Reform: Therapeutic services at risk

Not enough providers in western North Carolina By QUINTIN ELLISON
Special to the Cherokee Scout Wednesday, November 5, 2008 7:08 AM CST     Editor’s note: This is the second of a three-part series examining the mental health system in western North Carolina.

    It is difficult to imagine a family who could use the full support of North Carolina’s mental health system more than Denise Becker and husband Larry.

    Instead, the couple has rejected the state’s help, citing frustrations with young, inexperienced case managers, a lack of understanding for the family’s special needs and an inability to get critical care, such as a psychiatric bed, when a crisis hits.     And do they hit, especially when you have three children with bipolar disorder and one with schizophrenia.

    “I thought, ‘Forget it, I’ll do it myself,’ ” Denise Becker said.

    Now, instead of going through Smoky Mountain Center, the state’s mental health administrator for a 15-country region that includes Swain, Becker acts as her children’s case manager. She spends her days in a small garage-turned-office beside the house, running her husband’s carpentry business, overseeing their rental units, setting up appointments and finding aid for the children.

    To hear Becker and other people at the heart of the mental health system tell it, mental health reform - that great blueprint for change the General Assembly launched in 2001 – has been a dismal failure. And the losers have been the thousands of North Carolina residents suffering from mental illnesses who are receiving inadequate treatment and help.

Therapeutic services disappear

    The Becker family moved to Bryson City from Florida in 1999. They have a total of 10 children, three birth children and seven adopted through Florida’s foster care system.

    Four are grown and live outside of the home. Of the six remaining children who do live in the large rambling house on the outskirts of town, only two do not require mental health assistance.

    Additionally, Becker said she takes antidepressants to help her cope with physical disabilities.

    “Initially, we didn’t know our boys had special needs,” Becker said. “As puberty hit, mental illness began to reveal itself.”

    At first, she said, the family turned to Smoky Mountain Center and got the help needed. But with reform, which saw the state privatize the system, the therapeutic services disappeared.

    Smoky Mountain Center shifted mainly to a monitoring/administrative role, plus it manages mental health screenings and treatment referrals. Under reform, consumers such as the Becker family were supposed to be able to pick from a choice of providers.

    The problem was, there wasn’t – and there aren’t today – enough private providers in this region. Smoky Mountain Center noted in particular an “acute shortage of substance abuse professionals.”

The problem

    A state task force reported in April that the turnover rate among mental health professionals in North Carolina – which is as high as 78 percent a year by some estimates – is crippling the state’s mental health system.

    The report, “Workforce Development Initiative,” found “an inadequate living wage, poor or absent supervision, lack of benefits, unreliable schedules, no career ladder and lack of adequate training.”

    Meeting the state’s criteria to provide services can be daunting. Just ask Stephanie Almeida, who moved to Macon County from Boston last September. A substance abuse prevention consultant with 10 years experience in her home state, she’s been unable to contract directly with Smoky Mountain Center because, she said, she doesn’t have an agency/fiscal agent to bill through.

    Almeida, who serves as vice president of the National Alliance on Mental Illness Appalachian South, an advocacy group, said that in comparison to Massachusetts, North Carolina’s requirements are so demanding that many who would like to work in the field are barred from entering.

    There’s no doubt the need is there. Ten of North Carolina’s 100 counties – including  Clay and Graham counties – have no substance abuse counselors at all. Yet, 517 people in Graham need counseling, and another 638 in Clay, according to an analysis conducted in January 2007 by the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services.

    Other western counties aren’t much better off:

    For each qualified counselor in the county, Jackson has 313 people needing the counselor’s services.

    Cherokee has 1,687 people in need of services.

    Macon has 358 people in need of services.

    Swain has 148 people in need of services.

    Additionally, the shortage doesn’t stop with a manpower problem.

    Two of Becker’s children have required hospitalization. The family no longer waits for beds to free up, and instead takes them directly to private hospitals offering psychiatric services.

    Medicaid pays for the hospitalization, and also covers payments for therapy services through Post Adoption Support Services via Mountain Youth Resources, Becker said.

    For people without Becker’s time and expertise – she said she’s taken numerous classes to help her learn how to help her children plus has a background as a therapeutic foster parent while in Florida – options are limited.

    “I spend eight hours a day every day on mental illness,” she said. “That’s what I do. The average person can’t do this – they need a case manager.”

    Quintin Ellison, a former reporter for The Franklin Press and investigative reporter/editor for the Asheville Citizen-Times, lives in Bryson City. She can be reached at qlellison@hotmail.com.

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