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Shortchanging mental health

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By Deborah Barrett

North Carolina is initializing large-scale changes in mental-health care, moving towards privatization of services.

Soon, most patients will be referred to private practices while government agencies treat only patients with severe mental illness.

Although intended to reduce costs and increase consumer choices, the reality is that these changes will not offer greater cost-savings to the state or advantages to consumers.

The dismantling of the public mental-health system, coupled with budget cuts, creates gaps in the provision of services.

Large for-profit agencies, the main providers of privatized services, may offer limited therapy options or refuse to treat people needing costly care.

Supporters of privatization envision the emergence of new not-for-profit agencies to fill gaps left by for-profit providers.

However, the creation of these organizations will take time, and meanwhile, large numbers of people with serious mental-health needs will be untreated.

Public funding intended to assist with this transition has not materialized.

Even when they are established, the not-for-profits will be a poor copy of the system they are replacing.

The not-for-profits will be hamstrung with constant fundraising needs because many clients cannot afford the services they need. It is a gamble whether local communities can contribute enough to maintain services. Poorer communities are likely to provide fewer services, though their need for mental health care may be greatest.

Even relatively wealthy communities may struggle to provide adequate services.

The uncertainties of fundraising will also jeopardize the continuity of services these agencies can provide.

The public system had inefficiencies, but dismantling that system without a proper replacement is irresponsible.

Many of the inefficiencies of the public system will be inherited by the new system: Medicaid reimbursement procedures and extensive government regulations will continue to drain resources.

In addition, new inefficiencies will be introduced, such as the staff required for fundraising.

The likely result is that a broad group of individuals in need of mental health care will fall through the cracks.

Significant social and economic benefits exist in providing services to prevent mental-health difficulties from escalating, and in restoring individuals to functioning roles.

Yet, under the new rules, most will be ineligible for treatment in the public sector because they do not suffer from severe mental illnesses.

When governments fail in their responsibility to invest in mental-health care, then communities need to assume the obligation to the most vulnerable among us.

Let us hope our communities step up to this responsibility as the government backs away from it.


Deborah Barrett is a clinical assistant professor in the School of Social Work at the University of North Carolina at Chapel Hill.

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