Mental health: We get what we pay for - Ashville Citizen-Times

A legislative oversight committee co-chaired by Sen. Martin Nesbitt, D-Buncombe, recommends an additional $135 million be included in next year’s state budget to improve the state’s mental health system.

That’s a pretty dramatic increase over the $4.7 million in new spending recommended in Gov. Mike Easley’s budget. But it’s nowhere near one-fifth of the $2.7 billion ($540 million) a consultant hired to evaluate the state’s mental health system said is needed to fix it over the next five years.

When Christina Thompson of the consulting group that appraised the state’s mental health system delivered her assessment early this year, lawmakers signaled that they viewed the amount she recommended as beyond the state’s means, but Easley’s recommended increase fails to even recognize that there’s a problem with mental health delivery in North Carolina.

The state can and should allocate the amount recommended by the legislative oversight committee. It will pay for mental health services one way or another, and treating people before they are in a crisis situation is not only the most compassionate thing to do, it is by far the most cost-effective.

By providing inadequate, ineffective and inconsistent treatment and by failing to provide sufficient community-based crisis intervention and community detoxification services, the state ensures that not only will state mental hospitals be overwhelmed, so will local hospital emergency rooms and jails.

North Carolina comes in dead last in the nation for per capita spending on mental health, but it ranks No. 1 in admission rates to state hospitals, about double the national average, according to Thompson. As we have noted before, there might be a correlation there.

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 revamp it. While their goals of privatizing services to give consumers more choice and of getting people out of state-run hospitals and back into their communities were laudable, underfunding and poor planning seriously undermined the effort. In fact, the exact opposite of the objectives has resulted. Records show that the number of mental patients checking into state hospitals for short visits grew by 83 percent from 2001 to 2005 as a result of dwindling local services and treatment space at community hospitals.

Budget shortfalls soon after the effort to revamp the system was approved siphoned money away from the transition and unquestionably played a major part in the disarray that resulted, but mismanagement also played a major role.

The General Assembly increased funding for mental health services by $95 million in the budget ending in June 2006, but problems remain. Families complain that there is a lack of adequate crisis intervention and community-based facilities.

In their final report, approved last week, the Joint Legislative Oversight Com-mittee on Mental Health, Developmental Disabilities and Substance Abuse Services was critical of the Department of Health and Human Services for making decisions that lawmakers say prevent the local mental health agencies from getting the correct level of treatment to patients.

There are unquestionable administrative problems that need to be addressed, but additional funding is also needed.

The oversight committee wants more money earmarked to pay for crisis services and to create recovery units for drug and alcohol abusers. It also wants money set aside to treat people with mental illness held in county jails. A pilot program would give funds to local units that treat patients instead of sending them to more expensive state mental hospitals.

If state lawmakers want to ease suffering and be good stewards of our tax dollars, they will fund the legislative oversight committee’s request for an additional $135 million.

Otherwise, community institutions, especially jails and hospitals, will continue to be burdened and undermined by the need to care for the mentally ill, with whom they are ill-prepared to cope.

And state mental hospitals will continue to be the expensive last resort for overwhelmed families and communities dealing with patients, many of whom would not have needed to be hospitalized had they received sufficient treatment in a timely manner.