Officials in Guilford County are fed up with the current state of mental health services and aren’t going to take it anymore.
The county is now exploring all legal options for a potential pullout from its state mandated participation in Sandhills Center Inc. – a nine-county mental health administrative entity. County leaders want to bring control of mental health services back to Guilford County, where it was before Jan. 1, 2013.
Chairman of the Guilford County Board of Commissioners Jeff Phillips said this week that, if getting out of the current situation requires a change in state law, then so be it. He said, however, that a change in current law may not be needed, that the county has options for taking more control even under the current Sandhills-run structure and that current conditions warrant the county’s strong consideration of any and all options for regaining its control of mental health services.
Every major service that Guilford County currently provides citizens is based in Guilford County except one – mental health. Somewhat unbelievably, that critical function is run out of West End, North Carolina – a small unincorporated community in Moore County that’s over an hour’s drive due south.
County officials have never before even hinted publicly at an attempted escape from the state mandated system that put Guilford County’s services under Sandhills years ago, but at a special, Wednesday, May 31 committee meeting of Guilford County commissioners, representatives of affected departments and other county staff discussed ways that Guilford County might get out of the current arrangement or work around it. The conversation at the meeting made it crystal clear that, behind the scenes, those talks had been moving along briskly in this direction.
“We have discussed, at length, the notion – I think without a lot of metrics thus far,” Phillips said of breaking away from Sandhills. “Though I think we’re starting to make some headway in taking mental health services and behavioral health services back as a county, versus what we have today.”
Phillips, who’s been a volunteer in programs that address homelessness and mental health issues, added, “We’ve got to be more proactive and their needs to be more accountability. It worked better before. We don’t have a choice; we must move in some manner – I think in a different and hopefully better direction.”
Like many at the meeting who advocated pulling out of Sandhills or making other moves to gain more local control, Phillips stated that this was in no way an indictment of Sandhills. He said it was instead a result of the systematic forced removal of local control of mental health services from a large county and a transfer of that power to a nine-county collective where Guilford County had very limited say. The county is funding its mental health services to the tune of about $10 million every year, but due to the current management structure the county has limited power over how that money is used.
Phillips said there were a lot of people doing great work, including those at Sandhills, but he added, “To say the system is broken is an understatement.”
He said the process would be complex and the first step was for Guilford County to understand its alternatives.
“I know it’s premature to suggest emphatically that that’s what we’re going to do,” Phillips said of pulling out of Sandhills.
Commissioner Alan Perdue, who served as director of Guilford County Emergency Services for decades before retiring from that job and becoming a commissioner in 2014, said such an important move would take a lot of work.
Perdue said the next step is for Guilford County Manager Marty Lawing and his staff to determine the county’s options. Perdue cited several different ways in which being part of the Sandhills system was problematic. For instance, he said, transporting addicts to a Sandhills clinic in Asheboro rather than in Guilford County was a burden on county staff and others.
“Asheboro doesn’t sound like it’s that far away, but when you’re sending ambulances and GPD [Greensboro Police Department] and High Point PD and Guilford County sheriff’s officers, who are already short staffed, to Asheboro, that impacts operational efficiency and increases our budget. That ‘one size fits all’ mentality that often gets shoved down our throat doesn’t work.”
Like others in the room, Perdue said he meant “no disrespect to Sandhills.”
Guilford County Emergency Services Director Jim Albright also said the current situation was unacceptable and said that something needs to be done.
“If you go around the room, are we happy where it is today? No,” he said. “The ‘how do we get there’ is the super complex part. Can we? What are the options that Raleigh allows for us, and then what do we do if they don’t allow divestiture. Where do we go from there and how do we make it more effective?”
Like Perdue, Albright cited many shortfalls in the county’s current arrangements when it comes to dealing with mental health patients. He said many people get out of the jail system only to end up right back on the county’s hands.
Albright said the patient may get therapy and medication but, then, once released from that initial treatment service, he or she may not know where to go. That transition period is the downfall, Albright said.
“So when they don’t know where to go,” he said, “particularly when it’s cold and wet, etc., they end up calling 911, we pick them up and they end up at Wesley Long [Hospital].”
Until 2013, Guilford County had a county-run mental health department called the Guilford Center that oversaw mental health, behavioral health and substance abuse services for county residents. A change in state law forced Guilford County – and other counties across the state – to merge those services in order to create efficiencies through economies of scale. By law, all counties except the two largest – Mecklenburg and Wake counties – had to join mental health collectives, and Guilford County, after more than a year of negotiations, finally chose Sandhills to be its shotgun wedding partner.
One very interesting aspect of the current situation is that, before the initial legislation requiring consolidations passed years ago, a simple phone call from county officials to state legislators would have saved Guilford County from the forced merger. If the county had just asked, state legislators certainly would have allowed Guilford County an exemption. At the time, it apparently never occurred to anyone in Guilford County government – including the commissioners – that the state would be willing to make a minor adjustment in the legislation. The state allowed an exemption for the two largest counties and all it would have taken to exempt Guilford County is slightly lowering the population exemption requirement to allow self-determination for the three largest counties rather than the two largest. Several state legislators said, after the law was in place, that if Guilford County had made that request, they would have been fine with it. Current county leaders are now trying to pick up the ball that was dropped by the county years ago.
The May 31 committee meeting had a surprising guest that further illustrated the seriousness of Guilford County’s effort to set mental health services free. The committee brought in longtime former Guilford Center Director Billie Martin Pierce to get her advice on the way things were and the way to get back there. Pierce retired from the director’s job six years ago citing the massive consolidation and its harm to the mental health system as the main reason for her departure. Pierce said this week that, though she’d never met Lawing, she got a call recently from the county manager asking if she would meet with the committee.
Since the state’s forced consolidation, Guilford County – and many other counties across the state – have, just as Pierce predicted, seen an increase in mental health problems and had more mental patients ending up in the jails. There’s also been an increase in complaints from local mental health care providers about the way services are administered and the obvious deterioration in those services, which seems to be the key reason Guilford County is now ready to revolt against the status quo.
Guilford County officials didn’t like the merger idea when it began about a decade ago, but, though the initial legislation carved out an exception for the state’s two most populous counties, it didn’t extend that choice to Guilford County, the third largest county in the state. (Both Mecklenburg County and Wake County eventually entered into mental health collectives, making the state’s counties 100 for 100 in that regard.)
At the meeting, Phillips pointed out that, now, unlike five years ago, Guilford County has in excess of a half million residents – which was the cutoff point for allowing exemptions. He said Guilford County may have more latitude now that it is over that population threshold.
Guilford County Attorney Mark Payne said this week that he was in the early stages of researching the legal possibilities for the county regarding these discussions.
Commissioner Kay Cashion, who serves as the county’s liaison to Sandhills, and who sits on that board, said at the committee meeting, “I would love for us to have a building that says ‘Guilford County Mental Health/ Behavioral Health Substance Abuse Services,’ where you would know where to go. You take them in that door and they get whatever they get there. I don’t know if we can do it again. I don’t know if we can unwrap this or not.”
Phillips said a county the size and scope of Guilford County ought to have a significant influence on state legislators.
Albright said, “You know, it was complicated back in the day; I’m not going to say it was easy and it worked perfectly every time – but there was accountability.”
He said that accountability was there because Pierce reported to a local board.
Pierce seemed invigorated by the hope that Guilford County could get back some of the control it has lost.
“Take it back, take it back,” she advised. “Don’t we know legislators in Raleigh to put the heat on?”
Phillips said, “Of course we do.”
“Well, then you need to put the heat on,” Pierce responded. “If you can be it, you need to be it. You need to be the whole kit and caboodle.”
At the meeting, Albright also spoke of the alarming rate of heroin use and said that is putting more and more pressure on the system.
He said Sandhills does have a very good web page and online assessment test and tools.
“I took it last night and pretended like I was using heroin,” Albright said. “So if you get any reports, I swear I will drug test today.”
Perdue replied that the mental health treatment system is so complicated and convoluted in the county today that, “If you weren’t on drugs before, after you try to go through the process you will be.”
Pierce said that, even though she retired over six years ago, she still gets calls from people asking for help.
“I’m on the phone trying to call people and help, but my connections are all gone now,” she said.
Pierce said there were some major issues in other collectives across the state and in some cases actions seemed “criminal.” State legislators were very upset to discover that the CEO of the taxpayer-funded management entity that oversees Mecklenburg County and other counties received nearly $1 million in compensation last year.
Former Commissioner Ray Trapp stepped down in early April to take a job with NC A&T State University, but he would be a big fan of Guilford County pulling out of Sandhills. He was the board’s most outspoken critic of the current mental health system and, every chance he got, he spoke abut how inadequate the county’s mental health services had become and how absurd it was that the headquarters for Guilford County mental health was practically in South Carolina.
