A day to remember in mental health

A day to remember in mental health

- in Fitzsimon File

Thursday was a day to remember in the troubled saga of the state's mental health system, bringing both a stunning reminder of the problems that have plagued the system since the 2001 reform efforts began, and a bold proposal by Health and Human Services Secretary Dempsey Benton to consolidate local agencies into regional units and create statewide crisis teams to provide emergency services.

State officials announced that the federal government is withholding $138 million from the state's mental health system until improvements are made in the way community support services are managed.

A recent News & Observer series found that as much $400 million may have been wasted in overpayments to companies that provide basic life services to people with mental illness or a disability in local communities across the state. Benton told lawmakers Thursday that his department has already made changes to the program that dramatically reduced the cost of the services, though it is not clear if the changes are enough to satisfy federal regulators.

Benton surprised many lawmakers by proposing a major overhaul of the structure of the mental health system that would eventually lead to regional agencies assuming much of the management responsibility currently held by 25 Local Management Entities (LMEs) created by the reform legislation seven years ago.

The LMEs replaced area mental health centers, but don't provide services. Instead, they oversee private companies, profit and nonprofit, who work directly with patients.  The private system has been plagued by massive problems, with inconsistent management among the LMEs and lack of services in many areas, as private companies come and go as they compete to provide profitable services, leaving many basic needs unmet.

Benton also asked lawmakers for funding for mobile crisis teams, 187 emergency inpatient beds spread across the state, 24 crisis beds for people with developmental disabilities, walk-in clinics, and more help for patients leaving mental hospitals and returning to their communities.

There were plenty of other proposals too, including tougher certification requirements for private companies, funding for the 60 bed facility that will remain at Dorathea Dix, and incentives to reduce the turnover of the staff at the hospitals.

But it was the proposal to consolidate the LMEs into regional centers that created the most buzz in the legislative committee room, packed with mental health advocates, service providers, and lobbyists for the LMEs.  

Several legislators urged Benton to move slowly, defending the poor evaluation of their local LME in a recent consultant's report.  But people with mental illness, a developmental disability, or an addiction have been waiting since 2001 for a system that provides the services they need.

Benton told the committee that he is not sure a statewide system even exists under the current structure of 25 LMEs operating differently. Senator Martin Nesbitt at one point declared that "we have a system that is in crisis," an assessment that prompts little disagreement from thousands of families across the state.

Benton has his work cut out for him. The national economy continues to affect state revenues and finding the money for his proposals for increased services won't be easy.  And it is much harder to rebuild a more centralized system then it is to break one down, as all the current pieces have leaders and lobbyists with relationships with local legislators.

The market fundamentalists always oppose any plan to increase the role of the state government too, and Raleigh's most well known right-wing think tank was criticizing Benton's proposal almost before he finished making it, saying it was a troubling development.

But the point shouldn't be to meet some philosophical test or protect the interests of local officials or administrators. Benton was hired to turn around a system that had become a disaster with dangerous hospitals, few crisis services, and millions of dollars collected by shady private companies at the expense of needed services.

And most importantly, it was a system in which the people who needed help seemed almost an afterthought. Families trying to take care of a loved one with a disability or mental illness had lost faith in the leadership of the department charged with helping them.

There are still plenty of problems. In some parts of the state, people are still unable to access the services they need and deserve and hospital patients are still discharged to homeless shelters.

But whatever lawmakers and lobbyists think of Benton's proposals, nobody can argue anymore that there's a lack of leadership in the Department of Health and Human Services. That can only be good news for a system floundering in crisis for the last seven years.

About the author

Chris Fitzsimon, Founder and Executive Director of N.C. Policy Watch, writes the Fitzsimon File, delivers a radio commentary broadcast on WRAL-FM and hosts "News and Views," a weekly radio news magazine that airs on multiple stations across North Carolina.
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