Op-Ed

NC mental health system needs rebuilding

Dontay Jones lived for months under Wake County's guardianship in a house east of downtown. A city housing inspector found the building to be substandard and lacking proper heat in November, but the housing case still was unresolved three months later. Jones and his roommate are wards of the county due to mental illness. Portrait photographed Tuesday February 24, 2015.
Dontay Jones lived for months under Wake County's guardianship in a house east of downtown. A city housing inspector found the building to be substandard and lacking proper heat in November, but the housing case still was unresolved three months later. Jones and his roommate are wards of the county due to mental illness. Portrait photographed Tuesday February 24, 2015. tlong@newsobserver.com

North Carolina’s mental health system has been in crisis, and despite efforts within and outside the state government, it’s getting worse.

In the past year, WakeMed hospital in Raleigh had to stop accepting new patients because its 60-bed emergency department was filled with over 100 people with mental illness, UNC Hospital’s ED was routinely overwhelmed by those seeking mental health care and Mission Hospital in Asheville often had a quarter of its ED occupied by people needing psychiatric treatment.

This chaos in our emergency departments reflects the growing and unmet mental health needs across the state.

Four of our cities are in the top 20 nationally for opiate abuse, our prisons hold more people with mental illness than treatment facilities, suicides are increasing, the wait time for an urgent admission to a state psychiatric hospital is over five days and in 2012 the United States Department of Justice sued the state for not providing adequate housing for people with mental illness.

The reason for this crisis is simple. North Carolina has massively reduced and misused mental health resources for decades.

Since 1955, through the deinstitutionalization movement, cost-savings measures and a reform effort that began in 2001, North Carolina has reduced its state-psychiatric hospital beds by more than 90 percent. While experts recommend 50 mental health beds per 100,000 people, North Carolina has just 8 state-psychiatric beds per 100,000, a level last seen in the mid-1800s.

“A recent collaboration between UNC, Duke and N.C. State found that the central catchment area of North Carolina must increase its mental health beds by 165 percent to significantly reduce the number of patients with mental illness waiting in emergency departments.”

However, it’s not all about hospitals. Deinstitutionalization meant to transition people out of facilities and back into their communities through outpatient services. But the promise was broken. While the elimination of mental health beds occurred, the money pledged for adequate community services never fully materialized.

Across the nation there has been a 30 percent per capita reduction in mental health spending.

In North Carolina, it’s even worse. In the mid-2000s, the state privatized many of its mental health services and unintentionally allowed dubious agencies to bill more than $400 million for unacceptable care. From 2013-2015, we were one of only three states to reduce mental health funds each year, and over the past few years, North Carolina has decreased support for mental health by hundreds of millions of dollars.

Fortunately, the argument to rebuild the mental health system is easy. Because psychiatric disorders are one of the leading causes of disability in the United States with nearly 50 percent of Americans experiencing a mental illness during their lives, addressing mental health needs has profound impacts. It also saves money.

Already within North Carolina, there are proven and innovative solutions to meet outpatient and inpatient demands.

The emergency department is one of the most costly and ineffective means to serve those with mental health concerns, and stand-alone psychiatric centers such as WakeBrook Campus in Raleigh and Cleveland Crisis and Recovery Center in Shelby have reduced burdens on EDs, delivered expert care, and improved patient satisfaction.

Moore Place in Charlotte, which provides housing and medical/psychiatric services to the homeless under a Housing First model, has saved the city millions while reducing residents’ utilization of EDs, hospitals, and jails by 80 percent.

Integrated Care, which provides psychiatric services in primary care settings, has demonstrated that for every $1 spent there can be a $6.50 return on investment, and groups such as The UNC Center for Excellence in Community Mental Health, Carolinas HealthCare System and Community Care of North Carolina are finding results.

To tackle the opiate epidemic, last week North Carolina’s General Assembly discussed the Strengthen Opioid Misuse Prevention Act which can dramatically improve the state’s capacity to curb opiate misuse and provide treatment and relief for those impacted by opiate addiction.

And the above is just the beginning.

North Carolina has the resources, talent and services to significantly improve the mental health of the state, but we need more.

We must encourage our legislators and Gov. Roy Cooper’s administration to reverse the defunding of mental health, finalize and pass the STOP Act and invest in a dynamic and comprehensive mental health system.

Through this investment, North Carolina can obtain substantial savings, grow a robust and healthy work force, and ultimately do the right thing for its residents. We can end this crisis, and we can become better.

John Nathan Copeland, MD, MPH, is a child and adolescent psychiatry fellow at the University of North Carolina Hospitals in Chapel Hill.

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