The state is failing to make sure mentally ill children who have other disabilities get proper care, an advocate's report said.
Disability Rights North Carolina used stories of children left in emergency rooms for weeks and bounced from one hospital to another to illustrate the problems families face when they have mentally ill children with learning disabilities or autism.
"We have a fractured system with little accountability or continuity," Executive Director Vicki Smith said. "This state is entirely dependent on private providers who must focus on the bottom line in order to do business."
Families need more help keeping children at home and more special foster homes where children can live with adults specially trained to help them, she said.
Justin Hurd, 17, lives in an assisted living home in Asheboro, about 45 miles away from his parents in Burlington. John Hurd, Justin's father, said his son spent three weeks in a hospital emergency room last fall because it took that long to find a place that would accept a mentally ill teenager with autism.
"State officials can't tell you who to go to," John Hurd said.
Justin thought he was going to start supervised employment but ended up disappointed when the plan was abruptly canceled, his father said. The teenager now spends all day in his room doing nothing.
Hurd said his son has had good care, including 14 months in a center in Virginia and a few months at the Murdock Developmental Center in Butner. But all the best places were for short terms.
"He needs to be in a group home for people in his age group," Hurd said.
The state mental health system relies on private providers to offer mental health services and coordinate care paid for with public money.
In the next few years, the state mental health system will take on more features of managed care, with local mental health offices working with set budgets as they coordinate care for patients.
The state has been working to track the 600 or so children with complex disabilities living in special psychiatric facilities, said Michael Watson, a deputy secretary at the state Department of Health and Human Services. The state is looking at the treatment they're receiving and how much it costs. About one-third of the children are in treatment facilities outside North Carolina. The department wants to encourage development of specialized programs in the state and move as many children as possible from out-of-state treatment centers back to North Carolina, he said.
Changes coming to the management of mental health care will help those children, Watson said, because local offices will work to keep them stable and at home or in other community settings rather than have them end up seeking more expensive hospital treatment.
The state may also have to reconsider regulations that discourage facilities from accepting high-risk patients, Watson said.
Finding specialized mental health care is a problem for families in rural areas.
Rochelle Palacios' son Nate, 10, was involuntarily committed last September to Central Regional Hospital in Butner, five hours away from their home in Mitchell County.
Palacios had trouble getting her son into a residential treatment facility closer to home. With his mother caught in a legal dispute with Central Regional and her local Department of Social Services, Nate ended up in the hospital for more than two months.
Palacios said she was astonished during one visit to find bruises on her son, who has Asperger's syndrome and a mental disorder with symptoms of excessive anger. He told her the staff had physically restrained him. She took pictures of the bruises.
DHHS said that it could not discuss individual cases but that it takes seriously every allegation of abuse, neglect or poor care.
According to Disability Rights, which was involved with the case, Palacios has appealed the results of an internal investigation that determined Nate was not abused. Her son is now at a treatment facility in Asheville.
Palacios described the months Nate was in Central Regional as "terrifying," with weeks spent trying to get her son discharged and borrowing money for gas to make the long drive to see him.
"I've been put through the wringer because of it," she said.