Repairing 'reform'

Those with severe mental ills seem least likely to receive help under the state's reform effort. Fixing that is now a priority

Pity Dempsey Benton, the veteran public administrator hired last year by Governor Easley to run the state's Department of Health and Human Services. With that territory has come the formidable task of salvaging North Carolina's so-called mental health reform effort.

The poorly written reform law -- that's the well-expressed opinion of a legislator who has spent years trying to improve mental health services -- placed much of the responsibility for helping the mentally ill and substance abusers in the hands of private companies. It de-emphasized the use of state mental hospitals, and then gave county and state officials little direction on what and how services should be provided.

And pity Johnnie P. Yarborough.

In 2006, the 47-year-old Yarborough, suffering from bipolar disorder and addicted to crack cocaine, was so desperate for treatment that he beat on the doors of state-run Dorothea Dix Hospital in Raleigh and a private mental hospital, seeking to be admitted.

Because of the 2001 reform law, treatment once offered by Wake County's mental health agency had become spotty or nonexistent. Yarborough was admitted to Dix 14 times during 2006, but never for more than a few days. He began fearing that he might commit a murder. He's drug-free now and working, but that's thanks to the nonprofit Raleigh Rescue Mission, where he now lives.

Yarborough was profiled in The News & Observer's Thursday installment of a series of articles on the failure of mental health reform. One sign that the effort hasn't worked is that admissions to the state's four big mental hospitals are up. But consider this as well: In a 22-month period ending last month, North Carolina spent about $1.4 billion on minor "community support" services, in some cases for people who weren't even diagnosed as mentally ill.

In the worst cases -- and there are plenty of them -- services provided at $61 an hour consisted of being taken to the movies or to a mall. That probably wouldn't have been much help to Johnnie Yarborough.

Meanwhile, just $78 million was spent on seven services that the Department of Health and Human Services says are more likely to keep people out of mental institutions. Some counties, often rural ones, have never found enough private providers for those kinds of serious treatments. So they are left mostly with basic community services to offer patients afflicted with deep-seated mental illnesses. The state has spent even less on helping alcoholics and drug addicts shake their addictions, services that logically fall under DHHS's mental health umbrella.

The system prior to reform wasn't working well either. State and local agencies often did a poor job of coordinating or of providing consistent care to a patient who moved around. Or a local agency might have treated mental disorders and addictions separately when one was linked to the other. Unfortunately, coordination continues to be a weakness because the reform law isn't clear about who is responsible for monitoring care. The public pays, but so do people like Yarborough.

Benton's job should focus on directing limited funds to the greatest needs, and then ensuring that state-local and county-to-county coordination happen effectively. He inherited a mess, but with the well-being of thousands of North Carolinians at stake, along with the efficient use of huge sums of taxpayers' money, success is the only option.