We need to get serious about the goal of quality health care for all North Carolinians – and that must include mental health care.

Thousands of our fellow citizens struggle everyday with mental health concerns.  North Carolinians and their families who face mental illness, developmental disabilities, and substance abuse issues deserve our staunch support in dealing with their challenges. 
 
My background in health care tells me that it makes no sense to separate mental from physical health care.  The best research confirms that many patients have mixed mental and physical health issues.  Thus I am proud that my plan for expanding health care coverage to all children and more low-wage working parents has been praised by such leading advocates as Adam Searing of the North Carolina Health Access Coalition for containing "the most significant changes in health care access in North Carolina in, quite literally, decades."  To read more, please go to bevperdue.com/healthcare.

I strongly support the recent step taken by the General Assembly toward mental health parity and will continue to push for more comprehensive parity as Governor.  In addition to pushing for comprehensive mental health parity, my specific agenda for change of the mental health status quo includes the following:

1. Hands-On, On-Site, Personal Accountability by the Governor

I share the outrage of every other citizen when I read continuing stories about grotesque abuse and neglect in our mental health hospitals.  And it is important that elected officials and candidates spell out the policy changes that they think should be made and pledge that they will hold the system more accountable.  But to me at the most basic level, I see the issue of abuse and neglect in our mental health hospitals in personal not just policy terms. 

That is why as North Carolina’s next Governor I will initiate a simple but paradigm-changing course of personal action and accountability.  As I have made clear in speeches across the state, I will initiate an unprecedented personal, hands-on routine of On-Site Accountability over our mental health system and such other key government functions as other social services and the criminal justice system.

With my own selected team of accountability experts, I will be making regular unannounced on-site “spot check” inspections of what is happening in all our mental health hospitals, local management entities, as well as the HHS bureaucracy.  My administration will establish a pre-announced protocol of the accountability indicators that I will want to check – from job attendance records to case load activity and any report of patient abuse and neglect.

I will also insist on meeting with employees at all levels in a totally confidential manner, including line employees without the presence of management.  I will make sure that patient abuse and neglect by any employee is punished swiftly and fully. 

But I am not in the business of “scape-goating” the overwhelming majority of decent, professional, and hard-working employees.  I will solicit recommendations for change from our employees no matter what their job title and encourage them to be responsible whistle-blowers.   I will also be supportive of efforts designed to increase the professionalism of our work force and provide more competitive pay scales.

2. Extend Community Care Model to Mental Health and Establish Clear “Safety Net” Standards

North Carolina's Medicaid program has recently moved to the forefront in emphasizing the importance of a "medical home" for the primary care of adults and children.  Our Community Care of North Carolina has developed a very cost-effective and quality-driven model of statewide case management through health care community networks.  As Governor, I will extend this kind of collaboration and community network to the delivery of mental health services.  Every person served by the mental health system should have the benefit of strong and effective case management to maximize treatment and service plans. In my view, the concept of a medical home should play a major role in helping to revitalize our badly tattered mental health system, for Medicaid recipients and others served by the system as well.

As North Carolina's next Governor, I also want to establish the national model for an integrated approach to behavioral and primary health services for patients with mental health, development disability, and substance abuse problems.  One of my top goals will be to break down the barriers to the coordination of mental and physical health care.

We must also develop a set of standards that establish a basic safety-net which those in need of mental health services will have available to them.  These core elements will provide a strong foundation for a true community-based system of care.  Today there are just too many opportunities for people in need to fall between the cracks.

3. Develop Mental Health Courts

Among the more promising practices that have evolved over the last few years are specialized mental health courts.  These mental health courts, with judges and other judicial officials who have special training and interest in the field, focus on problem solving, seek to link at-risk and minor offenders with mental illnesses to needed treatment before they spiral into a life of habitual law-breaking.  The judicial system has a vital role to play here as a partner in dealing with local community services.  These courts have already proven their effectiveness in other states as well as a few communities in North Carolina.  As the National Alliance on Mental Illness has concluded, mental health courts "can play a productive role in a comprehensive strategy to break the cycle of poor treatment, worsening mental illness, [and] escalating criminal behavior." 

4. Focus on Rural and Underserved Areas

The quality and degree of care cannot be dictated by zip code.  That is why I will take such immediate steps as expansion of the Office of Rural Health's loan forgiveness initiative to place more mental health professionals in the rural parts of North Carolina where they are desperately needed.  This kind of state incentive can make a huge difference in the choices young students and professionals make when they are considering careers in mental health.   As chair of our state's Health and Wellness Trust Fund, I have already developed an innovative loan assistance initiative to help our rural hospitals modernize and provide more up-to-date services across the board.  Modernizing hospitals as well as attracting new health care providers will represent significant boosts to economic development in our small towns and surrounding rural areas, while at the same time enhancing the level of care for some of our most vulnerable citizens. In assuring access to services, as with all the issues we face in mental health, we must also utilize innovations in telemedicine that make expert advice and support more readily available throughout the state.

I know that we cannot neglect the need for strong in-patient services.  To the extent possible, these services should also be community-based, close to home, family, and other resources.  But the state cannot walk away from its obligations.  If needed services are absent in a local area due to a lack of private providers, we must work to put them into place through public facilities. 

5. Focusing on outcomes through Centers of Excellence

The state's overall approach to planning and implementation in mental health care must also be overhauled.  We need a fundamental shift to a focus on outcomes – setting high program and service standards and then clearly stating what results we can and should expect while setting up the conditions most likely to achieve the best possible outcome for each person. 

One way we can foster the highest quality services is to actively promote the best practices in the field.  I will push the state to develop centers of excellence within our colleges and universities which will advance evidence-based models and continue to build capacity for high-quality services across the state.   Through these evidence-based models we can point the way to more effective and efficient services. We can also better support the ongoing training and development of our professionals who work in the fields of mental illness, developmental disabilities, and substance abuse services.

Conclusion

I know that changing mental health care in North Carolina is something far more easily said than done.  Yet we cannot stop until we have a system that achieves access to high-quality mental health, developmental disability, and substance abuse services for all North Carolinians.  We certainly need better funding.  Our low standing in the National Alliance on Mental Illness' rankings of expenditures per capita is inexcusable.  But funding is only one piece of this puzzle.  We must work on many fronts to achieve the changes and improvements we need. 

Many people, both professionals and volunteer advocates all across this state, are working their hardest every day to improve our system.  The scale, complexity, and rapidity of change that they have endured over the past few years have been daunting but they are committed and determined.  Our state needs the benefit of multiple perspectives as we work through the serious issues now facing our system.  We will need to adopt a disciplined approach to maximizing system improvements.  And we must make sure that government officials and the mental health community listen to and learn from one another.

But at its most elemental level I know that a new and unprecedented era of personal, hands-on and on-site accountability is needed from our next Governor.  I am absolutely committed to making such fundamental change happen in the way we deliver mental health services throughout North Carolina.