By Tanya Glover
Capella University
Abstract
North Carolina has many issues to overcome in the area of mental health. While things are beginning to change with the new CAHBA regulations, the sequence of services is halting at every turn as local and state agencies try to figure out where to put mental health clients. Here the reader will get a glimpse of the state of mental health in North Carolina and a glimmer of hope for the future of the services and the clients that they are intended to save.
State Issues: North Carolina
Mental Health issues are forever changing and these changes vary from state to state. This paper will cover mental health topics in the state of North Carolina and include information on recent developments of mental health issues within this state as well as licensure requirements, funding sources, and the sequence of services from local to state level.
Hot Topics in North Carolina
The major hot topic dealing with mental health in the state of North Carolina deals with the availability of services for clients who are in dire need of them. Many mental health institutions have been closed to do cuts in funding and this has left many people in the cold without any place to turn for help. One of the latest articles in on the website for North Carolinas National Alliance on Mental Illness (NAMI) states that in Wake County (where the capital of North Carolina is found) people with mental health issues would be helped and that would happen in the near future. “The Wake County Board of Commissioners is partnering with UNC’s health care system and the state health and human services department to replace Wake’s local mental health agency, which monitors and provides some care to eligible people with behavioral health problems.” (Goldsmith, 2011).
Treatments will be based upon payment per person from Medicaid as well as other agencies that help fund treatment for low income clients. With changes coming in the federal health care level, half a million people in the state of North Carolina could be getting Medicaid services and this has caused officials to move much more quickly to get plans and places in order for mental health clients. This type of managed care will help to ensure the best possible treatment for mental health clients. “The changes, including the ability to dismiss providers who don't get results, are all part of pressure from the state and from the federal government to get a handle on costs in Medicaid, one of the most expensive entitlement programs.” (Goldsmith, 2011). So, while the government is in essence, doing much of this to help itself, the clients will also fall under the umbrella of betterment.
Another hot topic in North Carolina is using unlicensed mental health workers to provide client care such as paraprofessionals and associate professionals. The services provided by these types of worker typically fall into the areas of day programs and in home intensive services. This hot topic is led to a huge change in North Carolina mental health.
Recent Changes
One of the biggest changes the face of mental health has seen in the state of North Carolina is CABHA. DSS “has approved a definition and description of a new category of provider agency, a Critical Access Behavioral Health Agency (CABHA). The CABHA represents a new category of provider agency for the delivery of mental health and substance abuse services.”(Critical Access Behavioral Health Agency, 2009).This new program was put in place for places that employ unlicensed mental health workers. Its main goal is to ensure quality of care provided by the unlicensed workers to the clients and that each worker is under the direct supervision of a clinical licensed professional. Under CABHA, unlicensed workers can now do intensive in home care, day treatment, psychosocial rehabilitation, and substance abuse treatment just to name a few. Beginning in 2010, any individual or company seeking to open a treatment center or group home (all levels) are required to meet CAHBA criteria.
In the past it was fairly easy to open up companies like this but with the CAHBA regulations it has been quite an undertaking. One very specific requirement that is taking some time to complete deals with person centered thinking training. “Effective immediately, Critical Access Behavioral Health Agencies (CABHAs) have the following options to meet the 12 Hour Person Centered Thinking training requirements set forth in Intensive In-Home, Community Support Team, Day Treatment and Mental Health/Substance Abuse Targeted Case Management service definitions.”(Purdue, 2011). This is a good thing however, as the programs that existed before these regulations came about were very loosely monitored and many times, more harm than good was done to the client.
Licensure Requirements
North Carolina has a strict set of requirements to become a licensed mental health professional. (Hence the great need for unlicensed workers.) The NC Board of Licensed Professional Counselors require that in order to become a LPC the applicant must have 2,000 hours of direct counseling hours (internship and practicum do not count)and 100 hours of clinical supervision. “Hours of supervised professional practice accrued with a qualified clinical supervisor who was Board approved for the applicant prior to October 1, 2009” (NCBLP, 2011).Also, all educational requirements must be met and the examination passed. It is also required that once licensed, the counselor put in 45 hours of continuing education each year. This can be traditional classroom work or work under another professional who can teachthe topic required. Many of the requirements of continuing education revolve around diversity and multicultural training.
Funding Sources
Most of the funding in North Carolina comes from state run agencies such as DSS and provided by Medicaid. There are also several non-profit organizations and private hospitals that invest time and money into getting North Carolina’s mental health services up and running again. For example, much private and state funding went into providing extensive services at the state mental health hospital in Butner, North Carolina.
Sequence of Services
As with all medical things, there is a sequence of services in mental health as well. This has fallen under harsh criticism in North Carolina over the past 4 years as funding was cut and the sequence seemed to break down at the very beginning. It is the responsibility of the local agencies to provide care for people with mental health issues. An assessment is done and it is dependent upon the results of what will happen next. Outpatient local service may be deemed the best course of action. If there is no improvement within this boundary then the state issues an assessment. If inpatient services are found to be needed then the placement process begins. This is still a difficult process for North Carolina as they are still getting a grip on the mental health help deficient that the state has been experiencing. Placement is typically found within a state run facility.
World View of the Mental Health Professional
This writer spoke with Shannon Marr about this topic. While she stated that she could not effectively speak for all the counselors of North Carolina, she did feel confident that they all share a common world view. Mrs. Marr stated that “As for the world view of North Carolina counselors, I would have to say that it is that everyone deserves top quality treatment without having to fight for them.” (S. Marr, personal communication, August 20th, 2011). Mrs. Marr further stated that the world views of each person differ depending upon their own beliefs and values but the main goal at the heart of a counselor with pure intent is that all people get the help they need to be mentally healthy and that peace fall upon all who so desperately need it.
Conclusion
North Carolina has a long way to go in revamping its mental health policies. Using unlicensed worker who are required to work under the CAHBA regulations is a step in the right direction. There is an apparent lack of people becoming licensed though the requirements are not any more stringent as requirements found in other states. The lack of professionals may have to do with the fact that there is so much trouble in getting client services, more people are choosing not to go into this currently shaky field. However, even with this lack of licensed professionals to care for clients, things are starting to look up for North Carolina as more people are being treated under Medicaid and other nonprofit organizations. There is still much work to be done but at least there are people advocating for change to appear.
References
Goldsmith, T. (2011, August 16). Wake will revamp mental health care. News& Observer,
NCBLP, (2011). Licensed professional counselor. Retrieved from http://www.ncblpc.org/application-info/lpc
North Carolina Department of Health and Human Services, Division of Mental Health. (2009). Critical access behavioral health agency
Purdue, B. North Carolina Department of Health and Human Services, Department of Mental Health. (2001). Implementation update #86
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