Fixing this mess won't be cheap or easy. It will require the focused attention of the next governor and General Assembly.

This must be a front-burner issue, one that we make sure candidates for office address in this election year. Projects like NCMentalHealthVote.org are working to make this happen and deserve your support.

It requires that the best possible professional leadership be recruited to fill key posts in the Department of Health and Human Services and the Division of Mental Health.

That leadership needs to be able to learn from our experience with "reform."

The safety net must be restored.

This means that everyone must have access to a publicly funded safety-net clinic or clinical home where psychiatric assessment and treatment services are available.

For this to happen, the design of the mental health/substance abuse system must start with the clinical needs of very ill people.

Policymakers must stop trying to make the clinical needs of sick people match the contortions of multiple funding streams because, inevitably, people without insurance or Medicaid are left without services.

Funding schemes must support clinical needs, not the other way around.

Substance abuse treatment, including medical detox services, must be expanded dramatically throughout North Carolina.

This should be very attractive to politicians, since money invested in substance abuse treatment yields high returns -- reducing human suffering, mental health costs and crime.

The clinical work force must be restored.

Clinical homes must be designed so clinicians can work in a clinically viable setting with financial stability.

For example, when psychiatrists are in short supply, they will not work in the "prescription mills" demanded by so many private providers.

Psychiatrists and other mental health professionals need to work in settings where they can provide high-quality care to those with serious medical and psychiatric conditions.

The state's leaders must understand that the imperatives of privatization and the imperatives of a safety net are, to a large extent, mutually exclusive.

We have learned that the free market will not provide services for very sick people without money.

In an unfettered "any willing provider" environment, there can be no safety net. You must have a clinical home where patient care is coordinated and provided.

And, to repeat, it won't be cheap. The solution will cost hundreds of millions of dollars.

This series has taught us that the state is already spending that money. Let's spend it wisely and effectively.

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