From the Editor

Drescher: On mental-health care, serious work remains

Executive EditorMay 31, 2013 

The largest mental institutions in North Carolina aren’t the state psychiatric hospitals in Butner, Goldsboro and Morganton. Our largest mental institutions are county jails and state prisons.

An estimated 15 percent to 20 percent of jail and prison inmates are believed to have a serious mental illness. That’s about 9,000 detained people in North Carolina – most of whom eventually will be released. That’s 10 times more mentally ill people than the 850 beds in the state mental hospitals.

In the last decade, as North Carolina’s population grew by more than 1 million, the state has cut the number of beds in the three hospitals by half (from 1,750). The state mental hospitals went from treating 16,789 patients a year to 5,754 a year, according to the nonpartisan N.C. Center for Public Policy Research.

That has left mentally ill people crowded into adult-care centers, local hospitals, jails and prisons. The News & Observer’s Craig Jarvis recently reported on the case of James Taylor Jr., 46, who is bipolar. Taylor’s parents called Raleigh police in January to commit their son to a crisis center. Instead, he was taken to jail and charged with assaulting his father and a police officer.

He spent three months in jail before finally receiving a psychiatric evaluation from Central Regional Hospital in Butner. Taylor has returned home to live with his parents.

Private providers

North Carolina has struggled with its mental-health system since the U.S. Supreme Court ruled in 1999 that states had to treat people in less-restrictive settings. After cutting beds, the state has strained to build a network of community treatment options.

In December, then-Gov.-elect Pat McCrory said: “Frankly, we have a broken mental-health system in our nation and in our state. We’ve got to do some serious work to close those deficiencies.”

I asked McCrory’s staff how he proposed to fix the mental-health system. They pointed to McCrory’s plan to overhaul the state’s Medicaid program by having managed-care companies offer plans that cover physical and mental-health needs.

The coordination of mental and physical care is a worthy goal. But the state’s track record in hiring private providers for mental-health treatment is dismal. North Carolina wasted more than $400 million when it relied on private companies for community-based care, The N&O reported in 2008. If McCrory wants to rely on private providers, the state will have to manage them better than it has in the past.

Leaders’ interests

McCrory’s staff also said his proposed budget increases funding for mental health. It adds $17 million or about 2.5 percent. By contrast, the Senate budget cuts mental-health spending by 3 percent after several years of cuts.

Neither Senate leader Phil Berger nor House Speaker Thom Tillis, each in his third year of leading his chamber, seems interested in this issue. Improving mental-health care and delivery isn’t a path to higher office.

If we are to truly reform our mental-health system, it will have to come from the governor’s leadership. McCrory first ran for governor five years ago, so he’s had plenty of time to think. In his campaign for governor last year, he was better at talking about problems than solutions. That was perhaps expected from a candidate who ran as an outsider who would clean up Raleigh.

But now McCrory is governor. Whether he wants to or not, he owns the state’s mental-health system. His appointees will run it. He said “some serious work” needs to be done. Based on his modest proposals thus far, serious work remains.

Drescher: 919-829-4515 or On Twitter @john_drescher

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