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 One in Four Will Need Mental Health Care
by Tom Campbell
May 24, 2007
Statistically, we are told that one person in four will need mental health care sometime during his or her lifetime. The question is, where and from whom will you get that care. “Anytime people lose faith in a system, you have a crisis, and people have lost faith in our state’s mental health system,” moderator Chris Fitzsimon told a group of three hundred assembled for a “Crucial Conversations Luncheon” about the state of mental health in our state. The 2001 mental health reforms were “well intentioned,” but aren’t working well.
A panel that included an advocate, a legislator, a regulator, a family member, and a newspaper columnist assessed the problems. Our reforms were not just “tweaking,” but sweeping system changes. They were implemented without an adequate planning period and insufficient business plans. There was no pilot program initiated on a small scale to oversee and work out problems. Too many changes were implemented at one time and there was little consideration of the impact decisions would make on other parts of the system. Counties and regional health agencies did not step up and take the reins being handed them. Meanwhile many service providers, especially hospitals, eliminated beds for mental health at the same time the number of short-term hospital stays, owing largely to drug abuse, increased sharply.
The litany continued. Guidelines were inadequate and few were held accountable. Bureaucratic slowdowns and rigid decisions on the federal and state levels hampered flexibility and innovation. Because there were so many major changes made there were internal tensions inside the Department of Health and Human Services, between the department and the legislature, between the state and local/regional authorities, and even among local parties. Finally, there were few champions with sufficient clout to correct problems.
Is there any wonder we have a crisis? How do we fix it? First, we must find leaders who can and will be champions within the executive branch, the legislature, the department, and local/regional governments and agencies. We have not demonstrated we have the expertise to address this crisis and would benefit from consultants who do and are given the authority to right the ship. Several speakers said we need to stop making changes every other week and allow the system to stabilize enough to decide what is and isn’t working. Clearer guidelines with greater accountability are essential. Counties, local management entities, and local care providers need to step up. We need to prioritize and provide care to those with the most severe needs first, then implement a plan for others. Insurance parity, requiring health insurance carriers to provide mental health care, might help put more money into the system, even though it would likely increase premiums.
We cannot allow our prisons and our hospital emergency rooms to continue to end up with our mentally ill. If a society is judged by how well it treats those who cannot provide for themselves, North Carolina is currently found wanting. Too much is at stake and this is important. What we now have is shameful. |
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