Report suggests fixes for mental health system

Staff WriterOctober 9, 2008 

A report on the state mental health system says efforts to improve care have failed, citing high suicide rates, increased involuntary commitments and demands on sheriffs' offices to drive patients to hospitals.

The report by Ann and Gerry Akland, members of the Wake County chapter of the National Alliance on Mental Illness, offers a list of recommendations for improving the system. Among them: adding psychiatric hospital beds, making it easier for deputies to drop off patients at hospitals and better reporting of hospital information.

In the last few years, news reports and studies have chronicled the failure of the mental health system. Not enough community-based treatment is available for people with serious mental illnesses, and the federal government frequently cites state psychiatric hospitals for poor care that endangers patients.

The Aklands started out looking for success stories that could be duplicated around the state. But the information was so full of holes, Ann Akland said, "You couldn't determine what was working and what wasn't." She is a former president of the Wake advocacy group and a vocal critic of the decision to close Dorothea Dix, the state psychiatric hospital in Raleigh.

The couple decided to compile information they could find in public records and in interviews with sheriff's departments to develop a picture of the state mental health system. They found that 87 percent of sheriff's departments said they were spending more time transporting and sitting with patients in hospitals. Sheriffs estimated that the cost in deputies' time was at least $3.7 million a year.

More than half the state's counties have suicide rates higher than the national average.

Mentally ill adults without private insurance cannot find hospitals near their homes that will admit them, the report said. More than 1,150 Wake County residents with mental illnesses or substance-abuse problems were transported outside the county for care, Akland said, and they were sent to all corners of the state.

The Aklands recommend that the state require for-profit and nonprofit general hospitals to set aside beds for psychiatric patients if those hospitals want permission to add more lucrative services.

The state budget includes money to purchase space in local hospitals for mentally ill patients, but the $8.1 million will purchase fewer than 100 beds this year.

State Rep. Verla Insko, a Chapel Hill Democrat who helps lead a legislative committee on mental health, said she would support requiring hospitals to accept mentally ill patients, but other legislators wouldn't consider such a law.

"It's so controversial," she said.

The system's central flaw, Insko said, is the lack of community services. Legislators envisioned a system in which care would be available close to patients' homes, but it's often not available.

As an example, she cited the state's decision to cut what it pays for heralded community treatment for people with severe mental illnesses.

"We're not putting the pieces of the puzzle together," she said.

lynn.bonner@newsobserver.com or 919-829-4821

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