Two of Charlotte’s top medical leaders told a Monday night forum on emergency mental health care that the system is at the breaking point.

Dr. Roger Ray, chief medical officer for Carolinas HealthCare System, described the situation as a “bona fide crisis.”

Dr. Greg Clary, head of Presbyterian Hospital’s psychiatric wing, said the needs of the state’s mental health care are as familiar as they are complex.

“Deinstitutionalization took place in the ’60s,” Clary said. “We’ve been chasing our tails ever since.”

Both made their remarks near the close of a “Solving it Together” forum sponsored by the Observer and PNC Bank.

Ray was one of five panelists. Clary sat in the front row of an almost filled auditorium at UNC Charlotte’s Center City Building. They were joined by an audience of about 350, including everyone from mental health professionals to patients advocates to families with loved ones with psychological problems.

All of them braved stormy weather, and the stigma of a subject that is rarely discussed in public. One of the panelists urged them to do more to bring about change.

“It’s hard for people to tell their stories, but it’s important, too,” said Mebane Rash, a Charlotte native who has helped lead a five-year study of North Carolina’s mental health care for the N.C. Center for Public Policy Research in Raleigh.

“You are the public in public policy.”

Charlotte-Mecklenburg police Chief Rodney Monroe, whose officers often act as a front-line of mental health response, told those on hand that dealing openly with what has always been a private subject can change public perception and policy.

“If you have passion and commitment, you can make a difference,” he said. “But you have to pull back the curtain.”

More than 1.4 million North Carolinians, including 300,000 children, need some sort of mental health care. But a shortage of facilities and repeated changes in state mental health policy, leadership and financial support have left thousands of patients baffled on how to find treatment.

Particularly acute is the shortage of care for children. Clary, who took over the Presbyterian unit in late December, called the situation for adolescents “a disaster,” and said he has five children waiting at his hospital for longer-term treatment elsewhere. Such stories are becoming a statewide norm. “We’ve run out of room in the inn,” he said.

Meanwhile, recession-fueled budget cuts have left Charlotte-Mecklenburg Schools with far fewer counselors, social workers and psychologists to deal with the growing behavioral needs of the 141,000 students, said Karen Thomas, director of the schools’ support services.

At current staffing levels, she told the forum, “We can’t address all of these issues.”

“It sounds like a question of dollars and cents,” said moderator Taylor Batten, the Observer’s editorial editor.

“It is a question of dollars and cents,” Thomas replied.

Batten then turned to Pat Cotham, chairwoman of the Mecklenburg Board of County Commissioners, which gives millions of dollars to the schools each year. She said that during a tough economy, restoring cuts like those at CMS become “hard decisions that we have to make as a community.”

For now, emergency rooms bear the brunt of crisis behavioral care. Carolinas HealthCare, according to Ray, is “doubling down” to ease some of the backlog. Not only does it operate CMC-Randolph, home to the state’s only psychiatric emergency room, the hospital chain plans to open a new psychiatric hospital in Davidson next year.

“The math can’t support it, but it’s the right thing to do,” Ray said. “What we have today is not enough.”

Ray also said the hospital system plans to make behavioral care a part of its overall treatment, where mental-health screening will be as common during a doctor’s visit “as questions about blood pressure or diet.”

In the meantime, thousands of Mecklenburg County residents will be turning to MeckLINK, the county’s $300 million network for mental health care, which started March 1. Executive Director Phil Endress, hired in August, said MeckLINK has already authorized more than 8,000 cases for treatment. The goal: getting patients in touch with the proper care that keeps them out of emergency rooms or even jail.

“We’re growing into it,” Endress said. “We are not making any promises that we will be absolutely perfect every time.”

Audience members submitted more than 200 questions. During the 90-minute discussion, they asked about ways to keep mental health patients out of jail and heard new approaches for dealing with the homeless. Chief District Court Judge Lisa Bell talked of the need for a crisis center that would keep the mentally ill out of jails and ERs.

Afterward, the conversation continued in the auditorium and the outside lobby.

Mental health advocate Mike Weaver, though he called the evening a success, said the panel should have included a stronger voice for consumers.

Dr. Cheryl Nicholas, CEO of InnerVission, a behavioral-treatment nonprofit in uptown, said mental health care is still plagued by “too many silos and not enough collaboration.”

Assistant Police Chief Eddie Levins said approaches have to change: Why can’t hospitals and other providers have more mobile teams to treat the mentally ill?

“If we’re waiting for them to come to us,” said Levins, a leader in getting police officers training to work with the mentally ill, “nothing is ever going to change.”