The road to reform

The recent launch of a new public mental-health board marked yet another step toward dismantling the region’s existing public mental-health system.

Board members of the new Western Highlands Area Authority were sworn in on Oct. 30 in Asheville. The 16-member board includes two representatives from each of the eight mountain counties — including Buncombe — that are combining and revamping their mental-health programs.

Under the state-mandated reform, services will be managed by the public sector but delivered largely by the private sector. The change has been billed as providing more choice for clients.

As of Jan. 1, 2004, Western Highlands will serve as a “local management entity” (LME), taking over the administrative functions of the Blue Ridge Center and two other regional mental-health programs.

The Blue Ridge Center — which now provides public mental-health services in a four-county area — will begin reducing its services over the next few months and is expected to be totally phased out as of July 1, 2004. The Rutherford-Polk Area Program and the Trend Area MH/DD/SA Area Authority both are scheduled to shut down as of the same date.

The importance of Western Highlands’ work — and the uncertainties about how reform will actually play out — aren’t lost on Community Planner Sandy Padgett of the Rutherford-Polk Area Program, who attended the meeting with a fellow staffer. If needed services aren’t available under the new system, Padgett fears that local emergency rooms, jails, schools, health departments and the community at large will be overwhelmed.

“My concern: If this doesn’t go well, it’s going to impact our communities,” Padgett told Xpress. “I’m just real concerned that services … that are needed [will be there] and consumers can access them.”

A rocky start

Already, the reform process has had its share of controversy: The first meeting of Western Highlands’ governing board followed months of wrangling over its makeup.

Back in March, mental-health advocates turned out in force at a Buncombe County Board of Commissioners meeting to insist that the commissioners obey the state requirement that the new board include as many care recipients, caregivers and family members as county officials.

County staffers, however, had argued that the state statute allowed them to appoint a majority of county-government representatives if they so chose.

Finally, in September, the Buncombe County commissioners learned that the state attorney general’s office had ruled — back in February — that mental-health advocates were indeed entitled to an equal number of seats on the new board.

Once the governance issue was settled, officials in the eight-county region moved relatively swiftly to assemble the board. County managers and a county commissioner claimed half the seats. On Oct. 28, those appointees then voted to approve the remaining members, who were nominated by the respective boards of commissioners.

Thompson wins interim post

No sooner were the Western Highlands board members sworn in than they went into a two-hour closed-door session in a meeting room at the Blue Ridge Center in Asheville to discuss appointing an interim director for the new agency.

Back in September, Blue Ridge Center Area Director Larry Thompson had informally gotten the nod for the job from the group of seven county managers (and one assistant) that has been planning reform for this region for nearly two years. Thompson has garnered praise from folks including Buncombe County Commissioners Chairman Nathan Ramsey — as well as persistent criticism from some advocates — for how he’s handled his nearly 29-year tenure with the public agency.

Near the end of the lengthy session, attorney Curtis Venable (who’s been assisting the Buncombe County reps) walked into the lobby and asked Thompson to come into the room to answer questions. Seven minutes later, the meeting-room door was flung open to allow members of the public back inside.

Venable then read Buncombe County Manager Wanda Greene‘s motion that Thompson be offered a one-year contract as interim director of Western Highlands (beginning Nov. 1), with quarterly reviews. With no discussion, the group voted unanimously to appoint Thompson to the post. (Board members Nancy Carey and Robert Ratcliffe were absent.)

Challenges ahead

After the meeting, Thompson told Xpress: “I think the LME’s got a big challenge, and I was pleased with the amount of support for addressing the challenge by the board members here.”

“My intent is to be very open and responsive to community concerns,” continued Thompson. “I told this group that I would focus a lot of my effort on building bridges in the community in all eight counties, with both consumers [and] families as well as providers.”

Thompson’s stated intentions jibe with the requirements handed down from Raleigh that care recipients and family members be given more input in local reform plans.

In a Sept. 25 letter, Richard Visingardi, the director of the state’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services, notified Thompson that the state has conditionally approved Western Highlands’ “local business plan.” To obtain full certification, however, Western Highlands must develop ways to ensure the “meaningful involvement” of local care recipients and family members, the letter states.

Faced with a substantial workload, Western Highlands board members plan to meet at 9 a.m. every Friday (except for the Fridays closest to Thanksgiving and Christmas) in the ground-floor conference room of the Blue Ridge Center, 356 Biltmore Ave. in Asheville. Meetings are open to the public.

At the helm

Sixteen people have been appointed to the governing board for the new Western Highlands Area Authority, which will be responsible for managing services in an eight-county area as of Jan. 1.

County officials — including the managers of Buncombe, Henderson, Mitchell, Polk, Rutherford, Transylvania and Yancey counties — account for half the board members. Madison County’s government rep is County Commissioner Hall Moore.

The remaining board members represent care recipients, family members and caregivers in the eight-county area: Nancy Carey, Micaville; Bill Cook, Bakersville; Nancy Hazzard Crozier, Hendersonville; Susan Hendrick, Rutherfordton; Patricia Franklin, Marshall; Dr. Robert Ratcliffe, Tryon; Keith Parker, Brevard; and Dan Zorn, Asheville.