Opinion: Daily Journal

On Mental Health And Privatization

RALEIGH – Please explain this to me.

North Carolina’s state psychiatric hospitals have for a long time now been experiencing serious operational and management woes. In a heart-rending case, a patient at Goldsboro’s Cherry Hospital just died after being neglected by hospital staff for hours. Investigators have urged the federal government to defund the hospital until patient safety can be assured. Another state hospital, Broughton in Morganton, recently lost an appeal in its bid to regain national accreditation after years of documented problems.

In response, the Left blames “privatization.” Huh?

At least Dempsey Benton, currently the state secretary of health and human services, has a better grasp of the situation. The department announced last week that a private firm will take over management of Cherry later this month, albeit on a temporary basis, while also conducting a management study of the institution.

In reality, the catastrophe in North Carolina’s mental-health system didn’t happen because of privatization. The state has long made extensive use of private providers and vendors to deliver mental-health services. The reforms enacted by the General Assembly and implemented (poorly) by the Easley administration didn’t originate the use of private contractors. Instead, they sought to economize on local administrative costs by merging small-county agencies into larger ones, while tapping these agencies as contract administrators rather than mixing contract-management and direct-provision responsibilities, as was the previous practice.

The reforms went awry for a variety of reasons, as JLF’s Joe Coletti has explained in some detail. The next governor, whoever he or she may be, will have to straighten out the management issues and redefine how the state issues and assesses contracts with mental-health providers. But very few policymakers actually want to replace all or most private providers with state employees. It wouldn’t be practical, for one thing, and the scandalous shortcomings of care at state-run psychiatric hospitals hardly constitute an argument for it.

Making effective use of contractors is both an indispensable element of successful governance and an extremely challenging task. All governments contract out some services. Public employees don’t build roads or print textbooks. In many communities across the state and nation, private contractors clean public facilities, manage public databases, pick up garbage, teach special-needs children, feed public-university students, and manage public pension funds. Competitive sourcing is not a yes-or-no question. It is a series of when-where-how questions.

I have no idea whether contract management of state psychiatric hospitals is a viable long-term approach. In the Cherry case, the temporary contract appears to be a reasonable response to manifest shortcomings and the need to restructure the institution’s managerial structure. In the months ahead, North Carolina policymakers should make a careful study of how other states manage their systems and how best to strike a useful balance between public and private providers in mental health.

Here’s a good way to begin a constructive dialog: think before you speak!

Hood is president of the John Locke Foundation.