As a therapeutic foster parent for the past 10 years, I’ve had the privilege of being part of the lives of 19 children. Due to no fault of their own, these children have been abused, abandoned, left behind, and worst of all, unloved. Their young brains have had the crap beaten out of them.
I’ve also had a front row seat to the mental health system in North Carolina. In the past year, we’ve had two children with severe trauma-related mental conditions, and we’ve fought like hell to get these kids help. In each case we’ve witnessed what can only be described as a tragic comedy.
One became so troubled his psychologist recommended he be sent to a psychiatric residential treatment facility. Three months later they were still trying to find a place for him. He was still in our home, still in school, and he was getting worse. At school, he assaulted staff members and got in fights. He threatened to murder his teachers. It got so bad the teachers tried to refuse to allow him into their classrooms. CMPD took him away. His mental illness had become a crime.
They never found him a slot. The system finally shipped him off to another home, another county, another school. That’s what we do when things don’t go well. We just move them.
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North Carolina has been “reinventing” its mental health system for the better part of the past 20 years. In an effort to get better results for less money, we’ve managed to achieve neither. The odds of getting help before something terrible happens aren’t good. And when something does happen, your only option is to head directly to the local emergency room. That’s where the fun begins.
In 2013, the N.C. legislature created public “managed care organizations” (MCOs). They were given a set amount of funding each year and told to provide all the mental health services to all the people in their catchment areas who needed them.
Legislators ordered LME-MCOs to save money. The savings were supposed to accrue and be used for needed services like crisis centers. Hasn’t happened. But boy have they been successful at “saving” money. Today the MCOs are collectively holding on to almost $1 billion of taxpayer money. In an effort to force them to deploy those savings, the legislature has responded by cutting their funding. The MCOs lost more than $86 million in budgeted funds this year.
From 2012 to 2015, North Carolina was one of only three states to decrease behavioral health spending each year, adding up to a loss of hundreds of millions of dollars. As a result, we’re now ranked 44th and have half the national average number of beds per resident. On one day last year, WakeMed Hospital’s 80-bed emergency department had 100 mental health patients sitting waiting for care.
As I write this, I just returned from visiting one of my foster children in a local ER waiting for a bed. He’s been there for six days, and he’s sitting in a small waiting room with 19 other children, who are also just waiting. Some have pulled out all of their eyebrows. Others are scratching sores on their skin. Several were just balled up in corners hiding. The staff is doing the best they can in a very dire situation.
There aren’t enough beds because there isn’t enough money being spent. It’s hard to figure out who’s at fault. But we’re all responsible. And our families, communities and criminal justice system are paying the price.
These kids belong to us all. They have names. They are ill and they need access to our health system if they hope to ever live any kind of meaningful life. They are the lonely, lost, last, least and left out. But they are beautiful. And they deserve better.