NC MENTAL HEALTH REFORM: 2003
By Mickey Skidmore, ACSW
I would be willing to bet good money, that many North Carolinians are unaware of the fundamental shifts that our Mental Health system will undergo in this new year - and the not-so-distant future. All across our state, in various stages of a “grand plan” (which many believe is modeled after Michigan’s failed efforts in recent years to reform it’s mental health system) Area Programs (also known as Community Mental Health Centers) will be moving in the direction of providing less treatment services and overseeing a gate-keeping system (much like an HMO), linking them to private providers in the community.
Such a move is unprecedented given that historically, Community Mental Health Centers (CMHC’s) were established by the federal government as a “safety net” for the disenfranchised. Even as you read this, efforts are underway to establish newly defined “target populations” of people who will be served by CMHC’s and who will be farmed out to private providers. Theoretically, such “target populations” would include individuals with the most severe afflictions or risk of mental illness, such as the persistent and chronically mental ill, the mentally retarded, and children. Apparently, the brain trust of this “grand plan” bought into the notion that “it’s easier to build a child … than to repair an adult.”
Never mind that the visionaries of this “grand plan” have yet to provide financial models or anything resembling a realistic budget of how CMHC’s will make these transitions or operate in this new, leaner environment. Never mind that virtually over night the mentally ill adult who does not fit into a newly defined “target population” no longer has a safety net to rely upon. This is going to happen. And in fact, has already been passed in the state legislature - despite the overwhelming facts that mental illness is shockingly common, affecting almost every American family - directly or indirectly. When compared with all other diseases, mental illness ranks first in terms of causing disability in the United States, Canada and Western Europe (O’Neill, 2003).
North Carolina has demonstrated for a very long time now that it has not had the political will in making the mental health needs of its citizenry a significant priority. Given two consecutive years of fiscal crisis in our state budget, it is not realistic to expect bold new direction from our political leaders on this issue. And perhaps our system is in such shambles that it needs to completely break down before we can create a new one. However, this particular “grand plan” experiment we are in the midst of is hopelessly flawed, and given the political past of our state, its conclusions are highly suspect.
REFERENCES
1) O’Neill, MSW, John O. Mental Health System Said “In Shambles.” NASW News, January 2003 p.7, Vol. 48, No. 1.
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