How can we let this happen

I found this very disturbing because we are on one hand trying to help people who are homeless - who probably have mental health problems and don't have any health insurance and don't have a provider to give them help - and we are shutting down another health provider that was doing great work in all three counties. Here's the article:

Around 1500 mental health patients won’t get services this year because of cuts in state reimbursement rates [says] Doctor John Gilmore, a psychiatrist at UNC Hospitals. The funding cut has caused mental health assistance group Caring Family Network to cease offering services in Orange, Chatham and Person counties.

CFN received around 12 million dollars from the federal and state budgets this fiscal year, and has dealt with financial problems. Gilmore says mental health funding for the state doesn’t provide enough money to go around.

Gilmore believes the problem centers around the privatization of local mental health centers so that public mental health systems are now in the hands of private companies.

- WCHL: Funding cuts causes patients to lose services

This is a shame we don't care more about our people. This makes me sick. A lot of those people are my friends.



Thank you for writing about this, Ellen. I think it's a travesty the way the US has been dealing with mental health ever since the Reagan era. And then it gets unbelievably worse year after year. How can our legislators not see what a detrimental impact these cuts have not just on those in need, but on our entire community?

Can someone explain more about what this means?  Is OPC going to close entirely? 

Privatizing mental health services for indigent people in North Carolina was wrong. The NC State Legislature messed up. I've heard they're realizing their error. Hopefully they will fix this HUGE mistake. In the meantime the legislature needs to increase funding to our counties and municipalities to improve public health care services. Pronto!
I think this ought to be put in the forfront of every board in opc area program how can this happen to us.its happening and many people that need services are going without right now or little bit of servicesthat the state can get away with. the dd population has it good compared to the mental health and subtance abusers we need to make sure that no other provider goes under

The NC Legislature did indeed make a huge mistake.  I understand that it was initiated because of  poor management by a couple of the area programs tasked with administering the fund and providing services.   Rather than  dealing with the one or two of the 8 area programs that were doing poorly, the Dept of HHS (?)  and the state legislature decided  to completely revamp the entire program.

 Our area program--Orange Person Chatham Mental Health Services---has done an exemplary job providing services during what has to be one of the most ill conceived and poorly managed government initiatives we've had in recent memory.  

The entire scenario started out because of trouble in a couple of localized organizations.   It's ended up creating a complete mess throughout the system.    Maybe whoever is in charge has learned that it is better to deal with the specific problems than fix what isn't broken in other places.  

 Those employees at OPCMH truly deserve our thanks and support.   They are dedicated and are hanging in there despite not knowing most days if they have a job tomorrow. 

Yes! OPCMH folks do deserve our thanks and so much more. Its amazing to see how long they've held on doing a job that pays crap. That says a lot about our community and the people who live in it. Real sacrifice. Thank you!

Thank you Ellen for starting this discussion and to those concerned about mental health services in North Carolina. Clearly the problem that we are facing started with the profoundly flawed "reform" instituted by the State Legislature and their over reaction to the few bad apples who took advantage of the way community support services were mandated by the state to make a quick buck off some of the most disadvantaged members of our communities. Why should anyone be surprised that this happened in a market driven system where there is built in incentives to use paraprofessionals instead of more experienced, qualified, and expensive workers to provide services? Mental health "reform" has clearly failed, as CFN's closure demonstrates yet again.

However, there have been failures at many levels including with CFN management and with OPCMH. I do not doubt the dedication of OPCMH to their mission of attempting to ensure that mental health services are available to all those who need them in a system that is underfunded and clearly unworkable. What I want to address is how they are handling CFN's closing. Read the news articles and you find multiple quotes about a "plan" for ensuring continuity of care for their clients. Do you know what that plan is? I don't. CFN is closing it's clinics in five working days. Where are their clients going to recieve their medications, therapy, and community support in a provider system that is already stretched beyond capacity? Ask a CFN employee. Ask a CFN client who has no insurance. Call the OPC STAR referral line. I don't think that you will get a concrete answer. If you do get one please share it. Many people directly effected by CFN's closing would love to hear it.

Let me very clear, I know that OPCMH are between a rock and a hard place because of decisions made at the state and agency levels. They are dedicated professionals doing the best they can in a difficult situation. Nevertheless, they need to be held accountable to how they are addressing this crisis. This crisis has been a long time coming and there has been a terrible lack of preparation for it and there has been an unexcusable lack of communication about what to do about it now that it has happened.

I posted a long comment here last night. Where is it? There was nothing inappropriate in it except for facts that some OPCMH fans might not want to hear.
  1. When you post comments on OP anonymously, you don't have any right to have them reviewed in a timely way. In fact, you don't have a right be published anonymously at all.
  2. I am traveling and in all-day meetings every day for work, so can't tend to the site as often as I usually do. In case you don't know, I manage this entire site by myself on a volunteer basis.
  3. You can create an account here and publish your comment immediately any time you like. That hardly qualifies as "censorship." Please try to be more mindful of the situation before you toss out such strong charges.
Assuming you are the commenter above, you did make some pretty serious statements, which would have more credibility from someone putting their name behind it. But I can understand why folks who may be part of the OPC system might have something to say but don't want to do so publicly.

I'm sorry I fired off my comments about censorship.  I'm new here and did not understand how the posting worked.  I'm just angry and frustrated about how this is being handled at the street level.  And you are right about some of us with something to say wanting to be anonomous at this time.  The poster below who talks about "armchair quarterbacking" has no idea how far off the mark that comment is.

Thanks again for everyone's concern for this oft neglected issue. 

I worked at OPC's Northside Clinic for 22 years, and have been with CFN since they took over 20 months ago. The previous comments about mental health 'reform' are right on. I'd like to add one salient (and probably unpopular) point. Verla Insko, who many consider to be a great champion of mental health services, was one of the architects of the mess we are now in. She tends to blame many of the failures on DHHS (and I agree with much of her criticism) but she has a lot of responsibility for creating a plan that was fatally flawed from the beginning. Two of my colleagues met with her shortly after the bill was passed and warned her that it would be a disaster. According to what they’ve told me, she brushed off their concerns and seemed not to know everything that was in the bill. Their predictions were quite accurate and my clients are now paying the price. I was very proud to be a therapist at one of the best community mental health programs in the state. There have been so many people who came to us when they were desperate, lost, and in terrible emotional pain and found what they needed at our clinic. My colleagues and I got about 30 days notice that CFN was closing and that our employment is terminated February 29. We were also told that another agency was very interested in taking over operations so we, and our clients, held onto the hope that services would stay in place. As that hope crumbled last week, we've been hastily helping clients try to find other services as we also tried to help them process their feelings of loss and betrayal. (Not to mention helping each other do the same.) Now I'm hearing rumors of other agencies who want to provide some services to some of our clients and may even offer jobs to staff. I sure hope it’s true but I hesitate to offer this hope to the people I serve. The emotional whiplash is getting to me and I sure don't want to jerk around folks who are already emotionally fragile. It's a mess for sure. Not many people in N.C. know or care much about mental health services for low income citizens; it’s heartening that you folks do.



From the front page of today's N&O:
Rep. Verla Insko of Chapel Hill was the primary sponsor of the 2001 reforms and is co-leader of the oversight committee. "We all fell short," she said. "Nobody gets an A or a B on this." She said that the Easley administration didn't oppose reform and that the Department of Health and Human Services "didn't have the expertise it needed."
Rep. Verla C. Insko, a Democrat from Chapel Hill, was the primary sponsor of the reform law. She is not proud of the results. "I think we're worse off right now," Insko said. "What they did was bring in easy-to-serve people, maybe even people who ... didn't need the service." She said the lack of proper treatment is causing more people who are mentally ill or who have a substance-abuse problem to be taken to hospital emergency rooms -- or jail. And they're rotating in and out of the state's psychiatric hospitals. On some days, state hospitals are so full that they are refusing to accept new patients.

The previous post is mine and I wasn't thinking clearly when I posted without registering. Since I'm criticizing a public official in my post, I think it's only fair to identify myself.

Bree Kalb

Your comment means a lot more to me knowing it comes from you, Bree.
Thank you for identifying yourself. We should support anyone who has the courage to speak and ID themselves. The more of us who speak and support others that do the stronger we are. IMHO :)
any ideas ellen

I'm not familiar with all the inner workings of OPC, but based on what I do know I want to try and address Anonymous' comments about OPC's response to CFN's closing.

First of all, remember that the state initiative required OPC and other area problems to separate administration and case management from service delivery and gave them a mandate to transition its clients to private providers wherever possible.  OPC had to either lay off its service providers or many of them saw the handwriting on the wall and left OPC before they got the pink slip. 

BUT, the law required OPC to be a provider of last resort if a client needed care and a private provider couldn't be found.  

Think about the staffing nightmare this creates.     You've just gotten rid of a skilled and licensed workforce, many of whom have worked for OPC for years, and now you expect a vastly reduced workforce to absorb some large number of patients who have been summarily dropped from a private provider because the provider says it can't make enough money to cover services.    AND I believe the mandate is that OPC must FIRST exhaust private sector options--so those case managers are out there trying to find a private sector provider before OPC can even be authorized to hire people.  

I personally don't know how OPC can be expected to respond to this kind of situation at the snap of a finger.   It is complicated,  it means they may have to hire staff--and think about whether you, as a licensed professional,  would be willing to go to work for an organization that cannot assure you how long your job will last.

I work in the same building where much of OPC is housed and have come to know many of its employees very well.    They are some of the most committed people I have ever met and I personally do not know how they do the job they do in the environment the state's reorganization has  created.      It's easy to sit around and armchair quarterback this one, but after watching the real players on the field, I am convinced that their organization is generally doing the absolute best it can and then some.  

 If you are outraged about this, or worried, or whatever,  your energy is far better spent calling up those folks in Raleigh and letting them know you don't like this situation.  They are the ones with the ability to fix this mess. 


is to act yourselves if you care about this sort of thing, do something for someone whom you consider in need, rather than to whine about some agency that may not work well no matter how much money they get from the state. To care is to do, as they say, caring isn't moaning and whining.

As a working community mental health professional I resent this comment. I support volunterism but some of us are trying to surivive working full time in this usually unnoticed sector (thanks N&O and Ellen for shining some light). The problem of community mental health is a governemt responsibility that is larger than any volunteer effort can or should be called on to address. The bottom line question is whether mental health services should be funded as services for the general public good, like Public Schools, or left to the whims of the for-profit market.

Clearly, market oriented solutions have failed. You can't make money off the mentally ill but you can save money (fewer people jailed or hospitalized, fewer people not working, fewer families disrupted, etc.) if we, as a society, choose to spend our tax dollars on public mental health. That is the choice.

<> I've left out the humanitarian arguements on purpose as they don't seem to get much traction not because they aren't actually more important to me.


Discussion can provide insight and energy for people to get out there and do stuff. It may be "moaning and whining". But I still think its very valuable to talk about your problems. Isn't that what a lot of therapist do? Listen to people "moaning and whining"? What do you suggest people do about this situation we're discussing? People need a public place to let it out sometimes.


Questions and Answers – 2/27/08

1. Is CFN going out of business?

No. Caring Family Network will stop providing outpatient and community-based services in Orange, Person and Chatham counties. They will continue to provide therapeutic foster care services in those counties and will provide additional services at other CFN sites across the state.

2. Is OPC going out of business?

No. OPC is not the same as CFN. OPC is the local governmental agency with responsibility for oversight and management of publicly-funded mental health, developmental disability, and substance abuse services in Orange, Person and Chatham counties. OPC provides screening, triage and referral for individuals needing services in the area; recruits and monitors an array of community service providers; and manages the distribution of state monies for services to consumers. CFN is a private agency that provides services in the OPC catchment area.

3. Why is CFN leaving?

CFN reviewed their operations in the OPC area and determined that they were no longer able to sustain their outpatient service array in the current mental health system.

4. What programs does this affect?

Person Counseling Center in Roxboro, Family Counseling Center in Hillsborough, Chatham Counseling Center in Pittsboro and Siler City and CFN’s outpatient clinic in Chapel Hill.

5. When will CFN stop providing services?

That will vary by county. In Person County, CFN will stop operating on February 29, 2008 but will continue to provide MD services through March 10. Currently, CFN plans to be operating in Orange and Chatham Counties at least until March 14th. However, OPC is currently negotiating the end-date with CFN in those counties, so that they may continue to provide services until new providers are established in those areas.

6. What is OPC doing about this?

OPC has hired a transition project manager, Jim Martin, to organize and facilitate the transition of CFN out of the OPC area. OPC has been recruiting providers to create sufficient service options that meet the needs of the community and minimize the impact of CFN’s departure. A transition team is meeting frequently to manage the details and is in communication with potential providers and other interested stakeholders and partners.

7. Will people lose services in this transition?

CFN is currently referring existing consumers to other agencies. Consumers who have not yet been referred may choose one of the new providers who have been identified to provide the service array formerly offered by CFN. Consumers who have Medicaid, Medicare or no insurance can call OPC 919-913-4100 and will be put on a waiting list to be referred to one of the new agencies. OPC Care Coordinators are collaboratively working with CFN to identify those consumers with high needs, such as those needing medications, so that those consumers will be tracked and assisted through the transition process.

8. Who will provide services to the consumers who were seen at CFN?

Again, that will vary by county. In Person County, two providers, Freedom House and Triumph, will be providing services from the Person Counseling Center space. Freedom House began providing daytime crisis and outpatient mental health and substance abuse services on February 12, 2008 and intends to begin providing community support and psychiatric services in the near future. We are hopeful that Triumph, who will provide outpatient services as well as community support and community support team, will be working on-site by March 3, 2008.

In Chatham County, OPC is working with Freedom House and Therapeutic Alternatives on increasing capacity to provide a continuum of outpatient mental health, substance abuse, crisis and community support services. OPC is currently in negotiation with these providers, as well as additional providers, concerning issues of endorsement, site location, etc. We are hopeful that agreements will be reached quickly and that additional services will soon be available in Chatham County.

In Orange County, Freedom House and Triumph are already providing mental health, substance abuse, and community support services in Chapel Hill and Hillsborough respectively. We anticipate that both of these providers will be increasing capacity in the near future to be able to serve CFN consumers. OPC is also in negotiations with other providers who we are hopeful will be able to create increased capacity for those consumers as well.

Currently, CFN has agreed to extend services in Chatham and Orange Counties until March 14th. Should the transition to the new providers in Chatham and Orange Counties take longer than anticipated, OPC and CFN have discussed an extension of the end date so that they can continue to provide basic coverage for consumers and allow an opportunity for existing staff to participate in a job fair with new providers.

OPC will also continue to work with our existing provider community to determine how they can assist in this process.

9. How did OPC pick these providers?

OPC had a meeting with area providers to determine their interest and ability to expand their service capacity. In addition, OPC directly contacted agencies who are currently providing services in counties adjacent to ours to inquire about the possibility of expanding into our area. OPC reviewed capacity surveys that providers completed and began negotiations with several providers who demonstrated the capacity and infrastructure to quickly expand their services to meet this pressing need.

10. Where can I find out more about these providers?

Freedom House –

Triumph –

Therapeutic Alternatives –

11. What will happen to CFN staff?

It depends on the individual staff member. Some staff members will take the same (or similar) jobs with the new providers, while other staff members may choose to leave.

12. What will happen to the psychiatrists who worked at CFN?

Three of the psychiatrists who worked at CFN (Drs. Fullwood, Jimenez and Jackson) are actually OPC employees who worked via a contract with CFN. OPC will continue to employ these individuals and is working to establish similar contracts with the new providers so that consumers may be able to maintain their relationships with those psychiatrists. Other psychiatrists were employed directly by CFN and will be making choices about where they will go (see previous question). We also anticipate that the new providers may have additional capacity for psychiatry in the OPC area if needed.

13. What about consumer choice?

Consumers absolutely have the right to choose their provider. If a consumer does not want to be served by one of the new providers who have been asked to expand as a result of CFN’s departure, they can choose another provider in the area. Consumers with Medicaid, Medicare or private insurance can choose a provider who accepts those types of insurance. Consumers whose services are paid for by state funds (IPRS) can choose from providers with whom OPC contracts. If a consumer wants to follow his/her current therapist/doctor to another agency, he/she can certainly do so, provided that the therapist/doctor is able to accept the consumer’s insurance or IPRS funding. It is important to remember, however, that a consumer is not required to follow their therapist/doctor if they leave their current agency.

14. Will the location of the clinics change?

It will vary by county. In Person County, services will continue to be provided from Person Counseling Center. Services will also continue to be provided in Hillsborough at the Family Counseling Center and in Siler City at the Chatham Counseling Center site. We are still working with providers to determine the locations of clinics in Chapel Hill and Pittsboro.

15. What will happen to the Community Resource Court?

In order to minimize the impact on the court system and the individuals involved in the Community Resource Court, OPC will temporarily operate that program and will hire the existing CRC staff. OPC plans to issue an RFP and hopes to award the program to an independent provider by July 1, 2008.

16. Will there be changes in the way people access services?

No. People should call the OPC STAR line at 919-913-4100 or 800-233-6834 for referrals. The STAR line can also be accessed by TDD at 866-598-6459 or you can call NC Relay at 711 and instruct the Relay Operator to dial 800-233-6834.

17. Will consumers have to do anything to make sure their treatment will continue?

Consumers will be asked to sign consents to have their records transferred to a new provider.

18. Will there be any more information sent to consumers?

OPC plans to hold meetings with consumers in all three counties, the first of which was held in Person County on February 25th. We also plan to continue to update information on the OPC website at

19. Where do I go if I have a crisis?

In Person County, Freedom House is providing day-time crisis services at Person Counseling Center site. CFN will continue to provide day-time crisis services in Orange and Chatham counties at least until March 14th. After hours crisis services have not changed. Freedom House still provides Facility Based Crisis and Mobile Crisis Services, both of which can be accessed by calling 919-967-8844. Individuals in crisis can also call 911 or go to their local hospital.

20. Who can I call if I have questions?

You can call OPC’s Customer Service Line at 919-913-4120.

Gov. Mike Easley today vowed to seek changes in the state's mental health system while placing blame on legislators and local management agencies for the failures of a 2001 reform effort.

In a news conference, the governor said he would urge legislators to transfer direct supervision back to the state Department of Health and Human Services.

He also called for a streamlined process to cut off private companies that have been charging exorbitant fees for providing support services to the mentally ill.

And he said he would propose a $40 million initiative to provide more beds in local psychiatric facilities and set up mobile crisis teams to travel the state. The idea would be to control admissions to the state's psychiatric hospitals.

Easley said he would submit the recommendations to legislators for action during the upcoming short session of the General Assembly.

The 2001 reform enacted by legislators "went too far too quickly," Easley said. He was particularly critical of measures he claimed eroded the power of the secretary of health and human services over the mental health system.

"Now Secretary [Dempsey] Benton has to go through an incredibly impossible, untenably complicated and time-consuming process" to rein in abusive providers of what is known as community support, Easley said.

"It is not workable. It is not something any manager can use... In short, we need to give the secretary of health and human services ... control over the mental health services process."

A recent series of reports by The News & Observer described hundreds of millions in wasted tax dollars, misdirected use of resources and sometimes fatal effects on dozen of patients.

For weeks, Easley has spurned requests from The N&O to interview him about problems with his administration's oversight of mental health reform.

At today's news conference Easley took one question each from three N&O reporters and chided them for attempting to ask more. The news conference lasted less than 39 minutes.

Easley said his administration vigorously opposed the 2001 plan, which privatized services and handed oversight to local boards. He said that lawmakers who claim that the Easley administration did not object to the reform have faulty memories.

When legislators were enacting reform, the DHHS secretary at the time, Carmen Hooker Odom, described the changes as a result of a collaboration between her and legislators.

Today, Easley said the department could have done a better job once the changes were under way by giving the local mental health offices more direction.

His proposals for improving the system centered on three areas:

- Giving the secretary of health and human services clear authority and the ability to act quickly to manage the mental health system. The 2001 legislation, he said, handed too much control to 25 county and regional mental health offices run by local boards. Easley maintained that there are too many local offices and that consolidation would save money.

- Improving standards for private companies that provide community support services to the mentally ill. He called for differential pay to the providers, depending on the level of services they provide. Some companies have charged the state's standard rate of $61 per hour for taking patients to the movies or watching them in school.

- Cutting unnecessary stays in psychiatric hospitals. The 2001 reform was meant to reduce hospitalizations, but instead the number of patients admitted has gone up, Easley said. More beds in local facilities and mobile teams of crisis workers to provide services locally will help reduce the number of people placed in the state's hospitals, he said.




Thanks, Ellen for submitting this! Mental Health is an issue close to my heart!


“Until the great mass of the people shall be filled with the sense of responsibility for each other's welfare, social justice can never be attained.” Helen Keller


i care about what happens to the mental health programs because im involved with cap[ community alterative program ]. thedivision of mental health subtance abuse and dd are all hooked together

see i have had cerebral palsy since i was a baby .




hi ,i care about what happens to the mental health programs because i'm involved with cap the division of mental health substance abuse and are all hooked together.


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