A TREATMENT PLAN

Improving the way North Carolina cares for the mentally ill and mentally
retarded, and for substance abusers, has proven to be a stubborn task. And
ask the family members of someone suffering with a major mental disease,
and they'll tell of how difficult it can be to deal with these chronic
afflictions in the absence of a well-organized, amply funded public support
network.

Yet the plan delivered to the General Assembly last week by Carmen Hooker
Buell, state secretary of health and human services, is a good start at the
difficult reform process. North Carolina has allowed its services to the
mentally ill to decline until they are worse than merely insufficient.
Despite the best efforts of dedicated staff members, who face serious
staffing and resource problems, crowded state psychiatric hospitals and
long waiting lists at detox centers have put patients at serious risk.
Federal officials are investigating whether some aspects of state services
violate North Carolinians' civil rights because of their deficiencies.

Buell's proposal would amount to the state's first major reform in more
than a quarter century -- a time of significant advances in the way
mentally ill or challenged patients are treated. Importantly, the plan
would revamp treatment at the county level while retaining a strong dose of
state oversight.

Counties would be required to establish management boards whose duty partly
would be to help clients live by themselves or in group-living homes. That
could bring real progress in helping the mentally ill learn to live
independently. The local boards would see to the creation of teams that
would keep patients on track with treatment, training and jobs. Friends and
family members know the constant challenge of focusing the mentally ill on
otherwise routine responsibilities such as taking medications and keeping
treatment appointments.

The plan would let the local management boards rely to a considerable
extent on contracts with private care providers. That could work, if the
state encourages the creation of non-profit groups to offer treatment. It's
less likely to work well if the contracts are snapped up by for-profit
companies. Officials only need look at problems in state-regulated,
for-profit nursing homes to move cautiously on contracting out mental
health services.

Reform isn't cheap, of course -- a particular hurdle for the new plan at a
time when the state budget is under much stress. New or expanded services
would tack an estimated $316.7 million onto the annual $1.7 billion that
the state already spends for care.

Even with advanced drugs that help many of the mentally ill cope with their
symptoms, it often takes months for doctors to regulate medications, for
example; drawn-out treatment regimens are bound to be expensive. Turning
recovering people into steady job holders can take longer still. But all in
all, the plan seems to offer reasonable options for delivering services
more effectively and for rescuing people from what can be the costly,
dehumanizing revolving door of treatment, release, jail and homelessness.