Point of View

The wide cracks of mental health care

January 4, 2013 

In the wake of the Newtown, Conn., shooting, there has been a predictable uptick in public discussion of mental heath care and treatment. It is natural that we all want an explanation, some way to fit this terrible story into the way we think about the world.

In an effort to make sense of the heartbreaking loss of life, we are tempted to list all the ways in which a perpetrator of violence is different from us, different from the people we love and different from the members of our own community.

But the truth is there are people in all of our communities, and in many of our families, who need and want treatment but can’t access it. It is a sad reality that many of our systems of care are under resourced. The result? Mental health services are not always reliably available to those in need.

So instead, we keep asking, “Why didn’t someone see the warning signs? Why didn’t someone do something?” It is very likely someone did notice – a parent, a sibling or other family member, a teacher, a classmate or co-worker. And that person very likely did try to do something – but was faced with insurmountable barriers.

The reality is there is a lack of affordable, accessible, preventive and coordinated community-based mental health services. Necessary services for people with challenging behaviors are very hard to find. The toll on families and on the individual with mental health needs is devastating.

Look at what we’ve done to our public mental health services in North Carolina.

In providing mental health care services, North Carolina has systematically shifted focus to cost control rather than outcomes. Though it is called “managed care,” it would more accurately be called “rationed care” so long as the primary goal is saving money rather than meeting the behavioral health care needs of our communities.

The N.C. model has eliminated case managers who helped develop a network of services. This model is likely to result in more people falling through the cracks.


The N.C. General Assembly hears report after report about how much money is being spent or saved but rarely learns about what that money buys. The focus is on the cost of services for people living with a mental illness with very little discussion about the long-term cost to our communities when necessary services are unavailable.

Service definitions are developed with an eye to controlling the “woodwork effect,” the result of too many people becoming eligible for a service that they need. The consequence is crises like that looming in our Personal Care Supports service.

Disability Rights NC represents individuals who are desperate to get help to feel safe and to survive. We represent many families who are frantically trying to get help for their troubled children.

The shooter in Connecticut was only 20 years old. In our state, he could have already fallen through cracks in the service delivery system – too old for services for children and youth programs and too young for the adult service system, both of which are riddled with gaps. We must do better.

In North Carolina, let us not fall into the easy trap of stigmatizing people with mental illness. People with mental illness are us; they are part of our families; and they are part of our communities. Let us respond to tragedy with compassion and a common sense approach to treatment that includes accessible, affordable services to promote recovery and community integration.

Vicki Smith is executive director of Disability Rights NC.

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