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Wednesday, 23 January 2008 00:00

Long-term fix must be found for state’s mental health care woes

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Perhaps it is going to take a complete fracturing of the mental health system before policymakers finally realize that North Carolina needs more inpatient facilities to treat patients who are a danger to themselves and society. Well, if it’s a total breakdown they’re waiting for, things are getting perilously close.

Right now, Western North Carolina is showing the effects of the state’s decision in 2003 to privatize most of its mental health care system. That privatization was supposed to lead to more effective outpatient treatment. That transition was still working itself out when the recent cutback in services from the nearest state-run mental health hospital, Broughton in Morganton, came into play. As a result, patients are going untreated for longer periods of time and a large financial burden is falling on counties as law enforcement plays bodyguard until a bed opens up somewhere in the state.

The broken system has become all-too-public over the last few months, primarily due to that burden being placed on local sheriff’s departments. In years past deputies were called in when involuntary commitment orders were served after family or medical professionals deemed a patient too distraught or violent. Law enforcement would take the patients to the nearest inpatient facility where they could be watched, diagnosed and put on proper medication if necessary. Police would spend a few hours taking care of this task.

Today, with inpatient facilities at regional hospitals closed down, Broughton became the destination of choice for those who were dangerously mentally disturbed. But that facility became crowded and the federal government revoked its right to bill Medicaid and Medicare for treatment. As a result, deputies have no place to take patients. This means they have taken on the role of caretakers, often staying two and three days with patients.

At the same time, these patients have been sitting in emergency rooms — often in restraints — while awaiting a bed in a proper mental health facility. These hospitals don’t have the staff of psychiatric professionals to administer to the patients, so often their condition just worsens until room opens up at one of the few state-run mental health facilities.

Patricia Frisbee Meyer has seen the worst of the problems. Her son suffers from a mental illness, and recently he spent nearly 48 hours in the Haywood Regional Medical Center awaiting space in a mental health facility. He had to be put in restraints as his condition worsened.

“I said the longer he is in restraints, the longer it takes to get a bed, the sicker my son gets and the longer he will take to recover,” Meyers recalled of the situation.

More than 18 weeks later, her son is still at Broughton.

And so it is for mental health care in North Carolina. The state is trying to do on the cheap — by opening a few new beds in traditional hospitals (see story, page 6) — what simply can’t be accomplished. These patients need many different kinds of treatment, from full-time inpatient care with daily counseling and medication to a regimen of counseling and peer support groups to which they must strictly adhere.

Mental health is not a popular cause. One can’t muster support for it like advocates do for education or the environment. But the truth is that foregoing mental health care needs adds costs to the criminal justice system, burdens social service agencies, creates major issues for local hospitals, and reveals a fundamental misunderstanding of a major problem.

The state needs to do better, and it could start by appointing a state study commission to develop a plan for a comprehensive fix. Then it needs to come up with the necessary funding. Any kind of patchwork proposal is simply, as one health care professional described, “Like putting a band aid on a leaking jugular vein.”

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