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Despite reform efforts, state’s mental health is not healthy

RALEIGH — No one would argue that North Carolina’s decade-long effort to reform and rebuild its mental health services delivery system has gone well.

That reform effort came about after a U.S. Supreme Court decision called for states to treat more of the mentally ill and mentally disabled in their home communities. A 1999 study of the state’s mental health system, overseen by then-state auditor Ralph Campbell, reached the same conclusion.

Since then, ill-conceived state programs have wasted hundreds of millions of dollars. Legislative initiatives to create community-based treatment programs have led to uneven results. Local governing entities have pushed back against consolidation, even as some were involved in well-documented mismanagement. State and local bureaucracies have fought over control.

The result hasn’t been so good for patients. Some have ended up in rest homes meant for the elderly. Published reports this summer showed that over the last two years at least four people in North Carolina rest homes were killed by fellow patients with a history of mental illness.

Against that backdrop, the U.S. Justice Department recently opened an investigation into the troubled system.

The investigation was prompted by a complaint filed by advocacy group Disability Rights North Carolina. The head of the group, Vicki Smith, says the investigation could force the state to fix its mistakes.

She may be right.

But a lot of well-meaning people — including state Secretary of Health and Human Resources Lanier Cansler and two legislators who have been focused on the problems, state Sen. Martin Nesbitt of Buncombe County and state Rep. Verla Insko of Orange County — have been trying to find fixes. On issues of governance and the availability of local resources, the state is probably in a little bit better place than it was three or four years ago.

But a big problem is that the state has limited resources in these tough economic times.

Another problem is that some people want to paint the system, as it existed prior to 2000, as all roses and lilacs. It wasn’t.

They need to go back and read the scathing Campbell audit documenting poor patient supervision at the state’s psychiatric hospitals, including Dorothea Dix Hospital in Raleigh, that led to the 1999 comprehensive study.

That study, by the way, called for closing the 144-year-old Dix Hospital.

Dix is finally scheduled to be closed next year, with most of the remaining 150 or so patients transferred to the state’s new psychiatric hospital in Butner. Some people remain opposed to the closing.

And so, it’s reasonable to wonder how much of this investigation is about fixing the mistakes and how much is about keeping Dix open.

Maybe closing Dix is one of the mistakes. Or maybe the fuss about Dix isn’t about patients, but about jobs.

I know this much: If I had a loved one in a psychiatric hospital, I’d rather they be in a facility that looks and feels like a hospital than one that looks and feels like a prison.

Scott Mooneyham writes about North Carolina politics for the Capitol Press Association.

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