State retreat from treating mentally ill patients creates big challenges.
By Tom Campbell
[4-23-04] It is shameful that people with mental illnesses have few powerful friends in North Carolina.
Partly because the system of delivery isn’t working optimally and partially because of escalating costs, North Carolina has embarked on a plan of mental health reform that is potentially risky and frightening.
The plan is to move much of mental health treatment previously provided by the state to the county level.
In essence, the state is getting out of treating mentally ill patients except for long-term care.
We are slated to close Dorothea Dix and John Umstead hospitals in favor of a smaller one in Butner.
Granted, the new facility will be more modern and better suited for today’s treatments, but the net effect is the loss of patient beds.
The intent is that patients can be identified quicker and better treated at the local level, where they are near family and friends. It is hoped that prevention can become a bigger focus than treatment.
Problem is that while the state is shoving the problems to local governments, they are not providing full funding to pay the costs. Most counties have neither the facilities nor the budgets to accomplish the assignment.
Many community hospitals that previously had psychiatric units are downsizing or closing them down. They are expensive to operate, often do not qualify for full Medicaid payments, find the work can be dangerous, and report it is hard finding psychiatrists who want to work hospital hours.
From 1999 to 2001, North Carolina lost almost 500 psychiatric beds and more have closed since.
Without proper resources at the county level, we will likely see hospital emergency rooms become the port of entry for suicidal, dangerously psychotic, and addicted patients who need immediate care.
In many hospitals, patients needing emergency care are already complaining about having to wait as long as half a day to get treatment.
Additional complications promise to clog up an already sluggish system, but, more importantly, could endanger patients and families who are already highly stressed.
We credit those who crafted the new reforms with good intentions, but fear the outcomes will not be as positive as hoped for.
The cause of mental health does not have vocal and powerful champions in the legislature or in high places of government. Further, the mental health community is disjointed and does not advocate with one strong voice.
It is sad that at a time when effective advocates are most needed, we do not see them. Mental health needs some champions.
Tom Campbell is creator/host of NC SPIN, a weekly statewide issues discussion, and a member of the board of directors of the A.J. Fletcher Foundation, which publishes the Philanthropy Journal.