NC Institute on Medicine Issues Recommendations

The North Carolina Institute of Medicine’s  (NCIOM) Task Force on Mental Health and Substance Use recently presented recommendations to the Joint Committee on Health and Human Services. The NCIOM is funded by the Kate B. Reynolds Charitable Trust, with the goal of developing recommendations to increase and improve community-based and evidence-informed prevention, treatment, and recovery services and supports for individuals with mental health and substance use disorders.

The Task Force focused on recommendations to support a full continuum of community-based mental health and substance use prevention, treatment, and recovery services for all North Carolinians.  Specifically,  the task force made 30 recommendations in total.  Some of the most promising recommendations include:

  • Increase access to and  utilization of mental health and substance use for uninsured residents.
  • NC should submit a 1915(c) waiver for kids with serious emotional disturbances.
  • Increase access to mental health and substance abuse services for older adults.
  • Payments should be connected to positive health outcomes for evidence based mental health and substance abuse services

Download the full report on the recommendations.

Update on Governor’s Task Force on Mental Health and Substance Use Pilot Programs

The legislative Committee on Health and Human Services recently received a November update about pilot programs developed from the Governor’s Task Force on Mental Health and Substance Use.

Dr. Jason Vogler, Director of The Division of Mental Health, Developmental Disabilities, and Substance Abuse Services outlined with greater specificity how the funds will be allocated.

The 2016-17 state budget provided $20 million to fund these pilot programs.  The funding is woefully inadequate to fully fund the recommendations of the task force and virtually none of the funds are allocated to assist adult criminal justice initiatives. The application for participation in the pilot programs was only open to LME/MCOs.  However, once granted, the LME/MCOs will subcontract with local service providers.

The programs on the verge of being implemented are:

  • Child Tiered Case Management Pilot. Case managers will work closely with juvenile justice and child welfare offices to provide assessments, develop person-centered plans of care, and link children/youth and their families to other recovery supports. This approach can assist with preventing youth from moving deeper into the justice system. Application period closed Nov. 14.
  • Comprehensive Case Management for Adults with Mental Health Treatment Needs and Substance Use Disorder Treatment Needs (AMH/ASU). A community-based behavioral health provider would provide around the clock coverage in the hospital Emergency Department (ED) to ensure individuals discharged would be immediately linked to community supports – preventing or shortening future ED visits. Applications are due by 5 p.m. on Nov. 23, 2016.
  • Facility-Based Crisis Services for Children and Adolescents. Community-based, non-hospital residential setting facilities are specialized and cost-effective alternatives for individuals in crisis who need short-term intensive evaluate.

You can read more on the pilot programs and the role local service providers may play.   If a pilot is located in your area, you’ll want to know about it.

New Contracts Awarded for CBI and Substance Abuse Services

The Department of Public Safety recently awarded over $3 million in contracts to agencies providing evidence-based Cognitive Behavioral Intervention and substance abuse services to individuals on probation or post-release supervision.

These contracts were awarded in a re-bid process because some providers withdrew from contracts leaving areas without services.  Many others have found it difficult to operate under the extremely low monthly reimbursements paid out under the current contracts.  There were also a few areas in which agencies had not bid for services.

While program completion is an important measure,  it would be better to reward improvements in completion, rather than completion alone.  Since the high risk/high need  population currently has a recidivism rate (measured by re-arrest) ranging from 35%-60%, even the most successful programs or probation officers are unlikely to realize a 100% completion rate.

Contracts were awarded to:

  • Coastal Horizons – $469,436 – Duplin, Pitt, Sampson and Wayne.
  • Freedom House Recovery Center – $228,521 – Caswell, Chatham, Orange, Person, and Warren
  • Insight Human Services – $2,044,566 – Cabarrus, Gaston, Guilford, Mecklenburg and Randolph
  • Loving Light Community Outreach – $55,339 – Chowan and Gates
  • Piedmont Triad Regional Council – $201,181, Rowan
  • PORT Human Services – $191,014 – Pitt
  • Walk Through the Valley – $412,722 – Edgecombe, Nash and Wilson

Durham Awarded BJS Grant to Address Mental Health Needs in Jail

The Durham Sheriff’s Department has been awarded a Justice and Mental Health Collaboration Program grant of $228,000 from the Bureau of Justice Assistance (BJS).

The purpose of the grant is to implement a system wide enhancement of identifying, screening and tracking prisoners in the jail in order to improve the jail’s ability to provide interventions.  Funds will also provide training to the jail staff in dealing with persons with mental illness.

The jail is partnering with the Criminal Justice Resource Center which operates the pre-trial service program and STARR, a substance abuse treatment program inside the jail.  Alliance Behavioral Health care, the LME/MCO for the Durham area is also a partner.

The jail is also preparing to implement a Mental Health pod/unit  to address mental health needs more appropriately.  Ongoing training and staff support will be critical to the successful operation of this pod.

Durham County is actively participating in Stepping Up,  a nationwide initiative supported by the national Association of County Commissioners.  Stepping Up is designed to reduce the number of persons with mental illness in local jails. This process has helped partners identify key areas for improvement.  We commend the Sheriff’s Department for working in collaboration with other community agencies to address mental health issues in the jail.

NC Criminal Case Management System – Time for a Change

Chief Justice Martin’s Commission on the Administration of Law and Justice is examining the criminal case management system in North Carolina.   A consultant speaking  to the committee found much room for positive reform in our system.

Key Findings Included:

1.  Cases are not being resolved timely in NC courts and are not meeting current NC guidelines.

2.  The lack of timeliness has an impact on justice including:

  • Victims wait too long
  • Witnesses may become unavailable
  • Public Defenders wait an average of 4.5 hours as do families of defendants.
  • Some people are sitting in jail 3-5 weeks – at a cost to the counties – because no counsel has been assigned.

3.  A number of NC practices don’t conform with other states and some deserve attention.

  • District Attorneys control the case flow but it is better to have the Court take on this role.
  • Every case setting should be a meaningful event; right now there are 6 or more continuances in every case.

4.  Benefits will result if the state addresses these issues including:

  • Reduced cost of pre-trial detention
  • Reduced security risks
  • Reduced costs of state and local officials

Recommendations Include

  1. The  NC Supreme court should manage a statewide effort to improve caseflow management and establish rules of practice.   The Court could establish a board responsible for overall strategy. The board could review existing statutes, recommend rules to reduce delay and establish and monitor pilot projects.
  2. Pretrial issues could be resolved at the Administrative setting.
  3. A case should be a single incident
  4. NC should collect needed data for case management.

TROSA Breaks Ground on Comprehensive Care Center

TROSA (Triangle Residential Options for Substance Abusers) will be breaking ground Oct. 13 for a new state of the art comprehensive health care center.

This is a remarkable achievement for any community agency, much less one that is dedicated to providing treatment options for substance abusers.  TROSA residents have multiple health needs and do not have health insurance, making adequate health care a significant challenge for its 525 residents.  TROSA transports residents to over 3,345 appointments and provides 7,691 appointments on site.  In addition 5,300 mental health services are provided.  Now, TROSA residents will be able to address health care needs on the TROSA campus.

Hats off  to TROSA for this tremendous achievement.