How can N.C. fix a broken mental health system?

In 2001, state legislators and Gov. Mike Easley's administration set out to reform the public mental health system with a sledgehammer.

They shattered an established system that entrusted individual counties with providing community-based mental health services to the uninsured and offered state psychiatric hospitals as a safety net. The old system, they said, was too expensive. Access to services and the quality of care varied greatly depending on where people lived.

The plan was rooted in the premise that the private sector could do the job better while saving taxpayers money through increased efficiency. The state would pay businesses to care for the mentally ill, and the free market would ensure more choices for consumers.

The five-part series in The News & Observer has chronicled how badly that effort was bungled, wasting more than $400 million in public money and costing lives.

The series showed that those looking to profit from the new system were drawn to a program called community service, which provided $61 an hour for companies that provided mentoring and other low-intensity forms of therapy that can be provided by those with a high-school diploma.

At the same time, companies that provided intensive therapy by certified medical professionals found it difficult to make money. Some have gone out of business. Last year, a state report said 25 counties had no practicing psychologist and another 15 counties only had one.

Many patients, suddenly without the core government-provided services they had relied on for years, slipped into crisis, flooding the downsized hospitals the reform plan had assumed would be less vital.

Some state mental health officials now concede it will take a new plan and many millions of dollars to get back to the level of services available to patients seven years ago. High-ranking administrators no longer speak of reform, but of "transformation."

So, where does North Carolina go from here? How do we take the best of what is working and remake the rest?

The answers to those questions will have an enormous impact on the lives of the more than 210,000 North Carolinians who sought mental-health services in the past year, as well as those who love and care for them. It will affect how many mentally ill people may end up in jails and prisons, living on the streets, in highway medians begging for money, or as silent witnesses to a broken system scattered in cemeteries across the state.

Today, Q offers its pages to those who have some ideas of where to start setting things right.

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