Those in need were limited in their choices, it was argued, because county health agencies providing help were strained and couldn't offer all the types of care that were needed. Rather than put so many people in large institutions, it would be better to bring the services closer to them, in their communities. Those services could be turned over to the private sector, with Medicaid, the federal/state health insurance program for the poor, covering the expense for those who couldn't afford care on their own.

The system, it was agreed by professionals, legislators and state officials, was broken.

Now, a five-part News & Observer series is unveiling the sad truth: the broken system hasn't been fixed. It's been further damaged by a lack of preparation for the changes made. There was an absence of adequate rules specifying types of care and requirements for those who provide it. And the level of "community support" services offered by some of the private companies (there are 784 of them) has been inconsistent at best. Certainly the huge sums expended for that ill-defined aspect of mental health care proved to be a painful and embarrassing surprise.

Let this be said, right away: Many care providers are dedicated people doing good work. But there are problems, and they are serious.

Duck and cover

Governor Easley, who's been in office since reform of the system began, has declined to discuss with this newspaper's reporters the problems that have come to light on his watch. That hardly rates as a stand-up demonstration of public accountability.

Easley did appoint Dempsey Benton, a capable administrator and former Raleigh city manager, as secretary of the Department of Health and Human Services after Carmen Hooker Odom moved on last year. Benton candidly recognizes that he is attempting to restore order to a system that is in chaos.

When reform began, private companies eagerly signed on to provide services. The most basic of those services was called "community support," wherein workers would help people cope with daily living -- establishing routines, going to the store, to movies, and so forth. Most of the service was provided by people with high school diplomas. Companies could charge up to $61 an hour, much of it coming from Medicaid.

It's a good business. One company cited in yesterday's N&O story, Dominion Healthcare Services of Raleigh, is owned by Joel Hopkins, a former Shaw University basketball coach. Traditionally, people who needed mental health services got referrals from doctors or health agencies. But Hopkins' company has recruited clients from neighborhood visits, sometimes going door to door, and in 18 months has charged taxpayers $33.9 million for services.

Payback time

Not surprisingly, some state officials have questioned whether all of Dominion's clients needed mental-health services. Officials are demanding that Dominion and other companies repay $59 million. It's astounding to think that such an amount could have been paid out in error, or carelessly, to those who didn't deserve it. County officials, who used to provide mental health services, were charged with monitoring programs, but clearly there have been breakdowns in communications.

The state needs to rethink reform, and that's putting it mildly. Perhaps the counties ought to again be the ones that provide services -- surely officials there must be thinking what they could have done with the hundreds of millions of dollars spent on privatizing care. Maybe the plans to close hospitals, including Raleigh's Dorothea Dix, were poorly conceived.

Were this a tale of government programs run amok it would be yet another maddening account of waste. But this is about human beings. Some are in dire circumstances, indeed, and for them to go without help or care -- especially because money was being wasted that could have been used to help them -- is unacceptable. That ought to be the point of reform, and Governor Easley should not tolerate anything less.