RALEIGH — With thousands of jobs lost, taxes hiked, state budgets repeatedly unbalanced, local budgets pilfered, and Medicaid funds horribly mishandled, the first three years of Gov. Mike Easley’s administration would seem to offer political rivals a target-rich environment in the coming months of the 2004 political season. Yet through it all, a key program of market-friendly reform has continued to work its way through North Carolina government. It’s a program for which Easley, and particularly his Health and Human Services Sec. Carmen Hooker Odom, should be commended.
I’m talking about the state’s efforts to merge redundant agencies serving the mentally ill and to implement a privatization model to deliver necessary services.
Carolina Journal‘s Paul Chesser wrote a cover story back in April 2003 explaining the reform plan in great detail. Its elements were intended not only to spend taxpayer dollars more efficiently but also to improve the range of choices and quality of care available to patients and their families. Rather than assuming that governmental agencies need be the providers of mental-health services, the administration proposed to transform their role to a purchaser and coordinator of care from competing private and nonprofit providers. Furthermore, state officials sought to minimize the number of counties administering their own programs, with the target of reducing the number of local mental-health agencies from 38 to 20.
There was a lot of resistance at first to the proposals, and some of it continues today. Some advocates and activists charged that the Easley administration plan was little more than a refurbished version of the old idea of deinstitutionalization — moving the mentally ill out of expensive psychiatric hospitals and into “community-based care” but with an eye more towards skimping than serving. This charge is false, but not absurd. Actually, the plan is a refurbished version of the older idea, but is much more than that. Simply downsizing mental hospitals won’t help anyone, taxpayers included, unless the patients are able and willing to access alternative care. By encouraging local mental-health agencies to assist patients to be informed purchasers choosing among a variety of options, the reforms change the kind of state action involved but not its extent or importance.
As a limited-government kind of guy, I nevertheless recognize that state government has an appropriate responsibility to fulfill with regard to the mentally ill. This is not a step down the slippery slope of the welfare or therapeutic state. Those suffering from severe illnesses and left untreated pose a risk not only to themselves but to the public. Generations ago, people with undiagnosed mental illnesses were put into poorhouses or locked into jails, both involving the extensive use of state power and tax dollars. It is incumbent on state policymakers to find a more humane and less costly approach to the problem, which appears to be the direction taken by the Easley administration. (I should note that it bears some resemblance to a plan for mental-health reform authored by Dr. Nat Fullwood, a former John Locke Foundation senior scholar.)
The debate over implementation continues. While some localities have already been taking steps to meet the state’s initial expectations, others are hoping that the rules will be altered or waived. Some smaller counties, for example, would like to retain their own mental-health agencies even though they don’t meet the state’s original population threshold.
No one should expect this process to be easy. Significant problems will no doubt present themselves, political tensions will continue, and numerous details will crop up and have to be addressed. Still, North Carolina is clearly moving in the right direction on mental health.
Hood is president of the John Locke Foundation and publisher of Carolina Journal.