Chris FitzsimonÂ
When last we checked in on the disaster in North Carolina called mental health reform, things weren’t going so well. Families were struggling to find services for loved ones with mental illness, two state hospitals were scheduled to close even though admissions were up and a new hospital is already overbooked and it hasn’t opened yet.Â
Advocates, providers and consumers were finding it frustrating to deal with many of the local management entities (LMEs), the regional bureaucracies set up to oversee the delivery of mental health services by private companies.
Things are different now. Recent news reports revealed that $20 million that normally pays for mental health services will now instead be allocated to LMEs to pay for administrative costs, which translates into a 5 percent cut in patient services.
Less money for services, more money for bureaucracy. That ought to help people with mental illness. It is not hard to believe there are administrative problems in the current system, but taking money away from patients is not the answer.
If there is one thing that everyone in the mental health community agrees on, it’s that there is not enough money in the system to provide services in local communities. State consultants have said that. Advocates have said it.
Last year the North Carolina Psychiatric Association said it loudly in a report that found the state would have to increase spending by $285 million to get the state’s per capita spending anywhere near the national average.
Not long before the revelation that paperwork was more important than people came the news that state officials believe private companies overcharged the state $45 million for community support services.
The response was to withhold 10 percent of the companies’ payments until they reimburse the state for the over billing. State officials also placed a moratorium on any new companies providing community support services until the mess is straightened out.
A few weeks ago, more than 200 people in Asheboro gathered to listen to a panel discussion about the problems in the mental health system and they heard some straight talk from Dr. Michael Watson, who has spent much of his professional life in the mental health arena and now runs the LME that serves Randolph County.
Watson said the problem with reform is that it was ideologically driven, relying on the market for everything, an approach that causes all sorts of problems as businesses fail and new ones start and profits drive every decision — and patients suffer.
This week a national progressive group encouraged Nevada state officials not to follow North Carolina’s reform example as that state is exploring mental health options. Pretty sound advice, and the basis of the recommendation was to avoid the privatization of services that North Carolina’s reform is built on.
That’s something folks whisper in North Carolina but don’t say much out loud, with the exception of people like Watson — that a fundamental problem with reform efforts is the reliance on private businesses and the market to provide services to people with mental illness.
The combination of privatization and still largely unaccountable but growing local bureaucracies to oversee it has created a maze that many families simply can’t negotiate through.
Also this week, a reminder that all this is not just about LMEs and paperwork and state regulations. A study by Mental Health America finds that almost 12 percent of adults in North Carolina experienced serious psychological stress last year and almost eight percent had a major depressive episode.
The jury is still out on new Health and Human Services Secretary Dempsey Benton, but the experiences of many in the mental health community has left them with little faith that his department is capable of or interested in solving the current problems.
More worrisome is that none of the candidates for governor have seen fit to talk much about mental health reform in their campaigns, which makes you wonder how much they will pay attention after they are elected.
Dr. Watson summed up his presentation in Asheboro by calling on state officials to calm the mental health system, adequately fund it and make it a political priority. That makes a lot of sense.
There have been too many changes too fast in the system, far too little funding has been dedicated to mental health and nobody from Gov. Mike Easley to the five candidates who want to succeed him seem to care much about it.
In other words, the latest from the mental health reform front is that the disaster continues.