Mental Health Reform–The Beginnings of It All

A State Hospital Dome
A Typical State Hospital Skyline








Since this is the very first entry into this site devoted to the contemporary history of one of the states’ efforts at “mental health reform’ since the late 1990’s, I should preview what will the be the ongoing thrust and intent of this effort.

  • This author will endeavor to focus primarily on my state’s mental health reform efforts since the late 1990’s
  • I will also in these early posts draw upon my knowledge of some of the first efforts in the United States to begin to grapple with the long dormant tasks, needs and dilemmas of the public mental health services sectors, long neglected and unchanged since the 1963 ‘Comprehensive Mental Health Center Act’
  • I will trace the many steps and changes that the effort in North Carolina has undergone, from incremental changes, improvements and commendable efforts at correction, the fits and starts, the usual “unintended consequences,” tough lessons learned since 1999-2001 when this started
  • I intend to also give credit where credit is due to the state of North Carolina, its leaders, political structure and veteran Department of Health and Human Services, to reach recently now consolidating improvements, and recent commendable achievements wrought under difficult circumstances when many were harsh and vocal critics of this uncertain reform effort, myself included in past years
  • And finally, I will try to observe a personal tenet of mine, to give credit and ‘compliments, as the positive fruits begin to take unmistakable and firm footing, that were long doubted by many especially the sector of mental health professionals [again including this humble observer; I believe that in our currently polarized and argumentative public climate, we have just about lost the sense of fairness in complimenting each other, looking past philosophical differences and vilify or deny the worth of others’ ideas; and a fitting compliment goes a long way to forging partnerships needed for fashioning corrective steps and improvements, when taking on such complex and overwhelming social problems that this blog attempts to describe, educate and promote a better grasp of where we have been and where we are hopefully headed in our efforts of promoting the common weal and good for all our citizens in need.
  • Along the way I hope to show how North Carolina, in my view is one of the nation’s leaders in devoting impressively large and comprehensive resources in addressing the effort of mental health reform even in these times of a lasting and lingering economic slowdown, where the temptation could be understable to stint on budgeting sufficient resources, and end up repeating the decades or even centuries old practice of giving short shrift to the mentally ill and cutting their budgets since they by and large, do not have powerful lobbying groups on a level with labor unions, huge corporations, nationally based special interest groups, with a few exceptions that serve special groups among the mentally ill populations.
  • Finally I pledge to the readers of this commentary observational effort, to present as even handed a presentation and historical accounting as this practitioner can, given I am not a trained historian, reporter or writer; similarly I must make “full disclosure” particular to this effort and my position: I am a psychiatrist and subject to the views and educational, clinical ethos or bias that goes along with and arises out of my four decades of practice and experiences, that I have practiced in many settings from private, academic, public state hospital and local mental health centers, HMO clinics, Native American populations, correctional facilities for adults and adolescents, outpatient and inpatient settings of all stripes from acute to residential. Mostly, I must respect the ethical expectations of my current employer, a state hospital of the state of North Carolina, and will not abuse this position and knowledge I have of this institution, its staff, leadership and especially its clients, all of whom I owe a debt of gratitude for permitting to practice and do what I love best, treat and help patients, and teach trainees and participate in a care organization that puts its efforts where its mission statements vows, to be an aid to all, operate with respect and be honestly transparent, and to constantly self-monitor and improve. I am in the twilight of my career in some ways, and realized when I came to work here, that I had come full circle, from my first years out of residency at Duke when I took a state hospital staff psychiatrist position at the then but no longer existing John Umstead Hospital north of Durham, to help start an acute inpatient adolescent unit and a comprehensive multidisciplinary family therapy training program. I was green, inexperienced, eager and did not know my own limits but always itching to contribute. Now I work with, in many ways, the most challenging clients of my career, and think in a karma kind of way, that venue I have worked in heretofore, no matter how different, has prepared me for what I do now, and I am ever grateful to be here, at a time of great change and challenge. I hope the reader will enjoy the story I will attempt to tell.

Respectfully yours,


Frank Black Miller MD DFAPA



Author: Frank

I am a older child, adult, geriatric teaching psychiatrist with over 30 years' practice experience in North Carolina, first at Duke as clnical teaching faculty, then in Western NC as a primary child psychiatry specialist. I have taught and supervised child psychiatrists and psychiatrists in training and many other mental health professionals and taught at two medical schools. I have served in many public and private practice settings. My primary interest is in observing and documenting the ongoing mental health reform efforts in the State of North Carolina and documenting its sucessess and failures at all levels. My favorite pastime among many others is spoofing my friends and kids with my deadpan sense of humor.

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