Advocate for mentally ill shifts gears

By Marion Blackburn

After the state in 2001 shifted care from county centers to private therapists and social workers, many communities in sparsely populated areas of the state were left without services.

Stepping in with referrals and information was the Mental Health Association in North Carolina, the state’s oldest advocacy group for the mentally ill.

The group continues that new role of providing services in addition to its traditional job of encouraging education, support and awareness, says John Tote, executive director.

The far-reaching changes also led the association to strengthen its 46 local chapters, including those in eastern North Carolina.

“With reform, we need to be there even more, to make sure people get the services they need and to provide education,” says Ginny Mohrbutter, the association’s eastern region program manager.

“We also serve as advocates, to make sure people don’t fall through the cracks,” she says. “The advocacy role is crucial now.”

Organized in 1914 as the Mental Hygiene Society, the organization is an independently-operated affiliate of the National Mental Health Association founded in 1909.

Its symbol, a bell, represents a real bell the national association forged from shackles and chains once used on the mentally ill.

Improving care and reducing stigma continues as a key goal.

With an $18 million budget, 500 staff members and 150 programs, the North Carolina association offers direct professional services.

Chapters operating in eastern North Carolina do not provide mental health services, but instead organize community discussions and host public forums, speakers, films, depression screenings and a yearly gift drive, Operation Santa Claus.

They also reach young people through the school-based “Healthy Minds, Healthy Children.”

Some are self-supporting through donations, grants and other revenue sources, while others depend on start-up funding from the Raleigh office.

The Tar River Mental Health Association in Rocky Mount, for example, raises its own funding and works with more than 300 volunteers.

State government leaders hoped shifting counseling and psychiatry services to private providers would reduce costs and improve efficiency.

Under the new system, people with mental illness, substance-abuse problems and developmental disabilities who had received services through county mental health centers now are referred to private providers.

County mental health centers have been renamed “local management entities” and decreased in size or closed altogether.

When the new system took effect, “there were no providers, so mental health centers started coming to us,” Tote says.

“These local management entities oversee services rather than provide them themselves, and services are paid through Medicaid, primarily,” he says. “It is a tightly drawn circle of available funds.”

Mohrbutter says isolated towns and crossroads often lack mental health services.

“It’s more difficult to set up private provider networks in rural counties, because professionals may not be available in those areas,” she says.

In some cases, local mental health associations become referral centers for people with many concerns including addiction.

Demands are likely to increase as state reductions continue, she says.

“The goal is to assess the needs in a county, to get a group of people together, and to work with them as an affiliate that can provide its own funding and services,” she says. “In some counties it takes time to do that.”

Tote says the association is working to address challenges that remain from the shift in the way mental-health services are delivered.

“As reform meanders along,” he says, “we are some way from seeing it run like everyone wants it to and making a difference.”

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