Serious mental therapy fades

Reforms aimed to scale back the role of state mental hospitals. Now people with severe needs are left without care

Johnnie P. Yarborough, a Raleigh crack addict with bipolar disorder, was admitted to Dorothea Dix Hospital 14 times in 2006 for short-term stays that did nothing to improve his mental health.

His frequent hospital admissions came despite a new state goal of reducing mental patients' reliance on hospitals in favor of outpatient care. Under the new philosophy, he should have been helped in a treatment center -- and someone at Dix would have helped get him there.

But each time, he stayed at Dix a day or two, maybe three, before he was discharged to the street or to a homeless shelter.

He'd show up again, asking to be locked up. Doctors said he needed long-term drug treatment, but social workers couldn't help him find any.

North Carolina's 2001 mental-health reforms aimed to make its mental hospitals places of last resort and to have as many people as possible seek treatment near their homes.

But that new network of local help, provided by private companies seeking profits, is dominated by a service called community support, which sometimes is as basic as escorting someone to the mall.

People needing more serious care are often left to fend for themselves -- or have had to enter one of the overwhelmed state facilities that nearly everybody wanted to close or reduce in size.

Signs that reform has failed:

* Spending on community support has consumed 90 percent of community mental-health spending. Only 4.9 percent has been spent on more intensive outpatient therapy.

* Spending on traditional therapy offered by licensed counselors declined 12.4 percent between 2005 and 2007. State officials wanted to de-emphasize office-based treatment, but doctors and counselors say it's generally more effective than the community programs that replaced it.

* State psychiatric hospital admissions have increased, and more patients have used the hospitals for short stays, which stabilize patients in crisis but have less therapeutic value. In the 12 months ending in June, 8,805 patients, more than half of all patients discharged from state hospitals, stayed a week or less. Six years ago, less than a third of those discharged, 4,881, stayed a week or less.

* Mental-health admissions to hospital emergency rooms increased 6 percent this past July, August and September compared with the previous three months, according to a state report. Another study last year cited "anecdotal reports" that more people with mental illness, unable to get adequate treatment, are going to jail.

* The state Department of Correction said in August that over the past five years, there has been a "steady increase" in the number of inmates with severe and persistent mental disorders.

State Sen. Martin Nesbitt Jr., an Asheville Democrat who has been involved in writing mental-health laws for four years, said the 2001 restructuring was seriously flawed.

"I don't think the initial package had the thought that it needed," he said. "The details weren't there. And some of the assumptions that they made on how it would progress were faulty by their very nature."

In again, out again

Yarborough, 47, was a regular at Dorothea Dix Hospital. The Louisburg native was addicted to crack cocaine and had been diagnosed at different times with major depression and a mood disorder.

Since 1994, Yarborough has been in state mental hospitals and drug treatment centers 33 times, sometimes getting help but never getting well. He spent nine years bouncing among relatives' homes, homeless shelters, jail, halfway houses and drug treatment. In 2006, the frequency of his hospital admissions increased.