At any point in time, 25 to 37 percent, or more than one in four people in the United States are dealing with mental illness, according to the federal Substance Abuse and Mental Health Services Administration.
“It can—and likely will—happen to anyone during the course of their life,” says Peggy Terhune, Ph.D., CEO of Albemarle-based Monarch, which offers behavioral health services.
This statistic totally disrespects any category of wealth, poverty, race, ethnicity, gender, or economic level. Yet Terhune says that what she does not find within the population of people who turn to Monarch for help are clients and patients.
“They are no such things,” says Terhune. “We call them people. If we call them clients and patients, we’re calling them ‘other.’ You’re saying they are different from you.” Terhune is adamant that they are not. “You’re a human being—I’m a human being—with all the hopes, desires and dreams that come along with that.”
Monarch provides services for adults and children with intellectual and developmental disabilities, mental illness and substance abuse challenges. Services, treatments and resource assistance in Mecklenburg County are administered through open access centers, outpatient clinics, intensive in-home services, community support teams, assertive community treatment teams, and transitional housing for people with mental illness.
Helping People Feel Better
Terhune is especially proud of Monarch’s open access centers.
“Somewhere, someone in need is walking into an agency. It’s like urgent care for mental health. We help them on the spot,” says Terhune. Most agencies will agree to see a person immediately only if they are presenting as suicidal or of harm to others. Terhune’s response is, “Why wait? Each person should get what they need when they need it.”
People exit from Monarch’s open access centers with an assessment, a prescription if needed, and an appointment or referrals for recommended therapies. “It’s so awesome to be with an agency that can do the right thing,” says Terhune.
“Peer support services also play an important role. Relating to someone who has walked in their shoes can really help another person along,” says Terhune. She also touts the Assertive Community Treatment Team. “They even go find people in need under bridges. If you are so depressed you can’t leave your home, we can come to you.”
Additionally, other services, such as those provided by group homes, employment services, day programs, and community services for adults and children, are available in various counties across the state. Services vary from one area to the next because providers such as Monarch are not approved to provide all services utilized by any one local management entity (LME) or managed care organization (MCO).
The MCO responsible for managing Medicaid funding for mental health, intellectual and developmental disabilities and substance use/addiction services in Mecklenburg County is Cardinal Innovations Healthcare Solutions, the largest MCO in the state.
“We’re very creative and innovative,” says Terhune, citing pilot programs across the state designed to further integrative care and safely keep people out of the hospital, as well as medical consultation and teleconferencing. Monarch is responsible for bringing Mental Health First Aid, developed on a similar concept to CPR, to get the individual out of danger to North Carolina. Training is available to individuals and professionals. Monarch is also looking for new ways to provide services to veterans.
A not-for-profit, non-governmental entity, Monarch has grown into an $80 million budget aimed at providing services across much of the state of North Carolina. Thirty-thousand people were treated or assisted last year through Monarch services. The organization operates over a 100 group homes. Still, these numbers aren’t Terhune’s focus: “I don’t care about the numbers. My priority is the individual person.”
“We have lots of programs, but we try to allow people to tell us what they need versus fitting them into a program,” says Terhune. “We want to meet individual needs; craft something around what those specific needs are.”
Terhune offers up a few words that she believes describe the organization: cutting edge, mindful, holistic, proactive, and evidence-based.
Monarch, mantra “Helping Dreams Take Flight,” refuses to define people by their diagnoses. “Instead, we recognize each individual as a person of worth and value. We teach and remind people, some of whom have often been marginalized, devalued, maltreated or stigmatized, how to dream—how to live self-determined lives.”
“Individual goals vary widely, develop over time, and often have to do with some aspect of mainstream desires for a home, job or relationship,” says Terhune. “But most people seeking help, initially, just want to feel better. People who are hurting want to be able to get up in the morning, put their clothes on and have a nice day.”
Meeting the Need
Monarch operates under a volunteer board of directors. Three-fourths of the members either have, or are recovering from, a disability or mental health issue or have a family member who does. Additionally, each member brings some expertise to the board, such as finance, legal, marketing, human resources, or a specific experience, all which add up to a diversity of skills.
Members who cannot read or are otherwise unable are assigned a board buddy who helps them navigate material and discussion. “We especially want to hear from these folks; they are the ones most affected by the decisions the board makes,” emphasizes Terhune.
Monarch’s origins date back to 1958, when Albemarle was a relatively isolated locale with Charlotte a distance away. The post-WWII baby boom increased the number of children with disabilities. At that time, it was illegal for children with disabilities to attend school. They could sit in Sunday school classes, where it was witnessed that they could learn. According to Terhune, this led a group of Albemarle parents to get together and form The Association of Retarded Children.
They established the first group home. Their work led to the organization of The Arc of Stanly County, which is one of many chapters across the state and country. The organization evolved, changing its name to The Association of Retarded Citizens, then Arc Services and later Arc of Stanly County, all before becoming Monarch. The Arc of Stanly County remains as the local advocacy chapter now operated by Monarch.
During the 1960s, with states beginning to realize that they needed to take care of people with disabilities, area programs started to develop. These programs were self-managed, often with little accountability of funding and costs.
North Carolina responded by establishing local management entities which were financially responsible, but contracted out all services. They act more like insurance companies, approving services and expenses, and are referred to as MCOs. These groups have continued to be reduced in number for greater efficiency.
Today, the legislative debate is over Accountable Care Organizations (ACO) in which health care providers come together to simultaneously lower costs and raise the quality of care. This model puts a premium on integrative care which allows doctors to communicate with each other and reduces the duplicity of services, particularly diagnostic testing versus more general managed care.
These several decades have seen enormous strides in mental health care. “One of the things we know today is that one can recover from mental illness,” says Terhune. “We’ve gone from warehousing people that we thought would never get better to thinking that people can get better with appropriate services and medical intervention.”
Causes and Costs
Although much has been learned about mental illness, its exact causes still largely elude the medical research community. It is generally accepted that some mental illness can be hereditary, or genetically acquired, or caused by chemical imbalances in the brain.
Also, many medical issues carry a psychiatric component. People with chronic disease, such as diabetes or heart conditions, are more likely to have mental illness, as well. Circumstances, especially loss or trauma, can trigger mental illness. It is also believed that greater rates of diagnosis are behind the increased number of people with mental illness.
The social impact of mental illness and the stigma around it is often measured in losses—of homes, family structure, jobs, self-esteem, and overall health.
“Sufferers, if not treated, can lose everything,” says Terhune. There is also a great cost to productivity and the economy with losses of wages and tax dollars, and increased cost of services and systems—fire, police, EMS, prisons, hospitals, and schools—which are burdensome to society.
“The cost is huge,” laments Terhune. “We could so contain that cost if we had adequate, sufficient services.
Monarch obtains funds from Medicare, Medicaid, private insurances, Social Security and individual payments. Funding also comes in the form of grants, donations and in-kind contributions.
“We lose money on some services—people with no insurance—and balance that with other services,” says Terhune. “We also have to spend money on buildings, furniture and fixtures. The square foot rental cost of the restored warehouse where Monarch’s state headquarters is located is discounted by tax credits, but we can’t find that everywhere.”
Terhune’s frustrations are apparent when the discussion turns political. “Do I seriously hope that North Carolina legislature’s agrees at this point to accept the federal Medicaid expansion signed into law with the Affordable Care Act?
“Because behavioral health services are capitated, predictable and cost-effective, North Carolina needs to accept Medicaid expansion,” says Terhune, who sits on the five-member Medicaid Reform Advisory Group appointed by N.C. Gov. Pat McCrory.
“Can you imagine how many people could be helped? People express concern over Medicaid but we keep voting the same people into office. Why don’t we vote in people who get it?”
Monarch has experienced significant growth since its name change in 2008 and its expanded service offerings (beyond those for people with developmental disabilities) to include mental health programs. “People keep calling us and inviting us in. We’re in all of North Carolina’s MCOs in some way. We have the value they want,” says Terhune.
Another way Monarch has grown is by acquiring services from other organizations. “We are happy to merge with other providers; we do it all the time,” says Terhune. “We’re mostly looking for shared values, but we have taken on groups that are inept or are about to go under.”
Terhune explains that these expansions can be expensive. “Our board of directors says that we have to break even.”
One at a Time
One of Terhune’s first experiences with mental illness took place growing up in Brookfield, Ill., in the 1950s when her father, who worked in medical supplies, took her along to an orphanage of sorts that provided her with some ugly truths about how America treated people with mental illness and developmental disabilities.
The children were very sick, expected to die. Babies were housed in cribs lining the walls. Older children, ages four or five, were in cages and had not been taught any language skills. There was no visible staff. Terhune tried in vain to persuade her father to take one of the children home.
She remembers his words: “Peggy, you can’t save everyone, but when you grow up you can do whatever you want to do.”
And Terhune is doing just that. As horrific as it was, the experience solidified her desire to do something for the people represented there.
Having earned her bachelor’s degree in occupational therapy in 1974 and an M.B.A. in 1984, Terhune accepted her current post in 1995, after being second in command with a similar organization in Rochester. She has since earned her Ph.D. from The University of North Carolina at Greensboro. She has been married to “the love of her life” for the past 22 years.
Terhune loves kids. Her husband loves kids. Together, they have raised a combined family of seven children and have fostered over 100 children. They are currently serving as therapeutic foster parents.
“It’s who we are,” says Terhune. “When you do what I do, it’s your whole life; it’s your value.”
“I have the best job in the world. I am so privileged,” says Terhune. “Every day I get to come to work and save the world and do God’s work. You save the world one person at a time. Every single day one of my 1,800 staff is touching someone in need; helping dreams take flight.”