Ways to reform mental health services
Counterpoint:
By Dr. Bill Nolan
One mentally ill person held five days in a community hospital’s emergency room is symptomatic of the continuing failure of mental health reform in North Carolina. More tragically, this incident demonstrates the deteriorating inadequacy of our state’s mental health system.
More disconcerting is the terribly wrong paradigm posited by Luckey Welsh, director of state operated services, that “delays in admissions (to our state psychiatric hospitals)... are necessary.”
The Division of Mental Health’s (DMH) current crisis includes failing to meet minimum standards at state hospitals, inadequate quantity, quality and integration of community services, plus insufficient state funding exacerbated by the loss of federal funding because of quality failures at the state hospitals.
DMH’s purpose is to ensure the most vulnerable citizens receive timely, sufficient, quality care at optimal cost to all stakeholders. To achieve this requires the governor to hold the director publicly responsible for demonstrably achieving this mission.
The governor should give the director support, including an authoritative executive task force headed by a gubernatorial appointee.
Participants must include representatives of patients, families, advocate organizations, ERs, service providers (inpatient and outpatient), provider advocate organizations, local management entities, sheriff’s and police departments, the legislature, DMH leaders, state psychiatric hospital leaders, and other state agencies. The staff should include experts in mental health systems management, information management and public relations.
This task force should be charged with achieving: 1) decrease in admissions and readmissions to ERs, state psychiatric hospitals and hospitals contracted for services; 2) decrease in inpatient lengths of stay; 3) decrease in ER stays; 4) ensure quality of services by each provider, especially at the state hospitals; 5) decrease costs for law enforcement, ERs, per-inpatient admission and per-patient day for each consumer within the system; 6) increase patient and family satisfaction with each phase of the system, especially ERs and state hospitals: and 7) increase staff engagement and satisfaction within state hospitals. Results for each indicator should be published no less than quarterly, monthly when available.
Without a comprehensive, integrated, transparent operational effort, the number and severity of personal tragedies will increase, human costs will increase for stakeholders, and the amount of lost dollars will worsen.
The writer lives in Greensboro and is a clinical psychologist.
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