Expanding the focus of the frenzy

by Chris Fitzsimon

Governor Mike Easley continues to face criticism for his alternatively disturbing and frustrating statements and behavior in the past few weeks and most of it is deserved.

But there’s a danger that other vital issues may be lost in the understandable attention paid to the possible destruction of public records and Easley’s insistence that that he opposed the 2001 mental health reform legislation, despite no evidence of that opposition.

Easley, not surprisingly, wants to change the focus to the future, on how to address the massive problems in providing services to people with mental illness, a developmental disability, or an addiction.

Reporters and advocates need to heed that call, not by changing their focus, but instead expanding it to force a broader debate about the fundamentals of the system created by the 2001 reforms, while continuing to press for answers on public record issues and the dismissal of the public affairs director of the Department of Health and Human Services.

Easley said at his abbreviated press conference last week that he wants the General Assembly to give Health and Human Services Secretary Dempsey Benton more authority over the 25 Local Management Entities (LMEs) that were created by the reform legislation to replace local area mental health centers, with one crucial difference.

The LMEs only manage mental health services. They do not provide them. Private companies, both for profit and not for profit, are paid to see clients and provide services. That shift to privatization, turning mental health treatment and disability services over to the market, was a fundamental part of the reform plan and yet remains the least examined and debated even now, seven years after the legislation passed.

Benton talks about the perils of privatization in an interview that will air this weekend on News and Views, a radio show that airs on the North Carolina News Network. (That interview will be available next week on www.ncpolicywatch.com .)

Benton won’t say directly that privatizing services was a mistake, but thinks there needs to be a different balance between government and the private market in providing services, that government needs to play a much more significant role.

He’s right about that, as least as far as he is willing to go. He also makes a clear case for more state authority over LMEs, which are currently controlled by boards appointed by local governments in the communities the LMEs serve.

Benton said he recently visited Cherry Hospital in Goldsboro to see if patients are receiving the continuum of care the law requires when patients are discharged. Two of the eight LMEs in the area served by the hospital have people assigned to work with patients and hospital staff to make sure the patient has access to services when he or she returns to their community.

Benton says that six LMEs do not have staff assigned to work with patients, which seems like an essential function of managing services. But there’s not much Benton can do about it. He has no authority to hire or fire LME executive directors. That is up to the LME Board, appointed by local officials from the counties the LME serves.

That means that some people leaving Cherry hospital get help returning to their communities and some don’t, which can’t be what supporters of the 2001 reform efforts had in mind.

Governor Easley has been wrong about plenty in the last two weeks, but he is right that the state needs more power over the LMEs to make sure that they are providing services to people who need them.  

It is all ultimately the state’s responsibility to make sure that people get the help they need. That can’t be left up to 25 individual entities with different priorities and plans. It shouldn’t be left to the vagaries of the profit-driven market either.

We need to get the bottom of this confusion about public records in the governor office. But it is also vital to figure out why 6 agencies in Eastern North Carolina are ignoring their obligation to help people leaving Cherry Hospital, and why so many public officials are willing to ignore the role that privatization has played in creating our current crisis.