DHHS chief: Mental health fix needs better tools

Ed Masters of Rocky Mount gets calls every month or so from parents asking for his help at a magistrate's office or a hospital getting a mentally ill adult child committed to an institution.

In many rural North Carolina counties, the first place to turn when symptoms of mental illnesses begin to overwhelm patients is a sheriff's office or people such as Masters, a volunteer advocate for the mentally ill.

Help is on the way, in the form of $20 million the General Assembly recently approved to help provide more local services. But before the first dollar is spent, an ongoing power struggle between the state and the local mental health offices has state administrators warning that the effort could fall short -- and will be legislators' fault if it does.

Regional mental health offices, run by local boards, have struggled for years to find enough doctors and psychologists to offer high-level services to the sickest people. In 2001, the state forced local offices to stop treating patients. As a result, the state never achieved a central goal of the 2001 reforms: to have fewer people admitted to state mental hospitals.

Once local offices stopped offering treatment, some patients with severe mental illness lost contact with psychiatrists on the public payroll and clogged local emergency rooms instead. State mental hospital admissions boomed, and the hospitals' short-term wards filled with people who could not find care near their homes.

Now the legislature has given the state Department of Health and Human Services about $5.75 million to help pay for 30 mobile crisis teams, a service used to calm volatile patients and take them to hospitals or clinics. About $14.2 million will be used to buy space in local hospitals for psychiatric patients and to start mental health clinics where people can seek care after they leave hospitals.

"I think it's an excellent move," Masters said. "It's a lot better than locking somebody in jail."

Dempsey Benton, state Department of Health and Human Services secretary, warned that legislators did not give his office the power to ensure immediate improvements.

"If problems emerge in those areas for which we requested the ability to have an immediate service impact, it will be through a lack of the legislative and administrative tools we sought from the General Assembly," Benton said in a written statement.

Faster action sought

In an interview, Benton said he wanted legislators to allow the state to more quickly take powers away from local offices that don't do a good job. The Easley administration complained for months that it took too long -- nine months -- to take jobs away from local providers who weren't getting proper services to needy patients. After three months of poor performance at a local office, the state had to offer six months of tutoring before taking over.

The legislature responded by giving local offices six months rather than nine months to improve. Benton said that's still too long.

"They should be able to carry out these functions," he said. "We're at a point where we need to see performance within a reasonable period of time or shift that responsibility" to another local office."

The extra money and responsibility going to local offices heightens the department's concerns about local performance.

"Are we concerned? Yes," said Dr. Michael Lancaster, co-director of the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services. "The legislature has given us a great opportunity to build a strong system. We don't want this to slip."