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The Governor
takes charge
By the time you read this, the House Mental Health Reform Committee may
have already given its blessing to HB 1188, which authorizes the
governor to appoint one-third of the membership of Local Management
Entities' governing boards.
Membership of many of these boards (if not most or all) already have a majority of members who come from county government. And perhaps the idea behind giving the governor this authority is to level the playing field with consumers and/or family members.
Even
were that the case, what about the intentions of the next governor and
the next. And what does having one-third of LME board members appointed
from Raleigh say about local control?
If anyone has any thoughts on the "why" of this bill, please pass them on to david@ncmentalhope.org.
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Better Late?
Hopefully, better late than never, but click here
for Perdue's budget recommentations affecting mental health, the Senate
response to those recommendations and mental health legislation
introduced in both chambers.
Individual bills and their progress can be looked up on the Assembly website: ncleg.net.
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Helping Hope
NC Mental Hope gratefully ackowledges the contributions of individuals and support from:
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NC Advocacy
Join the discussion on state mental health issues at NC Advocacy, more than 180 advocates statewide.
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News, news, news
Keep up with state mental health news at NCMentalHope.org
and don't forget to click on the Some of the "National News" tab there
for hundreds of stories from around the nation and the world.
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Legislating Medication
Sometimes it just makes your head hurt.
 It's
certainly made my head hurt this past week, searching for the
MH/DD/SAS "Antipsychotic Workgroup," Googling the Net and
searching my
fingers to the nub on the Health and Human Services and the Division
websites. Then I was told the group's proper name was the "Atypical
Antipsychotic Committee." "Ah, I thought," and Googled and searched on.
Still nothing.
And yet this is the committee I understood to
have proposed a special budget provision to limit medications to
individuals on Medicaid. Since some studies have shown that first
generation drugs (generic and cheaper) are as effective as
second-generation medications (branded and more expensive), a hop, skip
and grand leap in logic later, someone arrived at the conclusion that
psychiatrists should in most cases be required to first try a couple of
first-generation generics with patients. In theory, that would save the
state a gob of money that could be used for other mental health needs
(or it could also simply disappear). There are "flaws in in the
ointment" with the studies and logic, however, as you'll read.
I would give you the exact language of the provision, but searched and searched ... well, you know the rest.
Then
I heard this provision wasn't even the committee's suggestion, but a
provision in Perdue's original budget. Certainly Gov. Perdue is
intelligent, but I dare say her pharmacalogical skills might be a bit
rusty.
So where did the idea come from? Thin air must indeed be
good for something, or nothing, depending on your feelings toward the
provision. And why the need for a committee? Surely not to legitimize a
decision already made (although, according to its mission statement a
few paragraphs down, the committee can turn their attention to other
matters as well).
At an advisory committee last week, I
certainly felt like I was getting a sales pitch in favor of the
provision from Dr. Louis Stein, Western Highland Network LME's medical
director. As a member of the Atypical Antipsychotic Committee appointed
by MH/DD/SAS Chief of Clinical Policy Michael Lancaster, Stein said he was
there to inform advocates so they could make a considered decision.
Stein touted the studies, touted the savings, and said today's
psychiatrists had little experience with older medications and
would benefit from educational efforts. But, unfortunately, he said he
didn't really know how the committee evolved and whether there were any
individuals with a mental health diagnosis on it or their family
members.
Anyway, what would folks taking medication know about taking medication? (My satire, not Stein's)
About
the only thing I do know, because it's printed on an agenda (which must
make it official) is the committee's mission statement: "The
antipsychotic workgroup's mission is to promote an evidence based
approach to pharmaceutical management of mental illness in an effort to
improve quality of care and cost-effecitvve treatments to the citizens
of North Carolina."
Sounds good, doesn't it? And you would
think that creating an "evidence based approach to pharmaceutical
management" would benefit from the knowledge of those who daily
live in that spot where the proverbial rubber meets the proverbial
road. But perhaps Dr. Lancaster thinks the committee will be more
effective without a lot of people looking on and everybody having a say.
Oh,
yes, less I forget the "flaws in the ointment." The most recent study
on old vs. new, which garnered a fair amount of press, was actually a
study of studies and certainly wasn't a blanket endorsement for first
generation antipsychotics. In fact, even though older psychotics were
in general as (but not more) effective as second-generation
medications,
they induce more side effects, and if read objectively, news reports on
the study actually make it sound as if it leans toward the second
generation drugs, except for cost that is. (One such report can be
found here.)
As those who live on that spot where rubber meets
road know all too well, the right medications, the right mix, the right
dosage, can be one of the trickiest aspects in treating mental illness.
A smidgen more of this, less of that and you or a loved one can be
quickly sliding toward the edge. To take away a psychiatrist's choice
(especilly as far and few between as psychiatrists accepting Medicaid
are) in using all available tools to help someone seems ridiculous, especially when the initiative to do so seems to have been
plucked from thin air.
And then there's this whole pesky matter
of exclusion. The NAMI "Grading the States" report from a couple
of months back is the "need to create a culture of respect for
consumer" and "that systems need to be consumer-centered and consumer
and family driven." Apparently Dr. Lancaster must have skipped that part.
David Cornwell
Executive Director
North Carolina Mental Hope
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