Smoky makes it easy to keep up with what's going on with services for mental health, substance use or intellectual or developmental disability in western North Carolina. Whether you're an individual receiving services, a family member, a provider or a community partner, we're honored to share with you how we're striving to meet local needs in a way that only a public managed care company can. It is our pleasure to share with you information about Smoky news and events.

  

With reports of violence by people with mental illness dominating news headlines, it's all too easy to write off individuals with a mental health diagnosis as "lost causes." However, we know that most of the one in five Americans with a mental illness live healthy, productive lives in our local communities. Support from friends, family and neighbors can make all the difference - and you can help.

As we recognize Mental Illness Awareness Week from October 5 to 9, know that mental health conditions like depression, anxiety and schizophrenia are highly treatable. You likely have a friend, family member or co-worker with a mental illness, although you may not know it. Medication, counseling and services such as supported employment, housing assistance and peer support help people manage their symptoms and pursue a meaningful life. Treatment options are increasing throughout western North Carolina and may include same-day appointments, 24-hour crisis facilities and mobile crisis teams that travel to a person's location to provide care.

You may think, "I'm not a mental health professional. How could I possibly help?" In truth, everyone can play a role in creating healthier communities. If you're an employer, you can introduce or expand employee mental health assistance programs. If you're a medical professional, you can regularly screen patients for mental health conditions. If you're a school administrator, you can invite mental health advocates to speak to students about illnesses that commonly affect young people.

One important thing we can all do is offer support and empathy to people who are struggling. An excellent, free training called Mental Health First Aid is offered regularly throughout western North Carolina and teaches everyday people how to help someone who is developing a mental health problem or in crisis. Mental Health First Aid teaches a five-step action plan that anyone can follow (see box to the right).

Some people may hesitate to lend an ear because they want to "avoid drama" or have been taken advantage of in the past. This is understandable. But being a supportive listener doesn't mean you have to abandon your personal boundaries. Do what you can, when you can, and remember that taking care of yourself comes first.

We know today that social support plays an essential role in helping people cope with stress and difficulties in life. Many people are afraid to seek help because they are afraid of what others may think. As a friend, family member or other trusted individual, you can help prevent a person's mental health problems from becoming worse and can give understanding and support to someone in crisis. In fact, you can change someone's journey in life by being a caring individual at the right time.

The Inaugural Western Regional Recovery Rally included a walk around Lake Junaluska, guest speakers and Recovery Champion awards, all designed to show friends, neighbors and policymakers that people can achieve sustained recovery and live a healthy life. Part of National Recovery Month, the rally was organized by a broad community coalition that included Smoky, local law enforcement, healthcare providers, recovery-focused organizations and local government health agencies.

Speakers included Courtney Cantrell, director of the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services. Three individuals in long-term recovery and three recovery allies were honored for their work to promote the wellbeing of people in recovery and reduce stigma. Individuals in recovery recognized as Recovery Champions were Tracy Effler, a Smoky Peer Support Specialist in Lenoir, and Chris Morrill and Troy Daniel Reece, both of Waynesville. Recognized as allies were Genny Pugh, Smoky's Senior Director of Community Collaboration; the Appalachian South chapter of the National Alliance on Mental Illness (NAMI); and Waynesville Police Chief Bill Hollingsed. 

The rally was featured on ABC News 13, in the Citizen-Times, on NC Health News and in the Mountaineer on September 20, September 24 and September 25. 

A team of three Smoky community specialists will learn new, innovative ways to prevent suicide in local communities as participants in this year's statewide Injury-Free NC Academy.

Specialists Kate Glance, Melissa Ledbetter and Robin Winkler - working together under the team name "the Smoky Mountain Movers," were one of 10 teams selected from a statewide pool of applicants. The free academy, sponsored by the University of North Carolina Injury Prevention Research Center, the N.C. Injury & Violence Prevention Branch and the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services, aims to strengthen and expand the state's public health capacity for suicide prevention.

Teams complete a six-month program that includes two in-person sessions in Chapel Hill. Key learning areas include finding and using state and local data on suicide, learning evidence-based and promising approaches to suicide prevention, developing effective programs, measuring success with program evaluation, mobilizing a community coalition, successful grant writing and developing effective messaging.

"While the specific needs in each of the 23 counties that we serve may vary, preventing suicide is an important topic in all of them," Glance said. "By taking part in this academy, we hope not only to continue the discussion about suicide in our region, but also to learn what's working in other states, how to teach health professionals how to seek health for themselves and how to share stories of hope, resilience and recovery."

More than 100 residents participated in Broughton Hospital's second annual Recovery Event on September 25 on the hospital campus in Morganton.

Smoky Peer and Family Support Specialists Sam Sutker and Tracy Effler, along with Smoky Community Outreach Specialist Melissa
Ledbetter, shared information with residents on accessing care through Smoky, peer and family support, Wellness Recovery Action Plan training and getting help in a behavioral health crisis. Residents participated in a "recovery wheel" activity - spinning wheels featuring words like "support, hope, education, trust and self-advocacy" - and described what the "recovery word" meant to them.

Also, on September 19, Smoky participated in the 2015 Asheville Walk to End Alzheimer's. Ruth Jordan, Director of Smoky's Geriatric Mental Health and Adult Specialty Team, shared information on Smoky programs, dementia and upcoming trainings.

Governor Pat McCrory has appointed Smoky CEO Brian Ingraham to a new state task force charged with making recommendations to improve the lives of N.C. residents with mental illness and substance use disorders.

The 24-member N.C. Mental Health and Substance Use Task Force will seek to reduce stigma and encourage people to seek help before their situation becomes a crisis. This special panel consists of experts from the justice system, private sector professionals, healthcare providers, county leaders and non-governmental organization entities to tackle mental health and substance use issues statewide. In the six years Ingraham has served as Smoky's CEO, the organization has grown from its roots as an area program to a public managed care organization and expanded nearly eightfold.

"Serving on this task force is not only an honor for me - it's also a golden opportunity to effect real change and improve a public service delivery system that facilitates care for hundreds of thousands of North Carolinians," Ingraham said. "This panel's interdisciplinary nature will prove to be a tremendous advantage. Going forward, we need all hands on deck, working together, to use existing resources to achieve real results." 

The prevalence of some forms of substance use is declining among U.S. adolescents, according to a recent survey by the Substance Abuse and Mental Health Services Administration (SAMHSA).

The latest National Survey on Drug Use and Health report found that current tobacco use among adolescents aged 12 through 17 fell by roughly half from 2002 to 2014. Illegal alcohol use and nonmedical users of prescription painkillers also decreased in this group during the same time.

Meanwhile, use of marijuana - the most common illicit drug - is growing among people aged 26 or older. The percentage of people aged 12 and older using non-medical painkillers was similar to the year before, although current heroin use in the group doubled during the same time. The survey found an increase in the percentage of people 12 and older using any illicit drug, to more than 10 percent of the population. The report also found that major depressive episodes increased among adolescents and that young people who experienced depressive episodes were more likely to have used illicit drugs in the past year.

Smoky has received full reaccreditation in three areas of healthcare operations following a three-day, onsite review in July by URAC, the independent leader in promoting healthcare quality through accreditation, education and measurement.

URAC accreditation is nationally recognized by state and federal regulators to ensure the highest level of quality is delivered to consumers. Accreditation requires applicants to submit policies, procedures and other organizational information that is followed by a review. URAC's Accreditation Committee reviewed Smoky's application and granted full reaccreditation as a Health Call Center until September 2018, as a Health Network until November 2018 and in Health Utilization Management until September 2018.

Additionally, Smoky scored 100 percent in all three modules. "Smoky staff have worked long hours not only preparing for reaccreditation, but also working every day to ensure we are committed to quality healthcare management and strict quality standards," said Smoky Chief Operating Officer Christina Carter. "Ultimately, this benefits all of the people we serve."  

Beginning October 1, healthcare providers across the United States will shift from using the ICD-9 billing code system to ICD-10. This change, mandated by the federal government, will bring much greater detail to a consumer's medical record and documentation of all of the services and procedures they receive, helping enhance quality of care. ICD-10 will help providers treat complex medical conditions, coordinate care among providers and support new payment methods that drive quality of care.

Not only will ICD-10 expand a large number of behavioral health and intellectual/developmental disability billing codes, it will also bring sweeping changes to coding and compliance processes and IT solutions used by many providers. Smoky has worked proactively to update network providers about the new code sets, required documentation, technology and available training and support. These efforts included regular communications and checklists on ICD-10 readiness and compliance assistance, trainings involving ICD-10 coding specialists, a dedicated Smoky ICD-10 email address and an ICD-10 webpage to streamline large amounts of information to meet our providers' specific needs.

Smoky also worked with an ICD-10 consultant and within our IT system to successfully test whether our systems are ready to handle the change. Additionally, we invited providers to email us format testing files to ensure their systems are compatible with ours, as well as sending test files to NCTracks to ensure compatibility within that system. Smoky is confident that this strong transition plan will ensure our network is ready for the changes to come.

The reform passed by the General Assembly will privatize the state's Medicaid program, which provides care for 1.8 million people, and will come into effect in phases over eight years. The legislation allows for three statewide capitated contracts for Medicaid physical health management and up to 10 capitated contracts for provider-led entities (PLEs) to cover six regions created by the state. Key milestones include:

Other key provisions include:

North Carolina legislators finally signed off on the state's months-overdue budget for the coming fiscal year in October. The spending plan continues and even expands some initiatives significant to behavioral health and intellectual/developmental disability (I/DD) advocates. These include the expansion of three-way hospital beds and funding for both the N.C. Child Treatment Program and traumatic brain injury services.

The budget also dedicates funding from the sale of the Dorothea Dix Hospital property to create 150 new community hospital inpatient beds and expands START teams to include respite and services to children and adolescents with an I/DD.

Other budget items may mean significant changes to LME/MCO operations statewide. These include a reduction in single-stream funding of $110 million in the 2015-16 fiscal year and of $152 million the following fiscal year, with a potential $30 million offset to these reductions. Based on initial calculations, Smoky's share may amount to up to $14.9 million in the first year. The budget also calls for LME/MCOs to transfer more than $17 million cash on hand each year for the next two years to the N.C. Division of Medical Assistance, with Smoky's share being up to an estimated $2.3 million in the first year.