RALEIGH — North Carolina’s county governments have submitted to the state Department of Health and Human Services the first part of their strategic plans to reform mental-health care. The actions, required by state law, represent a large step forward in a process that is expected to be completed by 2007.
“It’s important to remember that system reform is an evolving, dynamic process,” said Sherry Harrison, coordinator for the State Mental Health Reform Plan for DHHS. “It’s not so much like turning a switch on a certain date as it is having a well-thought-out local business plan that establishes a viable framework for the future.”
All counties were required to submit plans by Jan. 2 that would explain how they would operate programs to serve physically and mentally handicapped citizens. The state plans to close Dorothea Dix Hospital in Raleigh and John Umstead Hospital in Butner and relocate their patients to local communities. The Raleigh and Butner hospitals would be replaced by a single mental hospital that would serve central North Carolina, leaving three such institutions for the entire state.
Several factors, other than federal pressure, led the state to reform its mental health system. While some of the motivation is to control costs, the prevailing thought is that local care will lead to better care for patients and reduced dependence on public services.
“We overuse our hospitals,” said Dr. Joel Rosch, senior research scholar for the Center for Child and Family Policy at the Terry Sanford Institute of Public Policy at Duke University.
Psychiatric hospitals introduced in the late 1800s improved care for mentally ill patients, many of whom previously were relegated to prisons. Conventional wisdom now says isolation worsens the situations of patients with treatable conditions. “The purpose of a mental health system is to get people to function in society,” Rosch said. “There are no good outcomes from institutionalization.”
He said that in addition to excessive hospitalization, both psychiatric and regional hospitals that provide emergency mental and substance abuse care, the rates North Carolina pays for its hospital care are high.
The state has already evaluated patients in its hospitals to determine what care they will need to allow their successful return to communities. “A number of people have already been relocated with appropriate supports and services in place for them,” Harrison said.
While cost-effectiveness is good, Harrison said, it is not the top priority.
“System reform has never been about saving money overall,” she said. “What it is about is making it possible for people with disabilities to live safely and satisfactorily in communities of their choice.”
Chesser is associate editor of Carolina Journal.