Under Latest Overhaul, Can NC Mental Health System Spot Trouble?


As North Carolina’s state mental health system undergoes its third major overhaul since 2001, the Charlotte Observer explores whether it will be capable of recognizing and helping those who are potentially violent. The issue of caring for the mentally ill took on more urgency Dec. 14 after a gunman with lifelong behavioral problems killed 20 schoolchildren and six adults in Newtown, Conn. Since then, state after state has examined its safety net and found already strained systems weakened from recession-driven spending cuts.

In North Carolina, emergency rooms and police are left with a growing role in crisis care. Chronic shortages of psychiatrists and hospital beds exacerbate the problems of providing care to the estimated 14 percent of residents who need behavioral help. Struggling to meet round after round of new state requirements, many providers have merged, changed names or closed. That drives more people to the familiarity of the emergency room. Or they stop seeking treatment altogether, which means police intervention becomes more likely. A statewide study of emergency departments shows that mental health visits are increasing far faster than the overall traffic. The average length of stay has also jumped sharply. Longer waits in a chaotic ER atmosphere raise the likelihood that a mental health crisis will worsen. The threat of injury to patients and hospital staff also grows.

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