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EDITORIAL: State of Caring...: North Carolina Should End Its Tradition of Shortchanging the Mentally Ill and Provide for Quality Community-Based Care

Posted on: Wednesday, 3 May 2006, 15:01 CDT

By The News & Observer, Raleigh, N.C.

May 3--The point of the reform effort now under way in North Carolina's mental health system is to make it easier for people to obtain care without having to become patients in large, regional hospitals. Care provided in a community setting can be both more suitable as a mode of treatment and more desirable as a way of life.

Changing the way in which care is financed is key to the reform. Instead of having money flow into state mental hospitals, it is being redirected so that it follows each patient to meet their individual treatment needs.

That's the goal. But it's a big job, and progress so far has been disappointingly slow. At this stage, gaps in services are the reality for too many patients. There is a concern that the state hospital system is being dismantled without an adequate network of community-based services to take its place. For many, the scheduled replacement of Dorothea Dix Hospital in Raleigh with a smaller facility in Butner gives substance to that concern.

Such doubts are understandable, but the reform effort is far too important to be abandoned. In fact, it's time to face up to the need for an investment large enough to bring patient care to a higher standard, even while the opportunities for community-based care are broadened.

The U.S. Supreme Court set that standard eight years ago in the Olmstead decision, which recognized mental patients' need for individualized treatment. For some, the best care comes through community services while they live independently at home or in group homes. Some will need hospitalization for periodic crisis care, and some will continue to need hospitalization indefinitely.

It's hardly worth debating that North Carolina still falls short of providing the scope of care the court envisioned. For example, The N&O's Jean P. Fisher reported on the case of a 39-year-old woman released from Dorothea Dix. The only place that could accommodate her was a local rest home occupied by frail, elderly residents. Common sense says that someone prone to depression and thoughts of suicide, as that woman is, would have difficulty thriving in such an environment.

A larger pot of state funding would encourage the creation of independent living arrangements better suited to the mentally ill. To remain in the community, many of them need therapeutic day programs, monitoring of their medication and other services.

A legislative committee overseeing mental health reform encourages the development of these services by pegging this year's need at $155 million. That sounds like a modest amount, given the size of past budget cuts.

But, like Tar Heel governors before him, Governor Easley already is lowering expectations for progress in mental health care this year. Only $100 million is doable, says the secretary of health and human services, Carmen Hooker Odom.

What that suggests is simply that the mentally ill need to be higher on North Carolina's priority list. Easley might re-examine his request for money this year to close economic development deals, for instance. With more people employed here than ever before and more leaving state mental hospitals, the state's economy would seem to have fewer gaps than its mental health system.

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Copyright (c) 2006, The News & Observer, Raleigh, N.C.

Distributed by Knight Ridder/Tribune Business News.

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Source: The News & Observer

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