CHAPEL HILL - The General Assembly's determination to build three new mental hospitals -- at Butner, Goldsboro and Morganton -- indicates to me that we have now come full circle in mental health services in North Carolina.

About 40 years ago, during the Terry Sanford administration, our state gained national prominence as a model of reform for services for persons with mental illness and mental retardation. This came when we "deinstitutionalized" the mental health service system and moved from a few mental hospitals to a 41-multi-county-area system. It included special Mental Retardation Centers strategically located around the state, backed by local diagnostic, rehabilitation and training programs.

These programs were mostly supported by state and federal funds. Sanford's leadership and subsequent support in the Scott, Holshouser and Hunt administrations brought services to a level of penetration and access no longer enjoyed by our families and communities.

Instead, we have a meltdown in services from our attempts to reduce our tax base and privatize human services in a probably well-intentioned but ill-advised effort to "reform our system for the 21st century."

Now we have two dozen or so "local management entities." This is corporate-speak for "who's on first?" on mental health and developmental disabilities issues. These non-entities are underfunded, understaffed and underhoused for their "customer groups'" needs. Now we are returning to the 1950s strategy of building new multi-floored hospitals, away from the major population areas, and apparently because of the much-needed jobs and the economic jolt that the construction of this archipelago would provide.

No mistake -- residential care and treatment are badly needed as key parts of a mostly community-based service system, but they need to be downsized and more widely distributed and clearly connected to regional coordination centers with the resources necessary to carry out their missions.

And forget privatization. There is no profit in human service. If there is, we have another kind of problem.

(Don Stedman, Ph.D., is a senior fellow with Action for Children N.C., dean emeritus in education at UNC-Chapel Hill and, until his recent resignation, a long-time member of the N.C. Commission on Mental Health, Developmental Disabilities and Substance Abuse Services.)

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