Legislative leaders who monitor North Carolina's mental health system are surprisingly positive after negative actions they took last month to close a budget hole.
They are pleased with new Department of Health and Human Services leaders who oversee treatment for more than 300,000 mentally ill patients, substance abusers and the developmentally disabled.
However, spending cuts for treatment as high as $400 million this fiscal year mean there's no doubt patients will lose local treatment options and see other services curbed.
"I'd be optimistic if we didn't cut the budget 20 percent," said Dave Richard, executive director of the Arc of North Carolina, which advocates for the mentally disabled. "You can't do what they're doing without hurting thousands upon thousands of people in the state."
The cuts had to be deep, because Democrats calculated the budget gap for this year at more than $4 billion. Improved cooperation with the department, though, helped prevent patient cuts from getting worse, said Sen. Martin Nesbitt, D-Buncombe.
"We now have people we can work with," said Nesbitt, co-chairman of the Legislature's mental health oversight committee. "This (reduction) is what we had to do to preserve the system."
The good feelings contrast with eight years of frustrations and setbacks for a mental health reform effort that a legislative watchdog agency said in July ultimately wasted up to $635 million in government money on a single initiative.
The positive vibes are traced to Secretary Lanier Cansler, who was hardly a newcomer when Gov. Beverly Perdue appointed him in January. The former House member, from Buncombe County like Nesbitt, was deputy secretary during then-Gov. Mike Easley's first term before a brief consulting career.
Under Easley, the department struggled to carry out a 2001 law designed to shift the state's mental health programs away from institutional care to community-based treatment offered by private providers.
Lawmakers and advocates clashed with the department under then-Secretary Carmen Hooker Odom because they said she didn't seek their input enough. However, they say Cansler wasn't part of the problem.
Relations improved in late 2007 when Dempsey Benton, a career bureaucrat in state and municipal government, succeeded Hooker Odom and pledged to fix the department. His tenure was short, though, and marked by the fallout from hospital patient deaths and hemorrhaging cash with the Community Support program.
Cansler, a Republican in a Democratic administration, seemed to have bipartisan support on the oversight committee last week. Nesbitt said he had never seen committee members listen so intently to a department secretary.
"I think we've got somebody that's very capable," said Rep. Fred Steen, R-Rowan, a committee member who acknowledged the panel has been accused at times of micromanaging. "It's difficult times and anyone is going to be tested no matter who's at the helm."
Cansler acknowledged the cuts – $55 million less to "local management entities" that evaluate patients and find them community treatment, a $16 million reduction for in-home services, and lower Medicaid reimbursement rates for providers – will hurt families and those that treat patients.
"There will be some providers out there that will not survive," Cansler said. "There are going to be repercussions, and there's no way to avoid it when you take $350, $400 million out of the system."
Cansler talked about a new effort to provide more financial accountability within the department and get divisions to work together to meet common goals.
He's also hired outside the department – a Tennessee behavioral health consulting firm director, a Lumberton hospital executive and Sandhills-area local treatment manager among them – to take key mental health positions.
"Sometimes when you have a new set of eyes with a different background, different understanding, you see issues that those who have been within the forest for many years don't see," Cansler said during a break in last week's meeting.
The good relations were tested in last week's oversight meeting, the first since the session ended.
Legislators complained how Cansler's department allocated $55 million in cuts to the 24 local management entities.
They spent most of the afternoon peppering new state Medicaid director Dr. Craigan Gray over the phaseout of the Community Support program, which provides non-medical care for 33,000 mental health patients living at home.
The Legislature agreed to eliminate the program by next June after a series of unflattering reviews that found overpriced care, such as paying $61 per hour to take clients to the movies or shopping.
Lawmakers were worried that patient transition to other treatment programs left out more fundamental assistance like teaching patients life skills.
By meeting's end, Cansler said the department would provide more data to legislators to help them decide if they believed lower-skilled treatments needed to be restored, according to Nesbitt.
Nesbitt quipped, "Isn't that refreshing?"