A chronicle of disappointment: Ambitious reform lingers in limbo - Raleigh News & Observer

LYNN BONNER, Staff Writer

The state hatched a grand plan in 2001 to improve mental health services. Five years later, nearly everyone involved says it has gone tragically off course.

Central to the change was having more people seek care in their communities from private contractors, not in large mental hospitals run by the state. Money that would have gone to support hospital care would instead fund community treatment. Local mental health agencies that had been seeing patients would instead act as HMOs, signing contracts with private operators to care for patients.

But the five-year history of the reform is a chronicle of disappointment more than accomplishment..

* In 2002, Gov. Mike Easley took most of the startup money that legislators put into a trust fund for community mental health programs -- $37.5 million of $50 million -- to cover other expenses during that year's budget crisis.

* More people are checking into mental hospitals, leaving less money to sustain the community programs that are supposed to supplant such hospital stays. Counties are grappling with shortages of local hospital beds and doctors and other professionals to deal with patients in crisis and keep them out of state hospitals.

* New community treatment options important to the reform were not approved by federal authorities until this year.

"Almost everything that was promised in reform in the community didn't happen," said Ann Akland, president of the Wake County chapter of the National Alliance on Mental Illness.

The new system was planned to have fewer state hospital beds and shape community services around patient needs. As Carmen Hooker Odom, head of the state Department of Health and Human Services, put it in April 2003: "We need to make sure that the system reflects an investment in people and in communities, not in buildings and programs."

Hooker Odom vowed to plow money saved from closing Dorothea Dix Hospital in Raleigh back into communities. It hasn't worked out that way. The Easley administration recently ordered that any savings from closing Dix should be used to pay the debt on a new psychiatric hospital being built in Butner.

The department is seeking about $100 million in the next budget for mental health services. That is much less than advocacy groups want and less, even, than the $155 million that legislators want. A portion of the department's budget request is for furnishings and computer systems for the new hospital.

Hooker Odom said hospital furnishings and computer systems are for patients. "You want beds for people, and you want a state-of-the-art [information technology] system," she said. "It is an expenditure for people, not buildings."

Early on in the reform effort, the state and local mental health agencies concentrated on reorganizing. The office shuffling took time, money and energy but had little to do with caring for people.

"We're wasting time on all this administrative junk, and we ought to be focusing on the patients," said Nicholas E. Stratas, a Raleigh psychiatrist who worked for the state mental health department in the 1960s.

Many mental health advocates now regret their initial support for the reform effort. The N.C. Psychiatric Association went from champion to critic.

"We got sidetracked looking at governance and who was going to get what pot of authority," said Robin Huffman, executive director of the association.

Hooker Odom said the changes have been difficult and chaotic but that mental health reform is pulling out of the dive that has come with dismantling the old system.

"I believe we're coming up," she said. "But we've had a very difficult time across the state in terms of going down that slope of sort of shedding off the old ways."

Staff writer Lynn Bonner can be reached at 829-4821 or lbonner@newsobserver.com