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Mental health: half is not enough

Posted on November 25, 2008 by Staff

Chris Fitzsimon

Television news cameras came early to Thursday’s meeting of the Mental Health Oversight Committee, a fairly rare occurrence but understandable the day after state officials announced that three staff members of Cherry Hospital had been fired in connection with the death of a patient in April.

Video from a hospital security camera showing staff members playing cards while the patient sat slumped in a chair in the corner was released Tuesday, prompting widespread outrage and renewed attention to the disturbing conditions at the state mental hospitals.

The cameras were there to hear state officials talk about the incident and Dr. James Osberg obliged, telling lawmakers that the state was working to fix the problems in Cherry and other hospitals. Rep. Verla Insko replied that there has been a “culture of disregard for patients” for years.

Reports of neglect and mistreatment of patients have dominated most of the headlines lately about the state’s troubled mental health system and should continue to draw media attention until state officials can guarantee the public that the hospitals are safe, adequately staffed and providing appropriate care for patients.

The report on the hospitals was scheduled for noon, but Osberg didn’t speak until mid-afternoon, frustrating the news crews by bumping up against their deadlines. What the committee discussed before the update on hospitals provides a revealing picture of the status of the mental health efforts that began in 2001.

The reforms were based on the idea that most people with mental illness or a developmental disability should be treated in their local communities instead of state institutions. The plan called for fewer admissions to state hospitals, which would save money that would help pay for local services.

Before 2001, the services were provided by government, including area mental health centers and the state. The reform set up a new creature, Local Management Entities (LMEs), and the decision was made that the LMEs would not provide services, but would instead contract with private for-profit companies and nonprofits that would actually work with patients. That privatization should have set off alarm bells, but they never rang.

Lawmakers also neglected to adequately fund community services, and money set aside in a trust fund was used by Gov. Mike Easley to balance the budget. The money was never fully replaced.

Hospital admissions never declined and chaos ensued, leaving thousands of people without services while government officials blamed each other for the problems or misleadingly claimed they opposed the reform when it was enacted.

On Thursday, lawmakers heard that the LMEs are making progress overseeing community services after an infusion of funding from the General Assembly for emergency care and mobile crisis centers.

That prompted a couple of committee members to wonder if the system was returning to the structure in place before 2001 when the state built local centers that provided services. Sen. Martin Nesbitt agreed the reforms were poorly handled in 2001 and that the old system was dismantled before a new one was put in place, but said LMEs are on the right track.

That claim was partially based on a spread sheet provided by the Department of Health and Human Services that showed how each of the 25 LMEs was doing on a series of critical measures, like services to people in need, timely follow-up after inpatient care and the effective use of state mental hospitals.

The spreadsheet did show that some of the LMEs have met the goals set by the department in each area. The goals themselves are worth noting. One was that the LMEs should see at least 28 percent of patients released from a hospital in their area within a week of the patient’s discharge.

Most LMEs are seeing more than 28 percent; some are seeing close to half the patients within seven days. But shouldn’t we expect more, seven years after a complete overhaul of the mental health system? The first few days out of a hospital are crucial to a patient’s adjustment, and yet more than half of the patients are on their own.

Forty percent of adults in the state with mental illness who need services are receiving them and that is slightly above the department’s goal.
LMEs are improving, and lawmakers heard about several promising pilot programs that might help. But the state’s own data shows that thousands of people are not receiving the services they need and ought to receive.

It is tempting for policymakers to frame this as a question of perception, the glass half empty or half full. But that doesn’t work when it comes to people’s lives. Half is not enough.

Chris Fitzsimon is the director of NC Policy Watch.

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