The history of mental health care reform in North Carolina is an agonizing one. A so-called overhaul of the system was nothing short of disastrous, a costly failure in 2001 plagued by inefficiency and virtually no improvement in treatment.
The state’s crisis has been mirrored in other states as well, with fewer psychiatric beds in treatment centers and a large number of mentally ill people in jails or on the streets, undiagnosed, untreated and getting worse.
U.S. Rep. Tim Murphy of Pennsylvania, a practicing psychologist, came to North Carolina this week with Republican Rep. Renee Ellmers of North Carolina’s 2nd District to tout his own mental health care reform package. Murphy, a Republican, believes the $130 billion or so in government money that goes toward mental health treatment is virtually unaccounted for and that those who receive the money are focused on retaining their funding rather on finding better options for care.
Reform, he says, isn’t just about funding. It’s about examining “systems that work and what doesn’t work,” he said in a meeting with News & Observer reporters and editors.
Newtown was the impetus
Murphy’s ideas – which Ellmers, a nurse, endorses – have virtue. Among them are focusing government funding on the most seriously ill patients and using treatment programs that have demonstrated positive results. He also wants to make it easier for patients to get the medicines doctors want to prescribe.
The congressman says he was spurred to action by the Sandy Hook Elementary School shootings in Newtown, Conn., in 2012, when 26 people, including 20 children, were killed by a 20-year-old man with a history of mental illness. With intervention and care, Murphy believes, that incident and others, so many others, might have been prevented.
One aspect of the congressman’s proposal has run into some opposition. He wants to require states that receive federal money for community mental health treatment to establish “assisted outpatient treatment” laws, under which judges would be allowed to order people into treatment. Opponents object to forcing people into medical treatment.
Frankly, Murphy has a pretty good answer for them: “Why would we say, ‘We know you have a deteriorating brain disease, but we’re not going to help you until you kill someone?’” Murphy said. “Why would we have that standard? It’s a perverse and inhumane standard to have for people.”
Indeed, at Duke University, one of the places Murphy visited while in the state, researchers have shown that in North Carolina, patients who were required to have treatment had 57 percent fewer hospital readmissions than others who were not required to have care. Duke also found that in New York City, the costs for mental health care patients dropped by half in the first year that assisted outpatient care began.
Vicki Smith, a powerful advocate for Disability Rights North Carolina, makes a salient point, however: It doesn’t do any good for judges to have the ability to order people into treatment if there’s inadequate treatment to be had. The state, she says, doesn’t have enough help for people who aren’t in a crisis yet but might be.
Exactly. Murphy has some good ideas here. But state officials have to do more to commit to solving this problem, and the efforts ought to be, as is Murphy’s bill, bipartisan. We know that there are too many mentally ill people in jails who ought to be in treatment or mental health facilities. We know that there is a substantial number of mentally ill people among the homeless. We know that this problem seems to be getting worse. We know that something must be done.
To his credit, the congressman is trying to do something. But state officials and others with an oar in this issue need to pull harder.