Poor planning doomed the plan to dramatically reform North Carolina’s mental health care system, according to a report delivered to the General Assembly recently. The failure cost taxpayers some $635 million and compromised the care on which thousands depend.
Those enormous mistakes are sure to weigh on lawmakers as they mull the tough decisions needed to balance a state budget facing a huge shortfall. But mental health needs significant change, not a sharp reduction in funds, if it is to become the system that North Carolina deserves.
When the Legislature considered reforming its system of mental health services, it sought to reduce a reliance on state hospitals in favor of community-based programs delivered by independent providers. That framework allowed the creation of a system known as community support, the root problem in a reform effort most now consider a significant failure.
From April 2006 to February 2009, about $2.4 billion was spent on new community services, with Medicaid responsible for much of the tab. However, about 25 percent, or $635 million, is now considered wasted money, according to the report by the Legislature’s Program Evaluation Division. Of that, $226.2 million came directly from state funds.
The report cites poor planning as the cause of the waste, claiming that the Department of Health and Human Services was unprepared for the crush of private contractors seeking a share of the funds. Administration and repayment lacked adequate oversight and a sluggish response to indications of fraud allowed the problem to fester.
The lessons are abundant. Programs with so broad and costly a potential impact need to be properly tested and carefully implemented, according to officials. And there needs to be thorough oversight and clear accountability when reform is undertaken.
But those conclusions do little to effect needed change in a system that serves thousands of state residents. Nor will a comprehensive outline of so massive a failure encourage lawmakers to invest in mental health when the state faces a massive budget shortfall that lawmakers must close.
Yet, the clearest evidence for support is the knowledge that effective mental health services are crucial to North Carolina communities like this. Lawmakers should not turn their backs on that system by dramatically cutting funding or ending all reform efforts. They must work with the new leadership in the Governor’s Mansion and at DHHS to enact the changes needed to restore confidence in the system.
This was an embarrassing failure for North Carolina, but lawmakers should be wary of compounding the mistake with hasty action.
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