Tenets

1. In order to have a humane, effective, and efficient system of mental health care, we must have a universal health care system where health includes what we now separate into physical and mental health. Whatever accommodations we make with the present system now, we must work towards a single-payer system with universal coverage.

2. The state is responsible for ensuring that mental health services are available to all citizens in need.

3. The focus of NC's mental health system must be on those who need its services, not on the system itself.

4. Any client who can be served in the community should be. Unnecessary hospitalizations are a violation of human rights and reflect service system inadequacies more than individual deficits.

Governance and structure

5. North Carolina's governor must rank the provision of effective mental health services as one of his primary responsibilities for successful reform to be feasible.

6. North Carolina must have a Secretary of Health and Human Services who sees the provision of effective mental health services as one of her primary responsibilities.

7. The Director of the Division of Mental Health, Developmental Disabilities, and Substance Abuse must be a nationally recognized leader in the field with experience in system reform. She or he must be willing and able to make significant and necessary changes in the Division, to effectively encourage the legislature to rationalize funding and oversight, and to centralize control over the mental health program in state government where it belongs.

8. The most critical task facing this Director is to develop an effective, feasible, and functional client-centered plan for services and funding.

9. The design of benefit plans and eligibility criteria, and key financial decisions about who pays for what and under what criteria should be made at the state level.

10. An effective and empowered Citizen's Advisory Board, composed of legislators, clients and their families, advocates, and providers must be established and given defined responsibilities with regard to mental health policy and performance.

11. State agencies, including the Division of Medical Assistance, the Divisions of Facilities Services and Aging and Long Term Care, Vocational Rehabilitation, Juvenile Justice, the Department of Corrections, and the Administrative Office of the Courts, must formally coordinate their mental health policies with the Division of MH/DD/SAS.

12. The Divisions of Mental Health and Medicaid must resolve and move beyond the current conflicts in their goals and policies.

13. Service areas and service provision should be standardized statewide. 14. The State must develop and implement methods of enforcing standards and ensuring evidence-based practices at the community level.

Financing

15. Sufficient financial resources must be invested in the mental health system to plan, provide, and effectively monitor high-quality, client-centered, appropriate care to those most in need. Simply said, we need more money, better spent, for more people.

16. The State must require all health insurers to provide the same level of support for mental health services as they do for physical health (parity).

17. Funding streams should be linked -funding must "follow the client." Currently funding for Area Programs and funding for state hospitals are separate and unrelated, promoting the overuse of involuntary inpatient commitment.

18. The state should take more control over the financing and policies of the Division of Mental Health, and local counties also need to be meaningfully involved. When state dollars and initiatives do not fall within local priorities, counties should increase their contributions to cover the disparities.

19. State funding for mental health must be based on need, taking into account numbers of people affected, severity of illness, and other funding sources. Those in need of services who do not qualify for Medicaid must also have access to high-quality services even when they are slightly above the required income level.

20. The State should ensure that all those with serious and persistent mental illness who qualify for Medicaid are enrolled.

21. As a first step toward costing out a more responsive, client-centered system, the most critical populations - at-risk children, adults with severe persistent mental illnesses, those with multiple disabilities, those at risk for institutionalization - should be assessed and service plans developed with them. These service plans could be used to develop cost estimates.

22. Money must be made available for housing for people with serious psychiatric disorders. They need subsidies and access to subsidized housing. Money must also be made available for developers of housing for mentally ill, and State-County Special Assistance must no longer by limited to licensed facilities.

23. The administration of NC's mental health system receives about $7 million, less than one-half of one percent of the program's $1.7 billion. A comprehensive review and analysis of administrative responsibilities is required, with a commitment to adequately fund effective management of the system.

Accountability and standards

24. Outcome-based accountability should be universally implemented, using the Client Outcome Inventory or a similarly rigorous instrument, with consistent standards defined and enforced.

25. The Division must establish and enforce standards with regard to access to services, quality and range of services, treatment decisions, and outcomes. All providers who work with the state must practice using those standards and engage in ongoing quality improvement.

Services and resources

26. Services must be culturally appropriate, evidence-based, and outcome-oriented.

27. Services must first serve those populations most in need.

28. Choice of provider should be incorporated into the system as much as possible.

29. Until alternatives are available, our state psychiatric hospitals should be maintained. In the short term, the facilities must be upgraded and properly staffed. However, we should consider the construction of newer and smaller facilities that are designed for treatment and not simply for the warehousing of patients.

30. Any savings that result from reducing the use of state hospitals and revenue generated from the sale or other use of state hospital property should remain within the public mental health system and support the delivery of appropriate community-based care.