RALEIGH, N.C. — Mental health care reforms that Gov. Mike Easley signed into law during his first year in office have suddenly become a stumbling block as he seeks a smooth exit from his eight years as the state's chief executive.
During a combative press conference Tuesday that ended when he cut off questions from reporters and quickly left his old Capitol office, Easley defended his administration's role in handling reforms to North Carolina's strained mental health care system, placing blame on state lawmakers and local oversight boards.
Earlier, he outlined three areas of the that he thinks need immediate reform and said he would push for legislation in the General Assembly's short session, which begins in May.
"We need dramatic change, and we need it quickly," Easley said.
Lawmakers changed the mental health system in 2001, making local governments responsible for monitoring private companies that would spend more time serving clients in homes, schools, homeless shelters and other everyday settings.
But Easley said they took privatization too far too quickly, and left the state with little oversight ability. Those changes in care shifted more patients from institutional care to community-based treatment by private medical providers.
"(Department of Health and Human Services) Secretary (Dempsey) Benton doesn't have the control under the current law. That is one of the things I'm going to ask the Legislature to give him," Easley said. "I'm hoping they will be more receptive this time, because if we can't control it, we cannot change it. And then, somebody else will have to accept responsibility for it, and this time, it will have to be the Legislature, because Dempsey can't manage where he has no control or authority."
Easley said the secretary needs more control over local management entities to be able to evaluate, appoint, fire and replace local providers a timely manner, he said. Direct control of cut what Easley said is a time-consuming process to correct or remove them.
Easley also wants to reduce the number of local management entities – currently there are 25 – so they can be held accountable and so there is a consistent standard of service across the state.
The governor also wants more control given to DHHS to handle the abuses of community support programs.
"The harder problem, though, is getting providers off the program once they are on the program," Easley said. "That's where the secretary needs some real help."
Under the Office of Administrative Hearings, Easley said, these providers can appeal and tie up the process for at least six months and still continue to provide services and get paid.
"That's OK if you're talking about somebody building a building," Easley said. "But when you're talking about somebody who's providing mental health services to the mentally ill, and they're not doing it right, you need to move immediately and have them removed."
Another proposed fix to combat abuse is to seek differential pay for mental-health care providers, who get paid the same, regardless of the care the type of care they provide.
"Differential pay will correct a good number of these abuses as we move forward," Easley said.
Easley also addressed the issue of mental health facilities in the state, saying he wants to cut back on unnecessary hospital stays. The 2001 reforms sought to move more patients from state-run facilities to private, community-based care programs.
"More people, since the reform of 2001, under that privatization plan, more people are going into the hospitals, rather than fewer," Easley said.
"The problem with privatization is you a lot of these agencies shut down on Friday afternoon and open back Monday morning, and people get sick and need help over the weekend, so they have no choice but to send them on to state hospitals."
Easley said the state is gaining 60 mental health care hospital beds with the opening the new $120 million Central Regional Hospital in Butner. He said that gain will only be achieved by keeping open 115 beds at the nearby John Umstead Hospital, which was originally slated to close this year.
The governor also proposed a $40 million plan to help cut down on hospital stays by setting up mobile crisis teams and provide more beds at local facilities.
The mobile crisis teams of psychiatrists and nurses started within the past couple of years, have been sporadic throughout the state. They travel across the state, including rural areas, so people in all areas have access to mental health care.
"We feel like it's something we need to do in order to cut down on the cost of these unnecessary hospital stays," Easley said.