Gubernatorial Candidate
Bev Perdue
http://www.bevperdue.com/index.asp
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 onsite
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.
Previous statement:
We must get serious about the goal of quality health care for all North Carolinians. As our next Governor, I will take unprecedented steps toward achieving this goal.
I am proud that Adam Searing of the North Carolina Health Access Coalition has praised my plans for immediate expansion of health coverage in our state as containing "the most significant changes in health care access in North Carolina in, quite literally, decades." To read more, please go to www.bevperdue.com/healthcare.
I do not believe in separating mental from physical health care. An essential element of our health care goal must be assuring access to quality mental health services.
Research has established that many patients have mixed mental and physical health issues. We need to break down barriers to the coordination of mental and physical health care. As North Carolina’s next Governor, I want to establish the national model for an integrated approach to behavioral and primary health services for adults and children with mental illnesses.
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. We need to extend this kind of collaboration and community network to the delivery of mental health services.
In my view, the concept of a medical home should play a major role in helping to revitalize our badly-tattered mental health system within and outside of Medicaid. Patients with severe mental illness especially need the security of a medical home as well as strong in-patient and out-patient professional services. We should also strive to define a basic level of mental health services to which needy patients should have access.
I know that improving our mental health system is easier said than done. We will need to adopt a disciplined approach with lots of two-way learning between government officials and the mental health community. That will require sound leadership, policies and coordination throughout our state DHHS.
As Chair of the state's Health and Wellness Trust Fund, I have led advances in preventive health care, rural health services, prescription drug assistance, and addressing access disparities. As Governor, I will be directly involved in taking on our mental health care challenges and pledge to be the leader we need to fix our mental health care system.
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