Merger raises many issues

Looming changes in mental health system rock clients, agencies and counties

Sunday, March 11, 2007

By Marcie Young
Charlotte Observer Staff Writer

MORGANTON - In 2002, Robert Cox was released from Broughton Hospital after spending 21/2 years recovering from an addiction to crack cocaine and receiving treatment for bi-polar disorder.

Outside the mental-health hospital, a still-fragile Cox attended counseling sessions and underwent intensive therapy. Within two years, Cox said, he had weaned himself off disability payments, had taken a peer-counseling job with Foothills Area Programs and bought a home.

Now, he's worried that Foothills, the agency he says is responsible for his recovery, is in jeopardy.

Responding to changes in state laws governing mental-health care, Burke County commissioners are considering merging Foothills, an agency that administers mental-health care in Burke and three other counties, with Catawba County's mental-health department.

The merger would end Burke County's 38-year partnership with Foothills, which also serves Alexander, Caldwell and McDowell counties.

The board will vote on the merger Monday evening.

But Foothills employees, clients and its contracted therapists and doctors worry the merger could interrupt services and hurt people coping with substance-abuse problems and developmental and mental-health issues.

"Any lapse in service, whether it be a day or an hour, could be very serious," said Laurie Bradshaw, whose 24-year-old son is deaf, mentally retarded and has cerebral palsy. "People with mental-health problems are very fragile."

Don Pagett, interim director at Foothills, said people are also worried that though the move is helpful for Catawba, which needs to increase its service population by more than 55,000 people to avoid state penalties, it is not so good for Foothills.

If Burke pulls out, Pagett said, longtime Foothills employees could find themselves without jobs.

"It seems odd to us that Catawba County's population problem has become our problem," he said.

Changes in state laws that were passed in 2001 but are just now taking effect require Local Management Entities, like Foothills and Catawba County Mental Health, to serve populations of at least 200,000.

Catawba County's population is 141,865, according to the 2000 Census, so it must increase the number of people it serves by the start of the next fiscal year, which begins July 1.

If it doesn't, the county could lose $320,000 in state administrative mental-health funding, said Catawba County Mental Health Director John Hardy.

Foothills serves a population of 248,000, so it doesn't need to change. But some Burke commissioners are considering the merger, they said, because Foothills is plagued with administrative holes, from the board of directors down, and is beyond repair.

Also, they said they worry that other counties in Foothills may pull out.

Commissioner Jack Carroll, who has sat on Foothills' 16-member board of directors for two years, said some board members have micromanaged the Foothills administration.

Steven Corley, former Foothills CEO, resigned in December and was replaced by Pagett.

In January, Burke commissioners asked the Foothills board to make changes, including replacing long-term board members, but they could not reach an agreement with the Foothills board.

"Do we stay with a group that we feel the management is broken?" asked commissioners chairman Wayne Abele. "Poor management leads to poor services eventually."

But commissioner Ruth Ann Suttle, the board's only Democrat, said that complaints about poor management aren't enough to justify leaving Foothills and that the county has an obligation to better explore the impact and details of the merger.

"No one can give me concrete information to what the problem really is," she said. "We should be able to work out those problems. Call in a mediator, heck, do something before you make this big decision to pull out."

And the chairman of the Foothills board said the agency has solved its management problems of the past. "The new leadership ... as well as changes in key staff positions, totally change the management style of this organization," said Rick French, who also is county manager of Alexander County.

Hardy said ongoing reform has left agencies across the state frustrated and that changes are still coming. If Burke doesn't merge with Catawba now, he said, another merger is likely just a few years off because of continuing changes in mental-health policies.

"Burke County saw this as an opportunity to stabilize things in the long term," he said. "For (Foothills), this is probably the last straw, but change is going to occur whether it happens this way, at this time or not."

The best possibility, many people on both sides said, would be a merger between Catawba and Foothills as a whole, not just Burke County.

That, however, would require coordinating merger meetings between Burke, Catawba, Alexander, Caldwell and McDowell counties, something Carroll said would be a difficult feat.

"I'd like to see everyone go along with it, and I'd vote on it in a heartbeat," he said. "But it's hard enough to get five commissioners to vote on something, not to mention five counties."

But clients like Cox and Bradshaw said commissioners aren't thinking about the real impact of the merger and how it will affect Burke County residents.

One of the biggest concerns, they said, is losing access to Foothills Education and Enrichment Center in Morganton, which provides support groups, peer counseling and activities for clients.

"This is a unique program," said Cox. "This is what is going to make mental-health reform work, and it's happening here."

Hardy said service interruptions are inevitable but would likely be minimal.

"Mental health is like a big tanker floating in the state, and you don't turn a tanker on a dime," he said. "Turning the tanker makes ripples on both sides of the ship and the shores that relate to
it, and that's what we're dealing with here."


About Foothills
Since 1969, Foothills Area Program in Morganton has provided mental-health, developmental and substance-abuse services to children and adults in Alexander, Burke, Caldwell and McDowell counties. In 2004, because of reforms in mental-health law, doctors and therapists began working with Foothills on contract. Foothills, with a service population of 248,000, last year received more than 8,500 calls for assistance.

SOURCE: Foothills Area Program

What is a Local Management Entity?
Local Management Entities (LMEs) are local government and county programs responsible for managing, coordinating, facilitating and monitoring mental-health and substance-abuse services and developmental disabilities. LMEs are responsible for developing and overseeing providers, handling client complaints and offering 24-hour, year-round access to services.

SOURCE: N.C. Department of Health and Human Services


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