Mental health woes still need attention from our lawmakers - Asheville Citizen-Times

A consultant hired to evaluate the North Carolina’s system of delivering mental health services had some disturbing news last week for a study commission established to fix the state’s failed efforts at reform.

Everybody knew it was bad, but apparently it’s worse than we thought.

Christina Thompson of Heart of the Matter, a consulting group, delivered the bad news to a legislative committee set up to oversee mental-health issues.

According to Thompson, the state provides inadequate, ineffective and inconsistent treatment; lacks sufficient crisis intervention and community detoxification services; and has a poorly functioning system for screening people with mental illness and providing community-based support.

Although the state comes in dead last in the nation for per capita spending on mental health, it ranks No. 1 in admission rates to state hospitals — about double the national average, she said.

Maybe there’s a correlation there.

Stop-gap care

Thompson said the mentally ill land in emergency rooms, jails and state psychiatric hospitals far more often than they should as a result of the failure to provide adequate mental health services.

The mental health system has been in chaos since state lawmakers passed legislation in 2001 to purportedly revamp it.

Their goals were laudable: to privatize the system to offer consumers more choice and to get people out of state-run hospitals and back into their communities where they could be closer to their families.

Underfunding and poor planning seriously undermined the effort.

Given the reform goals, it’s ironic that the state comes in first for admissions to state hospitals.

Free market gone awry

“The system is growing haphazardly in a free market kind of way,” Thompson’s report states. “This will ultimately result in failed provider systems and providers who refuse to treat the indigent population. ...Division monitoring and technical assistance requires additional work which cannot be effectively pursued with current levels of staff.”

The $2.7 billion Thompson said was needed over the next five years to fix the problem has little chance of being appropriated.

In a comment quoted by the Winston-Salem Journal, Sen. Martin Nesbitt, D-Buncombe, who co-chairs legislative committee, said that the mentally ill end up draining other state resources when they don’t get treatment.

“We’re filling up the jails, we’re filling up the prisons, and we’re hurting all of our other institutions because of the money we’re not spending here,” he said.

Some funding expected

But, in other statements, he cautioned against expecting the state to spend $2.7 billion, saying meaningful improvements can be made with less money.

Thompson’s report contained a long list of recommendations for improving the system, and the committee is expected to spend the next few weeks evaluating her proposal before making recommendations to the General Assembly.

Even though the report was less than reassuring, it’s good to have a comprehensive, outside evaluation of a system almost every institution in the state has evidence is failing. The failure to provide adequate treatment for the mentally ill impacts schools, departments of social services, jails and hospitals.

Adolescent care falling shamefully short

A Duke University study of 11 Western North Carolina counties, including Buncombe and Henderson, found that two-thirds of adolescents 13-16 living in those counties in need of mental health services are not receiving them. According to the study, which was published in the American Journal of Psychiatry, “Many costs for adolescents with mental health problems were borne by agencies not designed primarily to provide psychiatric or psychological services.”

What this says is that one way or another, as a society we will bear the cost of mental illness.

By failing to provide an adequate system of care, we burden and undermine institutions ill-prepared to deal with mental illness.

The mentally ill, their families and the rest of us suffer as a result.

It makes far more moral and fiscal sense to do everything possible to provide the care that allows people with mental illness to be as healthy and live as productively as possible.