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Mental health reform 2.0

Posted on June 12, 2008 by Staff

By Chris Fitzsimon

The most encouraging news about the state’s sputtering mental health system might be that after several years of neglect, most state officials are finally paying a lot of attention to it: the secretary of Health and Human Services, legislative leaders, candidates for governor and other statewide offices, and even the current occupant of the mansion, Gov. Mike Easley.

Health and Human Services Secretary Dempsey Benton, Sen. Martin Nesbitt and Rep. Verla Insko are the most active players trying to reshape the poorly designed and even more poorly implemented 2001 reform efforts.

The reform was supposed to shift patients from hospitals and other state institutions to community programs, but the combination of privatizing services and a new confusing maze of regulations administered by Local Management Entities(LMEs) left thousands of people without services, while hospital admissions continued to rise.

Meanwhile, newspaper reports and investigations by the federal government found serious problems in the hospitals themselves, including unreported patient deaths and injuries, high staff turnover and disturbingly high staff-to-patient ratios.

Plans to close John Umstead and Dorothea Dix and transfer patients to the new Central Regional Hospital in Butner have been repeatedly delayed by design and staffing problems at the new hospital. The controversy about the portrait commissioned by the new hospital’s director provided the perfect metaphor for a system overseen for the last several years by officials who seemed to have the wrong priorities.

Benton and the General Assembly are now working on creating mobile crisis teams, paying for inpatient beds in local hospitals, tightening restrictions on the much-criticized community support program and continuing efforts to provide housing for the mentally ill and disabled.

Benton wants lawmakers to expand hospital staffing and continues to work to increase the compensation of psychiatrists and other professional employees, though there is an equally compelling need to raise pay for health technicians and other direct providers of patient care.

Recent reports by two outside working groups appointed by Benton in January provide more evidence of the serious problems at the hospitals and are another reminder that people continue to tumble through the gaping holes in what is supposed to be the mental health safety net.

Benton was justifiably criticized for not including consumers of services in the groups, but the reports are instructive nonetheless. They found that staffing inadequacies create dangerous conditions for patients in the hospitals and when they leave them, with almost 1,200 people discharged to homeless shelters in 2007.

The reports pointed out other problems, like the shrinking number of inpatient beds for children and adolescents and wide disparities in access to services across the state, especially in crisis care for the developmentally disabled.

Easley’s budget and the one passed last week by the House include proposals for more crisis care and hospital improvements, as well as deep cuts in the community support program that a News & Observer series estimated wasted $400 million, an amount disputed by mental health advocates, but one that is now driving much of the debate.

The House budget slashes community support funding by $86 million and redirects most of the savings elsewhere, adding up to less spending next year overall on mental health, development disabilities and substance abuse services, despite the documented crisis in hospitals and local services.

Benton recently announced another month delay in the opening of the new hospital, not long after Charlotte Mayor and Republican gubernatorial candidate Pat McCrory called for one. It may not be the last delay.

Many lawmakers are still not convinced that the new hospital is safe or will be adequately staffed and current workers at Dorothea Dix are demanding a bill of rights to protect their interests in the transition to the new hospital.

Lawmakers are also resisting Benton’s call to consolidate the 25 LMEs into nine to save on administrative costs. Nesbitt doesn’t think much of that idea, pointing to the county health departments as a model.

But the health departments are government agencies that provide services themselves. The LMEs contract with for-profit companies that provide services that vary widely in quality.

Advocates for the mentally ill are understandably leery of more changes now in a system that has been defined by turmoil and missteps for the last seven years. Many nonprofits are now also providing first-rate services themselves, blurring their role in the debate.

And maddeningly, as late as last week Gov. Mike Easley said again in a television interview that he opposed the reforms in 2001, though he signed the bill, a pretty clear indication of support.

And at the heart of it all remain the families with loved ones with a mental illness or disability housed in a facility that may still be unsafe or living in a community where they can’t find care.

It is not ultimately about LMEs or reimbursement levels or inexplicable portraits. It is about taking care of some of the most vulnerable people in the state. There may be some incremental progress at hand, but it still feels like the voices and the interests of the people most affected by the overdue debate are heard much too rarely in the halls where decisions are made.

Chris Fitzsimon is director of NC Policy Watch.

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