To lift the weight from mental hospitals, state officials have pushed local mental-health administrators to build their crisis services. A county could use a local public hospital for patients who need short-term psychiatric treatment, or it could open a smaller clinic.

Crisis services have been slow to develop, although a number of counties have put them at or near the top of their list of needs.

Patients in Caswell County, for example, depend on a center in Yanceyville. Their other option is to go to Rockingham or Alamance counties.

The region called Five County, which includes Vance, Franklin, Halifax, Warren and Granville counties, is looking for a company to help build and manage a 24-hour crisis center.

A mobile crisis team -- akin to a mental-health ambulance -- answers crisis calls in four of the five counties, and Halifax Regional Medical Center does some crisis work.

Many people in trouble end up in hospital emergency rooms.

The local office that covers Cleveland County wants a locked crisis and detox center there. Patients now go to a crisis center in Gaston County or a unit run by Kings Mountain Hospital in Cleveland County.

Rural areas don't provide enough customers to make it financially worthwhile to offer intensive or specialized therapy, said Yvonne Copeland, executive director of the trade group that represents local mental-health offices.

The amount the counties are willing to chip in for mental-health services determines what help is available, Copeland said.

County contributions to local mental-health budgets vary widely, from Mecklenburg's high of $42.9 million a year to a few hundred thousand a year for some rural areas.

Wake County has budgeted $10.6 million for mental health; Durham County, $7.7 million; Johnston County, $1.7 million. Orange County budgeted $1.3 million as a contribution to its region, which includes Person and Chatham counties.

"You find good services in areas where there are good local contributions," Copeland said.

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