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New report about the mental health morass

Chris Fitzsimon

A highly anticipated report about the state’s mental health system by a new division of the General Assembly staff released last Wednesday morning paints a disturbing picture of a system plagued for the last two years by lack of oversight, poor planning and disorganized data that makes monitoring difficult.

The report includes a response by Health and Human Services Secretary Dempsey
Benton, who agrees the department needs to improve its reporting to lawmakers and the public, but disagrees with a recommendation to reorganize the way the department evaluates its performance.

Benton believes that is the job of the executive branch and bristles at the suggestion that department officials report the qualifications of individual staff members to state lawmakers, a position that’s hard to argue.

The Program Evaluation Division of the General Assembly released the report at a meeting of the committee that oversees it. The report puts recent troubles in the mental health system in the context of the 2001 reforms that were supposed to solve problems, not ignore them or create new ones.

The report documents the crisis in the mental health system before 2001, including the fact that one mental hospital was in danger of losing federal funding. Two weeks ago, federal officials threatened to cut off funding for Cherry Hospital in Goldsboro after an investigation found disturbing problems. The more things are supposed to change, the more they stay dismally the same.

A News & Observer story last week included the details of the death of one patient who was left unattended in a chair for 22 hours without food, while staff members played cards and danced.

The report from the Program Evaluation Division was originally scheduled for release in May but was delayed until after the General Assembly adjourned.

Much of the 19-page report is critical of internal policies and procedures in Health and Human Services surrounding the abuse and overbilling of community support services that an N & O series projected added up to $400 million, a figure that is always part of the discussion of mental health reform, though the actual dollar figure may have been much smaller, according to Benton.

The report isn’t likely to create screaming headlines, but it is another confirmation that the system that is supposed to care of people with mental illness, a development disability or a substance-abuse problem is still sputtering.

Data released a few months ago showing that 1,200 people from mental hospitals ended up in homeless shelters in 2007 proved that people are still tumbling through the state safety net. So did the latest death of a patient at Cherry Hospital after what appears to be shocking neglect.

The legislative report is filled with details about complicated accountability systems in Health and Human Services that fell apart or were never adequate in the first place. Many of the problems were related to the privatization of services, though the report is silent about the wisdom of that idea, as is virtually every discussion of mental health reform.

The report is also likely to re-ignite animosity between the Department of Health and Human Services and legislative leaders about roles and oversight and funding. Those are important questions that policymakers must resolve, and quickly.

People with mental illness or disability and their family members don’t care much about state-provider endorsements or how many local management entities there are. They just want people to stop dying in hospitals or ending up in homeless shelters.

The report lists the goals of the 2001 efforts for the consumers, providers and the state. One consumer goal was to improve access to the system for patients so there was “no wrong door.” Seven years later, there are still plenty of them.

Chris Fitzsimon is director of NC Policy Watch.

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