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Features Health & Wellness Mental health services costly in Macon County

Local government leaders across Western North Carolina are joining together in hopes of having more control over funding allocations to Smoky Mountain Center, the region's agency in charge of managing mental health services for the area.

Macon County joined other local counties such as Jackson and Clay in passing a resolution urging the state Department of Health and Human Services, the General Assembly and the governor to delay, revisit, and revise the requirements concerning the governance and appointment of elected county officials as board members to the Smoky Mountain LME/MCO Board of Directors.

Smoky Mountain Center is a privately run agency, but has state authority in 23 WNC counties to operate using Medicaid and state funding for mental health, substance abuse and developmental disability services. Commissioner Ronnie Beale, an advocate for mental health reform for the entire state, asked his fellow commissioners to join him in passing a resolution that would hopefully result in county officials being able to have some control or authority over local taxpayer funds being used within Smoky Mountain Center.

Smoky Mountain Center recently expanded in the region and is now serving 23 counties including Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Watauga, Wilkes and Yancey, which jointly provide more than $2 million annually to the agency.

The resolution states that counties are not provided with the flexibility and oversight for fiscal control of the regional LME/MCO despite the fact that counties are required to provide funding for a major portion of the costs of the system, which further hinders counties from providing needed communication and oversight in terms of services and special needs in the counties' respective jurisdictions.

The resolution requests that the rules of Smoky Mountain Center's Board of Directors be altered so that every county in its regional coverage area be allowed to have at least one elected commissioner serving as a voting member of the board of directors.

Beale explained that he believes counties should have more control of the funding because when situations arise, state and federal mandates end up being turned back to the county and programs become the responsibility of counties, and he believes that this could become another example of that.

“You're going to be asked to vote on a 21-member board that really knows very little about the mental health problems in our county or in really any county,” said Beale said of the importance of commissioners being on the board of directors.

Mental health crisis in Macon County

In addition to providing Smoky Mountain Center with operational funds, Macon County spends tax dollars within the county dealing with the issue of mental illness.

An unpredictable portion of the Macon County Sheriff's Office (MCSO) overall budget each year is dedicated to handling mental health commitments. The responsibility of managing individuals with mental disorders has shifted from the state to the counties in past years and has become an unmanageable burden on the county level.

Macon County Sheriff's Department Major Andy Shields believes the county's mental health issue is a problem that deserves more attention. “People with mental illness in this state cry out for help and get none, it is sad,” Shields said.

The MCSO is responsible for the transportation and supervision of every mental illness case in the county. Deputies spend hours transporting individuals to available facilities throughout the state, some of which are as far away as the coast of North Carolina. By law, deputies have to sit with each individual involved in a mental illness case through doctor evaluations in the hospital and two officers are required to transport individuals to facilities across the state, many of which develop into overnight trips that result in the county having to pay for lodging and overtime for the officers.

The lack of state facilities and available beds in appropriate treatment facilities have resulted in three and four officers having to leave patrolling duties to sit with patients at Angel Medical Center while they await transportation to a facility. On many occasions, these patients have accounted for every available bed in Angel Medical Center's emergency room.

Children facing mental health issues are the most difficult cases as there are only five beds in the entire state for children needing treatment for mental illnesses.

Dorothea Dix, the largest state hospital which began operations in 1856, closed its doors in 2010, creating a dearth in mental health services. When that state-run hospital that once served thousands of patients with more than 100 buildings ceased to exist, local governments were compelled to take on the roles of mental health professionals.

Broughton Hospital located in Morganton opened in 1893 and went from being able to serve 3,500 patients in the 1940s and 50s to only having 278 available beds today.

Involuntary commitments make up the bulk of Macon County's financial troubles with mental health related cases. In the last seven years, Macon County has averaged 138 involuntary commitments each year, with 2012 being the highest year, reporting 197 cases.

The taxpayers dollars spent for involuntary commitments can be found in the number of hours officers spend handling these type of cases. In the last seven year, with an average of 138 cases a year, Macon County Sheriff's Office deputies have spent an average of 503 hours handling involuntary commitment cases, which is typically considered extra or overtime work separate from the day-today responsibilities of the officers.

If hourly wages and benefits and transportation costs were the same today as they were in 2006, Macon County would have seen a 375 percent increase in the costs of mental health commitments.

The Macon County Board of Commissioners unanimously voted to pass the resolution urging that local government have a seat at the table when it comes to the region's mental health agency.


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