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 Back to the Basics on Mental Health Reform
by Tom Campbell
December 21, 2006
A long-anticipated study on our state’s mental health system is enough to send the healthiest person into depression. The report indicates that our well-intentioned efforts at mental health reforms are poorly conceived and even more poorly executed. Five years into the reforms, most everyone agrees the patients are getting worse care than when we started.
The report, prepared by two out-of-state consulting groups, is damning, indicating that our state needs to spend an additional 0 million per year or .7 billion over the next five years in order to fix what ails our mental health programs. Even the most adamant advocate of mental health understands this isn’t going to happen.
We began mental health reforms with the basic premise that the care delivery system then in place wasn’t working effectively and needed reform. Starting from that foundation the goal was to move a better quality of mental health care down to the local levels, making it closer to the patients and their families. The wheels started coming off the track in the implementation of this goal. Local governmental units were unprepared, unqualified, and had insufficient funding to provide the services being forced on them. Five years into reform the state mental hospitals are still the first line of service. Our jails are filling with mentally ill patients who have been turned out of hospitals, ending up on the streets for lack of adequate care in their home towns. Convalescent and retirement homes are rapidly gaining patients they are ill-trained and unprepared to house, putting other patients at risk.
North Carolina is between the proverbial rock and hard place with mental health. It is time to admit we don’t have a practicable plan for reforming mental health. Let us stop this process, step back, reassess all the basic assumptions made to this point to make sure they are valid, then develop a plan that has better chances for success. This would include putting a halt to the planned closing of Dorothea Dix and other state hospitals until sufficient planning is done and the transition from state hospitals to local care is working more efficiently. It would also include greater input and cooperation from local governments, listening to their concerns and ideas before reconstituting new plans.
The first step must be new leadership. Most everyone has lost confidence in those who are leading the effort. Fresh leaders with fresh perspectives are needed. We tend to promote those already working in our mental health system, so the experience of our leaders is limited. Other states have had better records of reform. Surely we can find leaders with experience in what these states are doing that is working. A more accurate assessment of the costs is also essential, so our leaders will know what is expected and all of us can learn what they are willing to provide in funding.
One of the primary functions of government is to provide services to those who cannot help themselves. The mentally ill fall in the first echelon of those who qualify. They have few advocates. It is essential that we treat them with care and provide the best we can afford for them. We cannot afford to let these people fall through the cracks. Let’s get back to the basics with mental health reform.
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