The governor’s proposed budget for the upcoming biennium continues to ignore the mental health crisis occurring in North Carolina. With all good intentions, mental health reform released mentally ill patients from state hospitals to the community, but it did not result in providing mental health resources to keep them safe, healthy and functioning at a level that would ensure their well-being. It doesn’t seem coincidental that suicide rates have continued to rise in North Carolina since the reform began.
Furthermore, resources for services for mental health programs have been cut by 30 percent. This appears to completely disregard tragedies reported throughout our state and nation, tragic encounters between the police and the mentally ill, and hospital ERs where mentally ill patients wait for days for inpatient treatment. WakeMed recently had to close its doors because 65 beds in the emergency room were occupied by behavioral health patients.
Must people in cardiac arrest or traumatic injury die because of no available ER beds before our state leaders make resources for additional help available? If you have a medical emergency, you expect emergency treatment in the ER followed by admission to a hospital bed relatively quickly if needed.
This is not the case for people in a mental health crisis. ER staff members are generally not trained to treat people with mental illness so treatment is delayed until they are admitted to an inpatient psychiatric unit or hospital. Our local medical hospitals – WakeMed, Rex Healthcare and Duke Raleigh – do not have inpatient units, so all patients needing admission must wait for a bed to become available in other hospitals.
The truth is, there is a statewide bed shortage, so patients are waiting in ERs without treatment an average of 3.5 days. The state has been making a limited amount of funds available to pay for more psychiatric beds in community hospitals, but this does not go far enough. Maybe it will take a violent behavioral health patient waiting for an inpatient bed in an ER to endanger the lives of other patients and staff to bring about change.
When mental health reform started, initial money to help the system set up new community-based services was diverted to the state general fund. This was followed by additional cuts to service funds because unscrupulous providers wasted millions of dollars. The outcome of these failures and resulting cuts combined with tremendous population growth is that people cannot get the help they need – even when they are in crisis and even when they have private insurance. The services simply are not available.
The problem extends well beyond hospitals to the criminal justice system.
The lack of inpatient psychiatric beds and community treatment services has directly resulted in an increase in the number of mentally ill people in our jails and prisons. Over 10 times the number of people with mental illness are incarcerated than are being treated in hospitals. Approximately 20 percent of the people incarcerated have a serious mental illness. In Wake County, approximately 3,000 people are incarcerated each month, and up to 60 percent of those screened are identified as someone who has a mental illness and/or substance abuse problem. Based on the numbers, North Carolina has traded treatment for mental illness to punishment for mental illness.
An argument can be made that the governor is trying to provide better treatment for those with mental illness by paying for more mental health beds and staff at state prisons. His proposed budget adds almost $7 million to the Division of Public Safety in 2015-16, and another $18 million in 2016-17. In addition, he is proposing $2 million each year to manage criminal offenders once they are released back into the community. On top of that, he is proposing raises for the correction officers, supposedly in recognition of their increased risk, for another $21 million, starting in 2016-17.
Because we are not capable of providing services in the community, the approximate $50 million in additional money to address the care and treatment of prisoners seems necessary. But I do not accept that this is the best environment for our mentally ill residents.
If one believes that treatment for those with mental illness would be better provided in the community than by correctional officers, more money is required than what the governor proposes. We need to push back the rhetoric of “getting more for less” and start providing more services with new money before something tragic happens. This means knocking down the roadblocks to community service. There needs to be adequate pay for providers and additional services to keep people out of hospitals and jails, such as more supported housing for those with mental illness, supported employment and a public school system educated in mental health and early intervention techniques. The legislature needs to address the funding needs of group homes that meet quality standards for caring for those with severe mental illness who cannot function safely in the community without that level of care.
The good people of North Carolina deserve a different funding priority than the governor proposes. I would like to think they want to give everyone a chance for a good quality of life, including an opportunity that provides hope for recovery for those with brain disease.
Gerry Akland is president of NAMI Wake County.