It’s time to rethink mental health reform

County managers are now reporting that the new system will cost taxpayers three times as much per year as our time-proven public system did — while providing only about half as much care for patients.

North Carolina is in the throes of a crisis in mental-health care. Tragically (and shamefully!), this is a human-made disaster, and the situation is steadily worsening at an alarming rate. If we continue down this road, a lot of seriously ill people are going to end up on the street or in prison, even as we continue to waste massive amounts of money. Yet I’m reminded of the story of the emperor’s new clothes — although many people are acutely aware of what’s happening, virtually no one even speaks of it, much less does anything about it.

Prompt corrective action is imperative. And the members of the Friends of Public Mental Health of North Carolina — a large, statewide nonprofit organization for which I am a spokesperson — have some very clear ideas about what needs to be done.

Some of our members have taught at prestigious universities, have done research on psychiatric illness, and have held positions of authority at all levels of the mental-health hierarchy. Collectively, our members have several thousand years of experience in delivering mental-health services. For these and other reasons, we staunchly maintain that we are better qualified than any other group in the state to know how to address the current chaotic situation. Our prescription includes:

1. Immediately halting further implementation of the so-called statewide mental-health “reform” plan, an ill-conceived and mean-spirited effort that is doomed to failure. It has already done a great deal of irreparable damage; allowing it to proceed will serve only to waste a lot more money while creating still more carnage. Despite a mountain of evidence to support this contention, however, proponents of the plan are exceedingly loath to admit it — and therein lies a grave danger. Some of these people are so utterly determined to have the plan succeed (for the sake of their own egos) that they will have to be standing eyeball deep in water before conceding that the ship is sinking. By then, it may be too late to save it.

2. Promptly stopping any further dismantling of the public mental-health system. It is absolutely essential that what’s left of it be preserved, because there is no workable alternative on the horizon. To do otherwise is tantamount to torpedoing our own ship. (If what remains of the former system weren’t still carrying much of the load, the dismal situation in which we now find ourselves would be profoundly worse.)

3. Expeditiously discharging all of the out-of-state consultants still on the state payroll (and perhaps demanding a refund from those who have already left) for the grief they have helped bring our way. When so-called “reform” is contemplated, a lot of people tend to latch onto it for their own benefit. But what state taxpayer would sanction having our scarce dollars dissipated in this highly suspect manner? The examples of other states provide abundant cautionary evidence, and better guidance is readily available locally — and for free!

4. Launching an independent, comprehensive, in-depth investigation of the state’s overall mental-health operations. The reasons for doing this are legion. They include the newly created layers of administration (which have eaten up a lot of the money that should be going directly into patient care) and the role of privately owned group homes (many of them nationwide corporate chains with terrible track records). We believe these folks are really the prime movers behind the reform effort; accordingly, we need an accurate and impartial picture of where things actually stand (versus Raleigh’s spin-doctoring). Taxpayers need to be aware of the staggering amounts of time and money that have been recklessly funneled into this ill-starred venture — leaving us, three years later, with pathetically little to show for it. For all practical purposes, our immense outlay of precious resources has been squandered.

At the outset, the state loudly trumpeted the “reform” as a dramatic money-saving endeavor (though, ere long, the utter fallacy of this claim was exposed). Instead, county managers are now reporting that the new system will cost taxpayers three times as much per year as our time-proven public system did — while providing only about half as much care for patients! How does that strike you? Who among us would be so foolhardy as to suggest that we and the patients are better off today than we were three years ago?

5. Scrapping current plans to close Dorothea Dix Hospital in Raleigh and sell the valuable property to profiteers. The present and projected needs for this facility’s services are immense. And don’t forget that the proposed new hospital to be built as a replacement for both Dix and John Umstead Hospital (in Butner) will have less than half the combined capacity of those two facilities. It should be readily evident that the new hospital won’t be able to meet the needs. Even now, before the closings, the total number of available beds is insufficient.

6. Any simpleton should be able to conclude from the evidence at hand that our state’s mental-health program has been on a path of destruction for three years. And despite effusive denials from Raleigh, it still is. When such deplorable conditions continue for this long with no real prospect of improvement, shouldn’t it be time to consider making major changes in top management — at the Department of Health and Human Services and elsewhere? There’s too much at stake for the patients and the residents of this state to have inept hands at the helm, increasing the risk of further damaging the system.

I’ve touched on only a few of the crucial issues demanding attention; an official investigation would bring a great many more into focus. And the information obtained in the process could greatly aid us in deciding what needs to be done to get out of this mess — assuming it isn’t already apparent.

[Thomas A. Smith, a retired psychiatrist, lives in Asheville.]


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