It's time to redirect focus to original intent of reform

Vicki Smith is the executive director of Disability Rights North Carolina, the state's federally mandated protection and advocacy system.

Disability Rights North Carolina doesn't hear from individuals who are having their needs met. We hear from people with mental illness, substance addictions, developmental disabilities or traumatic brain injuries. We hear from people who are difficult to serve, abused or neglected, and folks who are falling through the cracks.

For these people, no community safety net exists. They're forced to rely on the limited resources of first responders whose job is law enforcement, not treatment.

Then, if they're lucky, they'll be admitted to overcrowded facilities for a stay that will most likely result either in a premature discharge or an extended stay due to a lack of appropriate community services. If unlucky, they land in jail or prison. Tragically, this includes children.

In a report to the General Assembly on the state of North Carolina's mental health reform, Dr. Alice Lin stated "... the existence of authority does not make or break a reform, but a shared commitment and willingness to set aside power or turf battles for the sake of the common good would."

North Carolina's reform has not resulted in an exchange of ideas, problem-solving or even ownership of problems; instead, there is finger-pointing and blame.

Blame is plentiful enough to go around. But now is the time to stop looking for a scapegoat and focus on reform's original intent -- creating a comprehensive array of services from institutional to community-based care.

Establishing clear lines of accountability is the first step. Accountability starts and ends with the executive branch. Therefore, the state must establish and enforce:

* Clear criteria for effective clinical and fiscal competencies for local groups managing mental health service. They should get incentives for providing good care and should be penalized when they fail.

* Free-standing, independent case management that becomes the first line of accountability.

* Standard protocols for mental health care to ensure consistent treatment of both providers and patients.

* Minimum state standards for services that allow rural or urban communities flexibility to meet their unique situations.

* Direct responsibility for services, ensured effective case management and step-down components for people with complicated diagnoses.

* Equity for Medicaid and non-Medicaid providers so consumers get the same level of acute and long-term services.

* Local accountability mechanisms that authorize an independent local body (perhaps the Consumer Family Advisory Committee) to monitor services and correct local problems.

* Authority for state officials to take over local programs when groups perform badly.

Finally, the legislature must pass a Bill of Rights for people with disabilities receiving services from the state. Ultimately, fixing service delivery problems for all people with disabilities cannot be about saving money. It must be about saving lives.