Fixing mental health programs' reforms

No one knows what a mess the state's seven-year-old mental health reforms created more than Dempsey Benton, the capable administrator Gov. Mike Easley picked to run the Department of Health and Human Services and fix the mental health programs.

But it is not clear that members of the N.C. General Assembly – now debating revisions to the state's $21 billion annual budget and considering changes in state programs – fully comprehend where things stand. If they did, they'd surely be pushing for additional appropriations that would, at a minimum, come closer to providing sufficient staff to cope with the demands for mental health services.

The reforms launched in 2001 contemplated a shift of services from state hospitals to community-based providers. That sounded good, but the resulting system was managed poorly. Basic services were not in place and too often not available when they were needed.

Secretary Benton's plans to provide more crisis services, community inpatient beds and better psychiatric services in each region are a welcome step in fixing what's wrong. But even as the Easley administration pursues fixes, public understanding of the problems grows. Last week The (Raleigh) News & Observer reported on the results of two task forces the administration asked to look into specific problems.

A hospital management and operations work group concluded that patient stays at state hospitals are too short to stabilize and treat patients, and that frequent discharges to homeless shelters are inappropriate. The state should hire an additional 717 staff members including 202 registered nurses, 331 health-care technicians and 33 more psychiatrists. Without them, the panel said, “current levels of staffing are inherently dangerous” and the additional workers are essential.

A separate work group found a lack of adequate crisis services, insufficient patient assessment capacity and “significant psychiatric bed capacity shortfalls” as well as inadequate community hospital beds. In short, there aren't enough staff, enough beds and enough services.

These reports should be on every legislator's desk. Evidently they're not. Key lawmakers say they haven't seen the reports, which may account for the lack of a legislative response in the House version of a supplemental budget bill. It provides $68 million more for mental health programs, but no one argues that's nearly enough to repair the botched mental health reforms launched at the beginning of this century and now coming to light.

If a fix to this mess is to come, it will have to be in the state Senate, and will require firm leadership from the Easley administration. There's not much time left.