April 21 Commission for MH/DD/SAS Rules Committee

The Rules Committee met this week to discuss two groups of proposed rules: proposed new rules from the Division of MH/DD/SAS for the North Carolina Interventions (NCI) Quality Assurance (QA) Committee, and proposed amendments to rules regarding standards for mental health and mental retardation in the NC Department of Correction.

NCI QA Committee Proposed Rules

For those unfamiliar, NCI is a crisis intervention program (which includes restraint practices). It is one of several curricula in NC. The proposed rules for the QA Committee were published for public comment in the January 4, 2010 NC Register. The proposed rules describe the purpose of the committee: to establish policies and monitor the safety and effectiveness of the NCI training program; the duties of the committee; and the composition of the committee. The comments received during the comment period were presented to the Rules Committee on Wednesday.

DRNC provided the only comments to the proposed rules. We recommended 3 additional members: one licensed clinical social worker, psychologist, or physician with academic, clinical, or research experience relating to the effect of interventions on the three populations (persons with developmental disabilities, mental illness and addictive disorders). The proposed committee composition consists of 79% NCI Certified Instructor Trainers - we fear that with such an overwhelming percentage of members dedicated to the current program, there will not be any inclination to make changes to the program over time to maintain best practices.

The Division of MH/DD/SAS responded that the addition of such members is unnecessary because the most important function of the committee is to certify and recertify instructors. Additionally, the Division of MH/DD/SAS supports the use of licensed clinicians on its Curriculum Review Committee, which is an entity not set out in rule but exists by internal policy, to review and approve curricula related to restraint and seclusion. The Rules Committee recommended that a provision be added to the committee composition rule requiring that at least 2 instructors on the committee must be licensed clinicians. The Rules Committee also recommended that the policy regarding the Curriculum Review Committee be clear that there shall be members representing clinical and academic perspectives.

We also recommended that the duties section be amended to strengthen the role of the committee in improving the safety and effectiveness of the NCI training program. the Division of MH/DD/SAS accepted these recommendations.

The Rules Committee approved the Rules, as amended.

Proposed Amendment/Adoption of Department of Correction Rules: Standards for Mental Health and Mental Retardation

A subcommittee has been working on this set of rules for many years. The Committee spent a good deal of time reviewing the rules at this meeting but did not finish. Betty Gardner from the Division of Prisons presented the proposed rules. There were comments at the beginning about the use of the term "mental retardation" instead of "intellectual disability." There didn't appear to be a resolution on this issue but there was consensus that they needed to be consistent in whatever approach is taken.

There were comments about inconsistencies and lacking definitions throughout the discussion. Many revisions were requested so we will likely see a different version of the rules when they go to the full Commission for a vote before public comment.

One thing I did want to note specifically, in the Scope section, there was a question about whether there is oversight of the Chief of Mental Health Services. This led to a conversation about prison accreditation. 10 prisons are currently accredited in addition to the Central Office. They are also discussing JCAHO accreditation for the 2 new inpatient facilities.

Public Comments

An attorney from NC Prisoner Legal Services spoke during the public comment period and stated that NCPLS would be sending a letter to the Rules Committee regarding the rules relating to seclusion and restraint.

Martha Brock spoke during the public comment period and stated that she would be sending a letter to the Rules Committee regarding her concerns about the forced medication of inmates.