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More evidence of North Carolina’s failures in mental health care reform

Chris Fitzsimon

State lawmakers received a report on the state of the mental health system Wednesday, and the news is mixed at best: some improvements in the troubled system along with startling reminders of the huge problems that remain.

Maybe most disturbing of all, the report was completed before the devastating budget made by the legislature last summer to services for the mentally ill, developmentally disabled and people with addictions.

The report was mandated by the 2008 General Assembly and is an analysis of the gaps in services in a system plagued by problems in structure and funding since the 2001 reform efforts. It was prepared by the Department of Health and Human Services based on information from mental health consumers, advocacy groups, outside task forces and the local management entities (LMEs) that oversee the delivery of services.

It restates the primary goal of the mental health system after the 2001 reforms: to provide people with mental illness, addictive disorders and developmental disabilities the opportunity to live in their communities instead of state institutions, which are reserved for the people with the most severe needs.

That’s the plan. The problem is that for that to work, adequate services must be available in communities across the state. One common theme of the report and statistics furnished to the department every quarter is that services vary dramatically across North Carolina.

The last quarterly statistical report prepared by the department showed vast differences in the performance of the 24 LMEs. The state has a goal of proving timely access to care for at least 88 percent of patients with urgent needs. One LME saw 100 percent of the patients; another saw only 39 percent.

The state has a goal of seeing 70 percent of patients discharged from mental hospitals within the first crucial seven days after release. It seems as if the goal ought to 100 percent, but no LME did that. One saw 71 percent of patients released in its area. Another saw only 24 percent, leaving 76 percent without follow-up care.

Among the common problems identified in the report by various groups are waiting lists, especially for people with developmental disabilities, lack of transportation and lack of affordable housing, despite a significant investment in 2008 in housing for people with disabilities.

People with addictions continue to end up in prisons instead of treatment. The Institute of Medicine recommended expanding the successful Drug Treatment Courts to help, but new courts have not been established.

The report is basically an organized presentation of the problems faced by the mental health system in the first half of 2009, and the list of gaps in services is a long one.

DHHS officials have made some progress in finding more efficient ways to provide services, and some internal reorganization has helped. But none of that gets to the fundamental problem that was apparent in 2009 and is even more striking now.

The state simply does not adequately invest in caring for people with mental illness, developmental disabilities or addictive disorders. Not even close.

Much of the public discussion about mental health in recent years has understandably focused on the shocking problems in state institutions, where patients have died from abuse or neglect, and on the fraud and mismanagement in the community support program, which undeniably existed, though it may have been significantly overstated. But the funding problems have never really been addressed.

The report presented Wednesday makes it clear that the mental health system was scrambling last year to rearrange and redesign services to try to compensate for a lack of resources. And things have gotten worse.

Recent months have brought disturbing accounts of the effect of last summer’s budget cuts to programs across the state. Department officials themselves have reported that the cuts are being felt in jails, ERs and state mental hospitals. Programs for the developmentally disabled are being slashed or abolished.

That has led to more scrambling in an even more impossible attempt to provide more services with even less money. DHHS officials have tried to put the best spin on the problems, even claiming that the crises have provided the opportunity to streamline the mental health system.

None of that matters much to people with mental illness, a developmental disability or addiction disorder. They need and deserve our help. The report presented Wednesday shows many of them were not getting it last year and we know many more people are suffering alone now.

Enough already with reports. Let’s find the will to do something about it.

Chris Fitzsimon is executive director of N.C. Policy Watch.

3 Responses

Comments (3)

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  1. Virgil Stucker

    We at CooperRiis are very aware of the good efforts of Jeff Horton and his colleagues in striving to meet the needs of individuals with mental illness and worry that this article has not fully captured their intent amidst the challenging financial circumstances that are posed by underfunded mandates from the state. We wish them well!

    We at CooperRiis are licensed but not part of the state-funded mental health system and worry that this article does not fully capture the efforts of nonprofits like ours that are driven by mission and philanthropy with the desire to assist our clients with recovery from mental illness.

    We are pleased that our efforts, which are available through scholarship, provide at least 80% of our clients with access to sustainable recovery.

    We believe that Mr. Fitzsimon should widen his scope and more broadly review all of the efforts in North Carolina to meet the needs of its most vulnerable residents.

    Virgil Stucker
    Exectuive Director
    828 899 4673

  2. Frank Miller MD

    Dear Sirs: I just wanted to add my support of Mr. Stucker’s comments. There are still a few exemplary RTCs left in NC that do very high level work and Cooper Riis is one of them. I practiced previously in Hendersonville NC for 9 years and often referred to that program and treasured it. Unfortunately it was largely accessible to individuals who could fund its costs privately but it was and is a superb program. I cannot say anything remotely resembling that level of praise the current state system that is in it 10th year of being an unmitigated disaster with no improvement in sight really.
    Frank Miller MD

  3. Thomas Maultsby

    The fix for mental health reform is to stop the over-reliance on the private sector to provide clinical services and return to mental health centers and without the state micromanagement of the centers as was the case in the past. There is a way to do this that will provide much better service to those who need it and at less expense than is currently the case.
    As it stands now, and has for the ten years, North Carolina provides far from adequate services and at great expense. One would think that, in these economic times particularly, the state would be interested in a less costly mental health system, especially one that, at the same time, could provide much better services.
    I would be glad to share some further thoughts about this if any legislators or state mental health personnel are interested in hearing.

    I am a retired psychologist with 15 years experience in the NC mental health system and nearly 30 years clinical experience altogether.