Money matters in mental health

Money matters in mental health

- in Fitzsimon File

North Carolina’s mental health system is a mess. That is not a secret anymore. Media reports in the last several months have made clear what families struggling to take care of a relative with mental illness have known for several years, the state’s mental health reform efforts are mired in confusion, lack of funding, and broken promises. 

State legislators are finally coming to understand the scope of the problem and the hardship it places on families and the mentally ill.  State mental hospitals are releasing patients into homeless shelters because there is no affordable housing available or enough community services to help find a place for patients to live.

Durham County is suing the state to stop the reform efforts and the state announced recently that money saved from downsizing existing hospitals will be used to pay for debt service to build a newer smaller hospital, not to fund services at the community level. That was the promise of the 2001 reform legislation, to shift services and the money to provide them to local communities.

State officials have acknowledged the problem, but always point out that more money is not the only answer. That’s true of course, money can’t solve all the problems, but communities can’t provide services if they can’t pay for them.

A report from the North Carolina Psychiatric Association released Thursday shows just how under funded mental health services are in the state. In 2002-2003, North Carolina’s per capita spending on mental health was just slightly more than half of the national average, ranking the state 43rd in the nation. 

Per capital spending on community programs was roughly a third of the national average. Not hard to figure out why families have trouble finding services. They are simply not there.

Maybe most disturbing is the finding that North Carolina mental health spending fell 38 percent from 1990 to 2002, worse than all but two states in the country.

The report says that to get North Carolina to 88 percent of the national average, the General Assembly would have to increase spending on mental health services by $285 million.  That is quite a shortfall, and that would still leave the state below average, which is not acceptable.

The bottom line is that thanks to the Psychiatric Association, we now know that mental health reform is not just failing because of a misunderstanding between state and local officials or because of problems transitioning patients from hospitals to local communities.

It is failing largely because the state is not spending the money to make it work and people are suffering as a result.