaking of North Carolina's current sex education policy, which requires abstinence-only education and leaves our children with too little knowledge about sex. She contends that this lack of knowledge leads to teen pregnancy, HIV infection, and so forth.

I think Rep. Fisher's analogy could also apply just as easily to North Carolina's mental health system. Seven years of reform have devastated the mental health system in our state. It is in distress.

The leaders of the reform effort may have meant well, but things have not been working out as intended. It's time--past time--to take a good hard look at what went wrong, how it can be fixed, and who is best positioned to fix it. This month I will be blogging about mental health, but tomorrow I will lead off with a guest post by Mark Sullivan, the Executive Director of the Mental Health Association of Orange County.