Mental health a sore point

State still lacking, outside report says

A sweeping report on the state mental health system faults North Carolina for failing to provide mentally ill people and drug abusers with consistent and continuous care.

The state would need to spend an additional $2.7 billion over five years to get things right, according to a report by consultants that was released Friday.

But even legislators sympathetic to the needs for improved mental health services say the state won't be able to add $500 million a year over the next five years to the mental health budget.

"It is going to be a terribly depressing year where those kinds of services are concerned, to know what the needs are and what people will be hurt as a result of that and not be able to do anything about it," said Sen. Vernon Malone, a Raleigh Democrat.

The legislature pumped an additional $100 million into mental health services and housing this year. Politicians were responding to criticism that changes they made in 2001 failed to achieve the promise of providing care close to patients' homes rather than in state institutions.

Though the shake-up in the mental health system five years ago had a goal of increasing community treatment, state hospitals are still a first stop rather than a last resort for many, the report says.

Increasingly, rural jails are turning into way stations for the mentally ill, county sheriffs say, because local communities don't have enough agencies to treat those who need doctors or medication.

Consultants in Michigan and Florida who worked on the report fault North Carolina's mental health system for lacking a consistent, coherent philosophy, and for practices that lead to continued reliance on large institutions.

The state Department of Health and Human Services tends to promote people from within the state mental health division who don't have experience in other states or in the field, said state Rep. Verla Insko, a Chapel Hill Democrat who leads the legislative committee that asked for the report.

"I think the people who are there need training, or we need different people," she said.

Mental health services would be lucky to get an additional $100 million a year, Insko said. But she said the state is pursuing, or could pursue, changes that would lead to improvements at little cost.

Insko wants more local mental health offices to be able to manage services by setting up networks of private agencies and directing Medicaid patients to them. Such a system would require federal approval. As it stands, any agency that meets federal standards can treat patients and charge Medicaid for services.

The consultants' report describes community mental health services as fragmented and growing in a way that will "ultimately result in failed provider systems and providers who refuse to treat the indigent population."

The state mental health office is putting its muscle behind helping areas fill their gaps, said Leza Wainwright, deputy director of the state mental health office. Any widespread change allowing more local offices to set up networks would need more study by the department and the legislature, she said.

Looking to change

In a letter introducing the report, Carmen Hooker Odom, the state secretary of health and human services, said the department is already considering suggestions for improvements.

The state division is looking at working with local mental health offices on cutting back use of state psychiatric hospitals.

The division also wants to be able to set statewide guidelines that would have people who are not eligible for Medicaid pay for at least part of their bill. The department would need legislative approval to set a statewide payment schedule. Local offices set their own guidelines, and they vary widely. The state also lacks rules that require agencies to seek payment from private insurance before government pays the bill.

The report describes problems that legislators have heard about, anecdotally, for years.

Rural residents get the least service. Mental health and drug treatment for children and adults is insufficient and leads to unnecessary hospital and group home admissions. North Carolina spends less than most states on community services and more on state institutions.

Insko said the report reinforces that the state was right to change the mental health system but that it didn't make changes the right way.

"It has some features that are recognized across the nation as being good features," she said. "We probably didn't plan well enough for implementing it."