The News & Observer asked the four main Republican and two Democratic candidates for governor what they would do to address the state's mental health reform gone bad, and voila! -- up came some ideas with merit.
The state needs all of those ideas it can get, in view of a series of articles published recently by The N&O that found too little money spent on people with serious mental illnesses, millions of dollars wasted on a program aimed at less serious cases, failure of communities to set up local programs for the mentally ill, and too many (and unreported) deaths and injuries at the state's four large mental hospitals.
The Easley administration finally is paying proper attention to the issue. But there are stubborn, ingrained problems that the state needs to solve, such as determining to what extent the private sector ought to be allowed to provide mental health services and attracting professionals willing to work in this area of medicine.
State legislators, in fact, based their 2001 reform bill on letting private companies (instead of counties) both determine what services many patients needed and deliver those services. In the intervening years, companies, some of them new, flooded the market and made millions -- often with a mismatch between the rates they charged and the value of the services provided. Meantime, some patients who needed more intensive forms of care had to go without. State oversight was lax or missing altogether.
Bob Orr, a Republican candidate for governor and former state Supreme Court justice, says North Carolina should reconsider whether privatization of mental health services can work at all. Fellow Republican Pat McCrory, the mayor of Charlotte, suggests tougher standards for private companies, and setting up citizen councils to review contracts and possibly certify nonprofits that want the work. Both ideas should be explored.
Republican Bill Graham, an attorney, and Democrat Richard Moore, the state treasurer, say sensibly that the state should spend more in counties that have deficient services, either because they are rural or poor. Republican Fred Smith, a state senator, suggests paying community college tuition for nursing students willing to practice in state institutions.
Democrat Beverly Perdue, now lieutenant governor, proposes another good idea: have state universities and community colleges set up a "center of excellence" to train mental health professionals and conduct research. Modest pay, in the context of work that can be grueling, hinders North Carolina in hiring and keeping good personnel to staff public mental health facilities. For those drawn to the field, Perdue's center would provide expert training, benefiting provider and patients.
Treating mentally ill North Carolinians is a hard but sacred duty. It's costly, like most medicine in the United States. Fresh ideas about how to do it effectively, efficiently and compassionately are critically needed, and a credible plan for improvement should be on every aspiring governor's agenda.
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