Wake’s mental health care changes leave workers in limbo

tgoldsmith@newsobserver.com May 15, 2012 

  • Wake’s mental health changes Changes in Wake County’s system of looking after people with mental health problems represent years of evolving philosophies and government regulation. Under mental health reform, state and local agencies that once oversaw care directly had their roles diminished in favor of “local management entities,” which were supposed to pick the best providers from independent businesses and agencies. After massive overspending and lax supervision in the 2000s, both state and federal regulators have tried to tighten up management and oversight. County clinics that were once familiar destinations for people with mental illness closed in favor of a taxpayer-underwritten system of referring patients to agencies – for-profit and non-profits - on a list of providers. Wake County, with its mental health care deeply intertwined in a large human services department, found its hand was forced in joining with Durham under a management system to oversee both counties. Health and human services regulations no longer allow counties to manage mental health care and at the same time use their own agencies to work with clients. That’s regarded as a conflict of interest with independent companies or agencies. However, Wake County representative Deborah Ross said all the talk about management is really a smoke screen for a general lack of concern about people with mental illness. “Nobody’s making it a priority,” Ross, a Democrat, said. “They are saying it’s all about management and not about care and services. This is a lack of care problem. Nobody’s happy, and it’s not going to change until somebody cares.”
  • Bond vote considered Wake County budget planners on Monday recommended that voters pass judgment in November on issuing $200 million in bonds for expansions at Wake Technical Community College. They said that it would take a 2.7-cent property tax increase to raise $150 million a year for county schools construction. School board members have talked for several years about asking voters to approve construction bonds but haven’t assembled a definitive plan, as Wake Tech has. “All I want to hear is that we can do all this without a tax increase,” said Commissioner Joe Bryan. Not likely, said Nicole Kreiser, debt and capital director, noting that a 2.7-cent property tax increase would help address school construction costs without asking voters to approve more bonds. Financial officials said they weren’t recommending the tax hike, just doing the math for commissioners. Board chairman Paul Coble said he’d want to know more about schools’ current spending before considering a tax hike. The size of the schools’ rainy day fund concerns Coble. The 2.7-cent tax increase per $100 of assessed value would cost the owner of a $200,000 house about $54 a year. Staff writer Thomas Goldsmith

About 200 Wake County employees – who handle tasks such as working with drug-addicted homeless people and children with mental illness – are finding their jobs in limbo because of a proposed restructuring of county services by the UNC Health Care System.

In a work session Monday, county commissioners heard from County Manager David Cooke and Kevin Fitzgerald, chief of staff to UNC’s health care system and school of medicine, about the latest development in Wake’s mental-health system, which is merging with Durham County’s system.

About 45 Wake behavioral health employees have already joined the new, merged system. But about 200 additional Wake workers don’t know whether they will be able to join a UNC Health Care transition team, take buyouts or find other jobs within Wake County.

“There are some people in denial and some people who would love to go work for UNC,” said Beth Nelson, child mental-health substance abuse services manager, who agreed in December to take a severance package. “There are some people that are upset and angry because they don’t know what’s going on. There are so many unknowns.”

Some of those decisions could be made by the UNC transition team, whose role still has to be approved by commissioners in July or August.

“What we believe we can bring to the table is rigor and a set of expertise,” Fitzgerald said. “There are going to be important shifts that need to be put in place. We are going to pay a lot of attention to system performance, and we are going to be paying a lot of attention to integration of services.”

Severance payments

About 100 employees who were paid by state or federal funds have already left or moved to the joint operation, known as Alliance Behavioral Healthcare. Wake already has made severance payments nearing $500,000 with this group of employees, Cooke said, and could pay a similar amount for the second group.

The employees whose future remains to be determined are those paid out of the $20 million that Wake spends directly each year. Cooke recently held a tense meeting with many of those whose jobs are up in the air. Employees expressed concern not only about their own futures, but also about the care of long-time clients.

UNC will work with employees and those who serve the mentally ill as it sorts out which functions should remain in place for the roughly 5,000 people who get care from Wake County. Some programs are combined with other county departments, such as the perinatal substance abuse program, pharmacy services and homeless outreach, treatment and housing.

Some of these programs may continue with contract providers, while others could still be performed by county staff.

“We want to rebalance the system, with the goal of keeping people out of crisis and keeping people out of the emergency room,” Cooke said. “We have got about $20 million in resources that we have committed to behavioral health. This is us asking UNC Health Care to manage and administer our behavioral health services as we move through this transition.”

Things to figure out

In a letter to Cooke, William Roper, dean of the UNC School of Medicine, said that UNC and Wake should move quickly to review and define these areas:

•  How much oversight UNC would provide to the behavioral-health services and employees that still don’t have a role under the Durham-Wake agreement.

•  How UNC, Wake and Alliance will decide on the means to deliver care to patients in counties.

•  How much Wake will pay UNC under the arrangement.

•  How and whether Wake employees who haven’t been placed might work for UNC.

At Monday’s work session, Ellen Holliman, the CEO of Alliance, expressed concern about UNC guiding the transition by Wake into the new joint agency.

“I think we need assurance that we are not duplicating our efforts,” Holliman said.

Doug Fuller, director of communications for The Durham Center, which manages care for patients, said the phone numbers that clients call to access services and information will remain the same. While the merged entity will officially be housed in a building in Research Triangle Park, a satellite center will remain at The Durham Center’s current location in Durham.

The Durham Center’s employees, about 80, had an opportunity to apply for a position with the new organization, Fuller said.

“I am not aware of anyone who wanted to remain with the organization that was not offered an opportunity to do so,” Fuller said.

It is unclear how and if the services may change, said Robert Robinson, Alliance Behavioral Healthcare’s deputy director. That will be determined when Medicaid finalizes how much it will pay per member per month, which could come as late as October, Robinson said.

“Our intent is not to cut services,” Robinson said.

Town Hall informational meetings will be held in Raleigh at Wake County Commons at 6:30 p.m. on May 29 and in Durham at the Main Library at 5:30 p.m. on June 4. Both are open to all stakeholders and the general public.

Correspondent Virginia Bridges contributed to this report.

Goldsmith: 919-829-8929

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