The cost of reform

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CORRECTION

An editorial Wednesday about the costs of a new mental health program emphasizing community-based care by private providers incorrectly characterized the program as serving only the Charlotte area. In fact, it has a statewide scope, so the additional costs involved are being incurred statewide.

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State investigators are right to delve into the finances of a new Charlotte-area mental health program that serves more clients, by a relatively small percentage, than the program it replaced, but that costs $20 million more per month. The program understandably has raised the eyebrows of state Rep. Verla Insko of Orange County, who is one of the legislature's best informed members on the subject of mental health treatment.

The aim of Mecklenburg County's new program, run mostly by private firms, is to help clients toward self-sufficiency. That is an objective at the heart of what has been North Carolina's fits-and-starts attempt at mental health care reform. For nearly a decade, the state has been -- or was supposed to have been -- moving in the direction of getting the mentally ill out of long stints in big, centralized hospitals and into smaller programs closer to their communities.

The implicit goal, of course, is faster healing for hurting North Carolinians. They would be closer to supportive family and friends. Patients who get better sooner would be in a better position to get jobs and live independently.

But this change in treatment approach has proved neither easy nor cheap. Existing programs must be shut down and new local programs built, often from the ground up. They may have to go through periods of testing for effectiveness. State hospitals need to be reconfigured in keeping with their evolving mission.

The hoped-for payoff is that in the long run, money will be saved. Expensive hospital care, while it can't be eliminated, will give way to less costly local programming. Patients will be better off.

Critics of the Charlotte program say that companies are extending services -- personal aides who help clients build skills such as grocery shopping, house-hunting and searching for jobs -- to pad their invoices. The claims should be aggressively investigated. But state policy-makers should recognize that to make reform of the mental health system succeed, a large investment may need to be made in the short term to save money -- and help the mentally ill advance -- in years to come.