North Carolina falls behind in mental health funding

 Momentum for reform of the nation’s mental health care system slowed in 2014 as a result of failure by Congress to enact comprehensive mental health care legislation and a decrease in the number of states strengthening investment in mental health services, including North Carolina, according to a report released by the National Alliance on Mental Illness (NAMI).

The report, State Mental Health Legislation 2014 stands in contrast to one issued in 2013 which described a dramatic response by many states following the tragedy at Sandy Hook Elementary School in Newtown, Conn. on Dec. 14, 2012.

From 2009 to 2012, states cut mental health budgets by $4.35 billion. Thirty-six states and the District of Columbia began to restore funding in 2013 in the wake of heightened public awareness of mental health needs.

North Carolina is listed as one of the six states that decreased mental health spending in 2013 and 2014. According to the report, “In recent years some states―in a shortsighted attempt at achieving short-term cost savings―have imposed sharp restrictions on access to psychiatric medications in their Medicaid programs…North Carolina imposed a restrictive preferred drug list and prior authorization protocol for mental health drugs as part of an effort to save Medicaid costs.”

The General Assembly wrote into the budget that the Division of Health and Human Services was responsible for $12 million annualized in cuts to mental health medications but specified it might come from rebates In order to achieve these savings, DHHS is making changes to their preferred drug list (PDL) for Medicaid and Healthchoice. NAMI NC believes this to be short sighted and will result in fact in increased costs.

The Division of Medical Assistance (DMA) released the revised PDL for public comment mid-September, and many NAMI NC members and affiliates submitted comments about their concerns. NAMI NC’s position has always been to keep access open to medications, one of the few tools people have for recovery.  NAMI North Carolina was at the public meeting along with family members, individuals with mental illness, and advocates to fight to keep access open, with l7 speakers addressing the general issue of open access and the antipsychotic drug listing. The PDL panel held a public meeting on November 4, 2015.  One change was made:  instead of two “fail first” provisions before the individual can get the drug of their choice, there is one fail first for a particular long acting antipsychotic medication, as well as movement of this one drug back to the preferred list.

DHHS will post the finalized PDL to go into effect on January 2, 2015. At this time, the final PDL has not been posted.

NAMI NC supports exempting doctors in the LME-MCO system from these requirements,  an idea which came up at the hearing, which will also maintain open access for all of the patients they serve in the public system.  According to Executive Director Deby Dihoff:  “We remain hopeful after conversations with the Deputy Secretary just this week that we can revisit this issue and find other ways for the Department to realize their savings while letting people stay on medications that have worked for them. It just makes no sense to have people go through this change after what is often ten years of trial and error to find the right medication.”  NAMI NC will continue to advocate for keeping medications available to those with severe mental illnesses.  We also don’t need for doctors to have extra paperwork requirements just to get their patients on the medications that work for them.

For 30 years, NAMI North Carolina has provided free support groups, education programs, and advocacy efforts throughout North Carolina. NAMI NC is the state’s largest grassroots mental health organization dedicated to promoting recovery and optimizing the quality of life for those living with mental illness. Founded in 1984, NAMI NC has become North Carolina’s voice on mental illness, serving 34 local affiliates across North Carolina, who join together to meet the NAMI mission. For more information on programs, our advocacy efforts and the 34 affiliate organizations in North Carolina, visit our website at www.naminc.org