Landry: NC should get out of mental health care business

November 26, 2013 

There is seldom any good news about mental health care and the treatment of addicts in North Carolina. Many experts and relatives of the mentally ill denounce the state for failing to provide adequate care, facilities and programs for the mentally ill and those addicted to drugs or alcohol.

On the other hand, reviews of the state’s efforts at mental health care reform that brought treatment closer to the community have concluded that the mentally ill were poorly served and that millions of dollars were wasted.

In short, the state is wasting a lot of taxpayer dollars giving poor and inadequate services to a significant number of its residents in need of medical care.

No one ever asks the question that strikes me as being basic: Why is our state providing mental health care and treating addicts when it has no such programs or facilities for people who are suffering from heart disease, cancer, diabetes or any other type of physical illness and when our state has most definitely not demonstrated any great skill or aptitude at doing so?

I can think of two explanations.

In less-enlightened times, the mentally ill were essentially warehoused for their own protection and that of the rest of society in institutions called asylums. Housing the mentally ill became a state function in much the same way incarcerating criminals did. The state merely substituted a diagnosis or medical opinion for a sentence.

The other explanation is somewhat less historical. The delivery of medical care in our country has evolved in a rather haphazard way with many different delivery systems serving different constituencies.

Governments serve the poor, the elderly, the military and the mentally ill. Those constituencies have one thing in common: Health insurers are not interested in serving those segments of the population.

The poor are never an attractive market for any service. The elderly, the military and the mentally ill have or are likely to have a greater than average need of medical services. As such, health insurers don’t see them as profitable and have yielded to governments the function of providing them with health care.

With the enactment of Mental Health Parity and Addiction Act of 2008 and the Affordable Care Act of 2010, mental illness and addiction treatment are to be treated on an equal footing with physical disease and injuries in most health insurance policies.

Since most North Carolinians will be required to have health insurance that covers mental illness and addiction treatments without lifetime limits, those who need such care or treatment should be in a position to seek it in the same way as the physically ill.

The state of North Carolina currently owns and operates three psychiatric hospitals in addition to its three long-term substance abuse facilities. It also purchases services on behalf of the mentally ill and addicts from hundreds of providers.

I see the enactment of the Affordable Care Act and its mandates as a historic opportunity for the state of North Carolina to disengage itself from providing services it appears to be singularly unable to deliver in an effective way for the patients and in a cost effective way for the taxpayer.

I am not advocating that the state immediately put up “For Sale” signs at all of its mental health facilities or cease providing services to the patients currently under its care. However, society’s views of mental illness and addiction treatment are evolving, and the law is evolving as well. North Carolina should catch up so that, over a period of a few years, the distinctions between physical and mental illness disappear in fact and practice as they have in law.

Those who speak for the mentally ill and those addicted to drugs or alcohol are quick to say that those are diseases, just like cancer or diabetes. I agree.

To those who would argue that there is something unique and peculiar about the mentally ill and addicts and their treatment, I would reply that Washington has addressed the question and has decided otherwise.

Contributing columnist Marc Landry can be reached at

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