Commentary, NC Budget and Tax Center, Raising the Bar 2015

Raising the bar: The Governor’s HHS budget proposal for behavioral health

Editor’s note: This is the latest installment in “Raising the Bar” — a new series of essays and blog posts authored by North Carolina nonprofit leaders highlighting ways in which North Carolina public investments are falling short and where and how they can be improved.

Gov. Pat McCrory’s budget proposal for the years 2015-17 offers a welcome change of direction in the area of behavioral health services, which would see spending increase by 1.5 percent compared to current law. Though far from what is really needed, this modest increase would be a real turnaround from years past when lawmakers imposed significant cuts to programs and direct services as a way to balance the budget and make up for revenues lost to tax cuts. We are pleased to see the Governor’s support for restoring some funding to the health and human service budget to serve citizens with mental health, intellectual or developmental disabilities, and substance use disorder services.

In addition to stopping most of the bleeding, this money would help the state to catch up on at least some of what was lost during the recession and begin to rebuild to address current needs. Furthermore, over the past few years, lawmakers enacted provider rate cuts year after year. Under the Governor’s plan, there are no further provider rate cuts.

Some new things to take note of that we are very heartened to see: almost $24 million is invested in services for mental health treatment in our prisons. This is the first time funding has been allocated specifically for this kind of treatment. With this money, 72 beds that are not open due to budget constraints at Central Prison’s mental health hospital can be fully staffed. Additionally, behavioral health treatment units can be opened at eight high security prisons. Funding was put in the budget to support the Treatment Alternatives for Safer Communities (TASC) program. TASC integrates community mental health and substance use disorder services with the criminal justice system to improve outcomes. The funding, about $1.86 million, will reduce caseloads of care managers to accommodate more referrals.

Mental health services should see about $42 million for community based services under the Governor’s proposed budget. This is outstanding as the cost to treat someone in the community is much cheaper than a more costly service such as the emergency room or inpatient facilities. These services can actually keep patients from going to the emergency room or getting to such a bad place that they need inpatient care for a disease that has gone untreated for too long. This focus comes from the work of the Crisis Solutions Initiative that has been going on for a few years. This group has really made strides in improving community based services and working on public awareness of these services. The end result means less money being spent on overcrowded emergency rooms serving people in crisis and more money going to services that prevent people from going into crisis. Also, money is allocated to create a live bed registry. Currently, when people are in emergency rooms, it is up to the emergency rooms to call around and find an open inpatient bed for them. A registry will make finding a bed much easier and faster and will lift that burden from emergency departments.

While the Governor’s budget does shed some positive attention on needed services in our state that have been forced to endure repeated cuts, other areas were not so fortunate. For example, his budget fails to restore money that is desperately needed for drug treatment courts. These courts had $2.5 million appropriation eliminated a few years ago.

Also, about $2 million is appropriated to the NC START (Systematic, Therapeutic, Assessment, Respite, and Treatment) program. This program provides intervention and prevention for adults living with intellectual or developmental disabilities. Under the Governor’s plan, the expected money is slated to start a fourth team (there are currently three teams statewide) and provide services to children and adolescents. However, the money appropriated will not be enough to start providing these services to children and adolescents AND create a fourth team. In my conversations with colleagues, about $2 million more is needed just to be able to serve children and adolescents. No money was appropriated to relieve the wait list for people needing services through the Innovations Waiver. This means people will continue to go without services until new slots are available to serve those waiting.

Another thing the mental health community is deeply concerned about: several items in the Governor’s budget (expanding NC START, opening the new Broughton Hospital, facility based crisis units, and a few other areas) are all funded with proceeds from the proposed sale of Dorothea Dix Hospital. While we want to see money from this sale go to mental health services, we believe the money is stretched too thin among many services and we have concerns about appropriating money since the sale of the land that the hospital sits on is not a done deal.

The bottom line: The Governor’s proposed budget takes some very encouraging steps and we applaud the Governor and the Department’s effort to invest new money into some services that are greatly needed. That said, the proposal is only a start. We hope that leaders in the General Assembly will build upon these proposals in the coming weeks so that North Carolina’s investment in behavioral health can begin to return to a path of meeting community needs.

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