N&O Editorial

http://www.newsobserver.com/opinion/editorials/story/1015816.html
From today's N&O
Editorial: Published: Mar 28, 2008 12:30 AM Modified: Mar 28, 2008 03:20 AM
A mind for reform Steps taken by the state health chief to stabilize mental health services are encouraging. Now legislators must do their part.

North Carolina's mental health system mess needed a clear eye and strong hand to work at setting things right, and thankfully, that's what Governor Easley got when he hired Dempsey Benton to lead the Department of Health and Human Services. The former Raleigh city manager and state environmental official announced this week sweeping improvements to what was supposed to be the reform of public mental health care.
More must be done, some of it requiring hard-nosed help from Easley's office and from legislators concerned about those who need these critical public services. But Benton has made an impressive start.
Broadly, the changes will put the 2001 mental health reform law on more solid footing. That legislation was supposed to put services closer to clients, a turnabout from reliance on the state's four big mental hospitals. Instead, private companies often have been expected to fill the role of service providers.
In one component of that, several firms hired sketchily trained personnel -- high school graduates, for instance -- to help patients with mental problems. Called community services, the program ran up a huge and excessive tab -- far more than was being spent on services to other patients with more serious, often life-threatening mental illnesses.
Benton says that DHHS will redesign its programs to ensure basic psychiatric care to patients throughout the state. That is an essential change if North Carolina is to adequately address stubborn mental ills such as schizophrenia and bipolar disorder, which require expert care. To be fair, the need for such care was acknowledged amid the intended reforms. But too many people have not received the right kind of attention.
The department will overcome a lack of community-based hospital beds for the mentally ill by buying space in local hospitals. That, too, reflects a major deficiency in the reform legislation, which envisioned more acute-care options in a patient's community but didn't provide the funding to make it worthwhile for private-sector institutions to open such beds. Inevitably, patients landed back at the big state hospitals, causing overcrowding problems there. Or they went home or to the streets.
Overcrowding at the state hospitals may or may not have contributed to 82 patients dying under questionable circumstances since December 2000, but this is certain: The hospitals didn't always report the deaths to medical examiners. Nor were families always told the circumstances surrounding the deaths. Benton has consolidated three reporting policies into one, the nub of which is that state employees must report every mental hospital death immediately to examiners and cannot move the body until given permission. The medical examiner also will decide if any additional inquiry is needed.
Such scrutiny will shine needed light on care that the hospitals and their personnel give, and raise warning flags if things are amiss. That should provide comfort to patients and their families, as well as protect conscientious employees on whose watch a patient dies. It must not be forgotten, of course, that the point of reform was to do the best for people tormented by mental and substance abuse problems.
Benton's carefully considered fine-tuning deserves the benefit of the doubt. That means more work for legislators this year -- and close monitoring in years to come, to make sure that reform of the reform doesn't stall.