When the N.C. General Assembly implemented mental-health reform in 2001, it promised that North Carolinians who seek help from the mental health system would get better care, primarily through community-based support systems that would operate more efficiently and effectively than centralized psychiatric hospitals such as Dorothea Dix or Umstead Hospital.
Several years later, here’s where decentralization has brought us, according to a six-month investigation by the News & Observer of Raleigh: The state has wasted at least $400 million on a plan that has funneled critically needed care to private providers who operate with far too little oversight, sometimes using workers with little or no specialized training in working with the mentally ill. Among the more egregious examples cited in the investigative series were companies that charged more than $60 an hour for “services” performed by workers who had only a high school diploma. In some cases, the care they provided included taking clients to the movies or shopping or running errands for a parent.
The waste in itself is outrageous enough. Currently, the state is trying to recover $59 million from companies that broke the rules in providing mental-health services, which is a significant amount yet is still far less than the amount overpaid for unnecessary or sub-standard services. But what’s even more deplorable than the waste is the impact this inevitably has on some of the state’s most vulnerable citizens.
While private providers have been able to abuse the system at taxpayers’ expense, patients with serious problems didn’t get the care they needed, with sometimes devastating consequences. Initially, state officials had envisioned that the bulk of spending would go toward those type of clients, with the goal of reducing the need for hospitalization. In reality, from March 2006 through January 2008, community support for children and adults cost nearly $1.4 billion, far more than state officials had initially estimated, while a far smaller amount, $78 million, went toward more intensive services identified as likely to reduce the need for hospitalization.
State mental health officials and legislators are well aware of the many missteps in mental health reform. Other studies have previously pointed to waste and inadequate treatment in the delivery of community services. As a result, the state reduced its hourly rate for some community providers, and officials have taken steps to shore up the regulations and oversight of providers that contract to provide community mental-health services.
But as the years roll by and the problems pile up, it’s increasingly evident that North Carolina needs to revisit mental-health reform efforts that have shifted much of the burden to local health agencies, without ensuring that adequate resources are available to provide comprehensive community care. Failure to fix the system’s problems will result in more waste and more inadequate treatment for people who desperately need help.