Who will lead?

Staff WriterMarch 4, 2007 

  • The admissions units at the state’s psychiatric hospitals have been bursting at the seams, prompting the state to impose a cap on admissions.

    112

    people in a ward with 73 beds at Dorothea Dix Hospital in Raleigh

    144

    people in a 118-bed unit at John Umstead Hospital in Butner

    $50.26

    per capita mental health spending

    $26,808

    per capita income

    $417 million

    total 2006 mental health spending in N.C.

    D+

    overall grade for N.C. mental health infrastructure, information access, services and recovery support

    source: N.C. Department of health and human services; national alliance on mental illness

  • The National Alliance for the Mentally Ill, 2107 Wilson Blvd., Suite 300, Arlington, VA 22201-3042. Phone: 703-524-7600.

    NAMI is the nation’s largest grassroots mental health organization. It has chapters in every state and in 1,100 communities. North Carolina has 31 chapters, including ones in Durham, Orange and Wake counties, which provide support for individuals and families dealing with mental illness.

    www.naminc.org.

    North Carolina Mental Hope, 10 Timberleaf Drive, Fletcher, NC 28732.

    N.C. Mental Hope aims to bring attention to the needs of people with mental illnesses by working with the media, the public and policymakers. Its Web site includes regular news updates and the NCAdvocacy discussion group, a network of more than 100 advocates across the state.

    www.ncmentalhope.org.

Lynn Bellmore was 11 when she tried to kill herself the first time. At 35, she was formally diagnosed with major depression, then bipolar disease.

At 37, she began the treks in and out of Holly Hill and other psychiatric hospitals.

She describes her illness this way:

"When I'm not on meds, my mind is going so fast I can't get a thought together. It's like a pinball machine in my head."

Bellmore, now 51 and living on disability in Cary, is one of the estimated 1.7 million people in North Carolina who suffer some form of mental illness. That's nearly 21 percent of the state's population.

With limited insurance and no income, Bellmore is like thousands of residents with severe disorders who are in need of help from a teetering mental health system that remains underfunded, without clear political leadership driving it to more sure footing.

The system has been in flux since 1999, when the U.S. Supreme Court ruled that states should provide care for people with mental illness and developmental disabilities in the least restrictive settings possible. In most states, that has been interpreted to mean that patients should be moved out of long-term psychiatric care into community-based programs.

In North Carolina, the legislation setting this transformation in motion passed the General Assembly and was signed into law by Gov. Mike Easley in 2001.

But six years later, its implementation is still being hashed out. The National Alliance for the Mentally Ill recently gave the state, and its reforms, a grade of D+.

Some counties have moved more quickly than others to privatize community-based care.

In several counties, including Forsyth and the system encompassing Franklin and Granville, the "reformed" mental health services have collapsed under the weight of offering care for the sickest of patients.

Most recently, the privatized care system in Western North Carolina went under, leaving thousands of patients without a safety net and drawing the interest of state auditors, who have expanded their investigation to mental health reform.

Meanwhile, advocates for people with mental illnesses (and those with mental illness themselves) are wondering who will guide the system through the months and years ahead.

Will it be the governor?

Gov. Mike Easley's proposed $20.1 billion budget for 2007-08 sets aside $3.5 million in increased funding for mental health substance abuse and crisis services.

David Cornwell, an advocate who operates ncmentalhope.org, noted that only seven items ranked lower in a list of those targeted for increased funding in the governor's budget highlights.

"On the bright side," Cornwell quipped, "community services was just nudged out by the $3.6 million to run the state's ferry system."

Will it be the legislature?

The General Assembly has indicated it will take another look at mental health reform this session. But it may wait until the state auditor issues his report.

Will the leader be Carmen Hooker Odom, head of the Division of Health and Human Services?

In 2001, it appeared Odom would be the woman out in front.

But changing such a complicated system has proved more thorny than even she might have expected.

Key obstacles remain:

  • A crucial element of reform is closing psychiatric hospitals, but admissions keep going up.

  • Community care is not expanding as quickly as the need for it is. Meanwhile, advocates fear a lack of oversight to make sure group homes and others are providing safe, appropriate care.

  • Insurance companies are not required to provide the level of care for mental illness that they do for physical ailments.

    Bellmore said she is convinced that ignorance about mental illness is to blame. Lawmakers and bureaucrats don't know what it's like on the street, she said.

    "They don't get it," she said. "They don't care, and they're uneducated about it."

    Bellmore recently bought a single month's worth of medication for bipolar disorder and the anxiety and depression it causes.

    But she said she cannot afford the medicine every month. It costs more than $900 for a 30-day supply, about two-thirds of the $1,344 she receives from Social Security each month.

    What hurts most, she said, is that people treat the mentally ill differently from people who suffer other illnesses. "If somebody has cancer, do you just walk up to them and say, 'Get over it?' "

    Bellmore recalled how her own mother once asked her: How can you be so intelligent and so beautiful yet so sick?

    "Mom, believe me," she replied. "I didn't choose this."

    Ruth Sheehan can be reached at 829-4828 or rsheehan@newsobserver.com

    Ruth Sheehan can be reached at 829-4828 or rsheehan@newsobserver.com

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