Dan Barkin

Series touches a nerve

Staff WriterMarch 1, 2008 

Our stories this week on the problems of the state's mental-health system tapped into an intense public policy debate that has been going on since the state decide to "reform" the system earlier this decade.

That's my conclusion after looking at the forum at share.triangle.com/mentaldisorder.

You get the feeling from reading the remarkably detailed posts that we stepped into a vast hall full of people who have been arguing vociferously about the mental-health system: State and local government employees, mental-health providers, families, academics. It is a debate that doesn't typically get as much attention, say, as school reassignment. And if you aren't steeped in the details of the system, you may need a glossary to keep up.

What has struck me about the forum is the length and the thought that has gone into the posts, which had drawn more than 5,900 views from people who clicked on them as of Friday afternoon. One of the headlines on a post was the poignant "I can't take it anymore," written by the mother of an ADHD and bipolar son. On my desk, I have a stack of the posts, printed out. Some of the comments run for several pages. Here are some of the points that have been made.

* There's too much red tape in the system. Forms and more forms. One provider says one form has changed five times, and each time it changes, 400 employees need to be trained in how to fill it out.

* State mental hospitals are unsafe places to work, according to front-line employees. As the state has come under increasing pressure to reduce the incidence of patient injuries, some workers say that their safety is a secondary concern.

* The state hasn't provided enough training for service providers.

* North Carolina should look at states that do a good job of providing mental health services and copy their practices.

* As bad as things might be for the mentally ill in urban areas, those in rural areas have a harder time getting access to services.

Some of the most useful insights in fixing the system come from parents, siblings and children of the mentally ill, because they live with the challenges of caring for a loved one.

A number of the most compelling posts in the forum come from moms and dads detailing how the system has let their children down, how their kids bounced in and out of short stays in institutions and, in one case, wound up on the streets. One woman worries that her daughter, who has attempted suicide, will not live to see 30.

These are painful -- but incredibly informative -- to read. One suggestion that was made: Anyone in a senior policymaking position (like a governor, lawmaker, Cabinet secretary) should get involved with a family trying to get services for a suicidal spouse, or an anorexic child, or a schizophrenic sibling. See firsthand what that experience is like, and then design a system that would make sense for these cases.

It is traditional in a column such as this to say something like, "This forum would make useful reading for candidates running in this year's election." And it would.

I am realistic enough to know, however, that seldom do candidates see much political upside in vowing to provide better services to the mentally ill. Typically, you'll see candidates promising to fill more prisons.

Now, no one who knows me would ever say that I am soft on crime. But I was impressed by one point made in the forum: It is wiser to provide good mental- health services early on so we can avoid having to keep building costly correctional facilities for the many prisoners who are mentally ill.

That strikes me as something a smart politician could run on.

dan.barkin@newsobserver.com or (919) 829-4562

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