Winston-Salem Journal calls for overhaul

Winston/Salem Journal calls for immediate filling of gaps in care, including
24/7 crisis care across the state and more accountability to the area
programs (LME), while over-hauling the so-called "reform".

Thursday, December 8, 2005

State officials could spend months trying to figure out how their 4-year-old
plan to move thousands of patients from state psychiatric hospitals to
private community programs went so wrong. But they should instead focus on
quickly fixing the many holes in the overhaul - holes that now threaten the
health and safety of the patients and, at times, of the general public.

Last May in a family-care home in rural Alamance County, an 88-year-old
resident was stabbed and later died of her injuries.

A 25-year-old psychiatric patient who lived in a room down the hall from her has been
charged with murder in her case. That's an extreme example, but it grimly
underscores what can happen as private agencies take over much of the
residential care for the mentally ill that had been done by the state. More
numerous are examples of patients who've lost access to their health care
because they couldn't negotiate the bureaucratic maze created with
privatization, as a Journal series this week by M. Paul Jackson and Phoebe
Zerwick made clear.
Many of those patients, unable to afford care outside the public system, are
flooding emergency rooms at local hospitals. Some are ending up on the
street and in jails because they are not monitored and are not taking their
medicine.

Privatization was meant to save the state money while improving care for
those with mental illness, developmental disabilities and substance-abuse
problems. Through the plan enacted by the state legislature, the state pays
private agencies to provide much of that care for the needy.

But the overhaul has so far generally failed at improving that care - and,
in some cases, at even providing that care. The biggest failure has been the
HopeRidge Centers for Behavioral Health in Winston-Salem, which was supposed
to be a model for reform in the state's $2.3 billion mental-health system.
But one year after its creation, HopeRidge went bankrupt amid angry
recriminations between its leaders and officials at CenterPoint Human
Services, which started it.

Other agencies have had to absorb its clients. Some of those clients,
frustrated by red tape, aren't getting any help.

The failure of this mental-health-system overhaul is a complex problem that
demands comprehensive solutions. Among other things, there needs to be
greater use of Medicaid for psychiatric services, more 24-hour crisis
services in communities statewide, more accountability on the part of
community agencies and a heck of a lot more communication between state
officials and these agencies. The first goal should be making sure that
patients don't get lost in the maze.

Reform of the privatization overhaul will be neither cheap nor easy - but it
is crucial. The state is failing one of its most vulnerable populations, a
population ill-equipped to help itself.