Few gains yet for the state's mental health

RALEIGH -- We have now seen the 2004-05 Annual Report of the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services, "Transformation: A Commitment to Make a Difference." Twenty-four pages, pretty graphics and filled with good intentions.

But five years into North Carolina's failing mental health reform, good intentions are not enough. And the state's own report bears this out.

The Annual Report lists nine "major accomplishments," "turning points" -- and not one addresses what is happening to real people, whether patients or staff. Six of the "turning points" are bureaucratic, on the order of signing performance contracts and completing service definitions (greatly delayed, as the Annual Report neglects to mention). The other three are inspecting children's group homes (in response to scandal), developing a database and starting the construction of the new hospital in Butner. The Annual Report does not mention that on the day it opens the new hospital will be too small by at least 100 beds -- and some say 200 beds.

According to the report, "In state fiscal year 2004-2005, the public MH/DD/SAS system served 330,083 people with community services; that is 15,777 more individuals than in the year [2000-01] the transformation legislation was enacted." But while the system served 5 percent more people, North Carolina's population went up 5.8 percent. The MH/DD/SAS system was not able to keep up with the state's population growth.

The Annual Report reveals a 16 percent decrease in per capita mental health spending, from $16 per capita in 2002-03 to $13.39 in 2004-05, further evidence of the state's declining and inadequate support for mental health.

And now the preferred term for Reform is "Transformation...to reflect the dismantling of the old public system and the full and complete replacement by a new organizational structure."

Thus "transformation" means the destruction of the old mental health system. This leaves our patients and us in a quandary. What happens if the new structure isn't quite in place as the old system is being "dismantled"? Won't staff and continuity of care be lost; won't patients be harmed?

In fact, this is exactly what is happening right now, around the state.

If good intentions were all that was needed to improve care for those in need, the Division of MH/DD/SAS would have fixed everything long ago. But what North Carolina needs most is real accomplishment that improves the lives of real people. This Annual Report makes clear that the state has little of that to report. This report provides scant comfort for a mental health system that in reality has inadequate resources, fraying infrastructure, demoralized staff and patients going without care.

(Margie Sved, M.D., is president of the N.C. Psychiatric Association. The division's Annual Report can be accessed at http://www.dhhs.state.nc.us/mhddsas/)