Cut loose

Some patients leave state mental hospitals with skimpy follow-up plans that leave them at risk -- another tangle in 'reform.'

Two days before a North Carolina man, called only "TC" by the advocacy group Disability Rights North Carolina, shot himself to death, he was discharged from an involuntary commitment at the Broughton state mental hospital in Morganton. Doctors sent the dangerously ill man home with an "aftercare plan" that consisted only of his promise to call his family doctor, and despite knowing the following, according to Disability Rights:

"At the time of his release, TC's hospital records contained information that TC had a family history of mental illness; that he was being treated with medication for bi-polar disorder; that he had been involuntarily committed once before following a suicide threat; that the current hospitalization had followed a standoff with police who had to taser TC in order to take him into custody; that he had threatened to shoot any officers who tried to intervene; that he told his family he took 100 Valium; that in talking with family his speech was slurred and he was 'drifting in and out'; that he was intelligent and would try to minimize the event so he would be discharged; that he lost his job the day of the event; that he and his long-time girlfriend, who had a tumultuous relationship, had recently broken up; that he did not have any local support system; that he had anger management issues; that he had been treated for depression with medications for seven years; that he had access to weapons; and that he was aggressive and combative toward hospital staff."

TC is one of three patients profiled in a Disability Rights report who ended up dead after spending just a few days, or hours, in state mental hospitals and with little attention to how they would be cared for on the outside. (TC is Carl Wayne Tournear, identified in a recent series of articles in The N&O about the state's mental health care system. He killed himself on Aug. 3.)

A second patient was a 17-year-old Orange County youth. The third was released to a homeless shelter that actually had been shuttered a few days earlier. According to the report, 1,182 people were released from mental hospitals to homeless shelters last year. That is a disgrace, but not surprising as shelters, jails and prisons increasingly become way stations for the mentally fragile.

The report comes as the state tries to right a seven-year-old reform effort that was to provide more space in the big state hospitals for seriously ill residents but more services in local communities for those whose illnesses were stabilized.

Disability Rights makes sensible suggestions, including hiring more local and hospital staff to coordinate after-care services and setting a statewide policy for local mental health offices. Earlier this month, before the report was released, the state decided on its own to place county liaisons in hospitals to help identify appropriate services for patients returning home -- a welcome step.

Disability Rights has uncovered another hole in the state system that needs to be patched. Until the agency responsible for carrying out reform, the Department of Health and Human Services, gets better control of local and statewide services, troubled North Carolinians are likely to continue falling through the local-state cracks.