Report: Mental care failing the poor

Privatizing treatment left gaps in the system, an expert says, and people without Medicaid can end up with no place to go

State and local officials didn't do enough to help the neediest of patients when they reorganized the mental health system, according to an expert's report.

Sweeping changes in the last six years have converted the mental health system by making private companies largely responsible for community mental health treatment, taking that role from local government agencies. Instead of treating patients, local government offices were to monitor companies and ensure that patients were getting what they needed from private providers.

According to a consultant's report, local mental health offices are not able to guide patients to needed treatment or adequately monitor private companies.

"There has been insufficient joint effort at resolving consumer access problems," says the report by Alice Lin, a consultant to the state mental health division.

Eighty-five percent of patients, those whose care is paid by Medicaid, can find companies to treat them, Lin said in an interview Wednesday. But the 15 percent who are poor but don't qualify for the federal money or have hard-to-treat disabilities continue to slip through the cracks of the new system, just as they did the old.

Lin, who helped write the 2001 bill that changed the mental health system, said the changes were meant to help the tough patients, homeless people who use illegal drugs, for example. The state and local offices have not cooperated well enough to resolve the problems of patients unable to find care. Most states have a hard time with the same problems, Lin said, but "I wanted to feel proud of our system. I feel we can do better."

Lin said some good things have happened since 2001. North Carolina legislators pay more attention to mental health than do their counterparts in other states; the state has a special fund for mental health services; and consumers and their families are asked for advice on what counties need.

"I think it was a very balanced report," said Mike Moseley, director of the state office that oversees mental health services.

Lin focused on seven local mental health offices, including the Durham County office and one that oversees Orange, Person and Chatham counties. She also talked to state government officials and private companies.

Local mental health directors said remaking the system took effort, but they did not ignore patients' needs. "That's what we keep in the forefront of our mind," said Judy Truitt, head of the Orange/Person/Chatham office.

One man's odyssey

Deby Dihoff, executive director of the state chapter of the National Alliance on Mental Illness, said state and local offices are failing to help the neediest people, those discharged from state mental hospitals after short-term stays, for example. This week, she worked to find a shelter that would take a man who was discharged from the state psychiatric hospital in Goldsboro to the home of a casual friend. The friend said the man could stay a few days, but there were no long-term housing arrangements, Dihoff said.

NAMI, a nonprofit agency that runs a hotline, got the call for help after the man had been carried from his friend's home while still lying on a bed sheet. He had an appointment to see a psychiatrist 25 days after leaving the hospital, when he should have seen a doctor within five days, Dihoff said.

The hospital social worker and the local mental health office jumped to help when told about the problem, Dihoff said, but this case is one of the "horror stories" involving people getting out of hospitals with no place to go.

"We need to admit there is a problem with discharged and admissions. It's a complicated problem. If there aren't enough psychiatrists to go around, what are we going to do about that?"