North Carolina – The Mental Health Reform Blog

Credit to the Cherokee, Doing Everything Right

I wish to highlight an article that appeared in the Charlotte Observer this date of publication, March 10, 2019, entitled: For the Cherokee tribe in western North Carolina, America’s drug problem hits home by Thomas McDonald. This documents through the story of a young lady, a recovered opiate user and member of the Eastern Band of Cherokee Indians, the efforts that the Tribe has undertaken for years to address their substance abuse problems. Their efforts are frankly in my view, likely the very best that have been undertaken in any Native American reservation and deserve wide recognition.

Addiction Services Billboard in Cherokee NC

It is no secret in mental health and substance abuse treatment circles nationally and in the public mind, that the Native American population in this country has struggled in the last several decades with an enormous crippling addiction and substance abuse problem. For instance, it is long been known that in certain reservations and puts this is been highlighted, up to 50% of Native American adults are afflicted with chronic alcoholism. In the last three decades or so mirroring the invasion of prescription and illegal addicting drugs that have invaded initially larger urban areas in this country, and following the economic and recessionary collapses in the employment industries of urban areas by opiates resulting in our now well-known national opiate epidemic, Native American reservations have not been immune either.

In many ways, the Native American reservations have been incredibly more vulnerable for subtle reasons that are not well understood in majority American circles. For instance, Native American reservations are sovereign federal territories and administered in decades past or ruled over, might be the more appropriate sobriquet, by the Bureau of Indian Affairs. This unfair system started in the 1800s and resulted in the brutal colonial style of rule that prevented Native Americans by large from governing themselves and making their own best decisions in their behalf for decades. This finally began to be reversed in the latter part of the 1900s as various tribes began to restrict the power of the BIA and to rule themselves in matters of finance, economics and healthcare to mention a few. As Native American tribes began to seize upon the opportunity afforded them by almost “loopholes,” in federal law to permit the establishment of tribal-run casinos, the power of tribes began to exponentially increase on their own behalf as they gained more and more autonomous sources of funding separate from the sustenance funds afforded to them through the BIA and federal budgets. These casino funds in tribes who managed well there casino properties and revenue sources, made possible the establishment of many tribal-run agencies that began to operate solely for the benefit of the tribes and were completely administered by tribal figures and governance bodies. Over time the economic goal minds that the casinos afforded, made possible solid revenue streams for tribal improvement from everything from housing to healthcare.

But this did not protect the reservations from the onslaught and invasion of addictive drugs. From the sort of “humble” beginnings of applying and supplying destructively tribal reservations with sources of alcohol to feed and promote and sustain alcoholism for decades, the invasion of addictive drugs took on the characteristics of the entry into those poisons and the rest of American main street life. Outside drug dealers only a few decades ago began to I reservations as new and fertile territory for their goods. And without delay unscrupulous and antisocial figures within tribal populations themselves graduated from selling alcohol and marijuana to opiates and provided unwelcome bridges intertribal life for the distribution of opiates on the reservations.

Tribal reservations were quite vulnerable to these invasions from without and from within. 20 to 30 years ago tribal police forces were still somewhat small and understaffed. The FBI had dominion legally and jurisdiction over major crimes on reservations as this agency was tasked with law enforcement of major crimes. This hampered the ability of tribal police forces to undertake interdiction and law enforcement efforts regarding the opioid epidemic. Gradually tribal police forces were given greater budgets and expanded to meet the invasion of addictive drugs for sale on tribal properties.

The newspaper article that I am highlighting in this article which I commend to every reader of this post moved most highly to follow and read in the Charlotte Observer this date, weekend of March 10, 2019, makes brief mention of the next factor I wish to highlight. On reservations which have their own autonomous tribal sources of income such as casinos or entertainment venues such as the famous Hard Rock Cafe franchise etc., distribution of tribal income funds to all enrolled members takes place usually on a twice a year basis. This is called the “per capita,” or “per cap,” distribution day.

This is a unique phenomenon largely not known to the outside world. It means that every enrolled tribal member will receive so many thousands of dollars twice a year from the tribe and its autonomous revenue source such as a casino franchise. The amount may vary at every distribution date of eight dependent on the volume of business and profit from the casino for instance. Persons who are minors nowadays have their per capita funds automatically deposited in trust funds set up automatically on their behalf administered by their parental guardians. They become eligible to begin to receive these funds for instance, on the Cherokee reservation, after their 18 and graduate high school.

In years past, the per capita day began to attract an influx of illicit drug dealers twice a year for a certain period of time after the monies were distributed. I hate to use pejorative metaphors but I will go ahead in this case to give a bit of emphasis to the power of attraction that these kinds of monies being distributed could have upon vulnerable tribal members. Tribal members who were already addicts would have enormous amounts of monies, thousands of dollars, suddenly in their possession after cashing their per capita check. Illicit drug dealers would set up shop person’s homes, motels both often on the reservation properties and do a land office business selling drugs. Federal authorities, representing agencies such as the FBI and DEA, as well as tribal police began the twice a year interdiction efforts with undercover agents, often Native Americans from the reservation itself and from other tribes would not be known as law enforcement officers to the invading drug dealers. Nighttime arrests would abound and federal courts in cities near reservations would be full for weeks of newly arrested and indicted drug dealers.

The Cherokee tribe for over two decades has made enormous progress in trying to help tribal members manage their per capita funds wisely and be less vulnerable to the preying efforts of drug dealers at per capita time. The Charlotte Observer newspaper article makes mention of a huge effort that has been going on for nearly 20 years in the Cherokee tribe. Disbursements of the per capita funds were restricted and given in increments every five years after one reached the age of majority of 18 trying to help delay impulse spending on drugs by young immature tribal members. Another notable effort that has continued is the requirement of having high school students take budgeting and economic classes in high school to prepare them for the responsibilities of suddenly inheriting tens of thousands of dollars that they had earned throughout their first 18 years of life. The Charlotte Observer newspaper article makes mention of the young lady highlighted who spent tens of thousands of dollars of her per capita funds on drugs after she came of age. This story, unfortunately, has not been all that rare but the tribe has suspended enormous community-based efforts, financial education programs, and financial safeguards to help coming-of-age members manage their per capita funds wisely.

The article further documents that enormous resources that the tribe has spent in the last few decades on mental health and substance abuse treatment efforts. The young lady who is profiled in the article is an example of recovered tribal members have joined the community-based education prevention and treatment efforts of the tribe to address their outsized addiction problem. Of note is the statistic that nearly 50% of adults received some kind of substance abuse related diagnosis several years ago in an epidemiologic health study conducted to track and gauge the magnitude of the problem.

In the early 2000’s healthcare and medical leadership of the Cherokee tribe recognized the need to establish and sustain a substance abuse and mental health treatment service for the tribal members. In less than 10 years such a service was established and began operating with a full complement of substance abuse certified counselors, psychiatric social workers, school-based counselors (which had already existed for several years) clinical psychologists, an on-site clinical psychiatrist, numerous mental health and substance abuse related community-based support groups, and organized comprehensive buprenorphine anti-addiction clinic, and plans for a large residential substance abuse treatment center and plans to convert the original Cherokee hospital into a comprehensive mental health and substance abuse detox and treatment center after completion of the new Cherokee medical hospital facility accomplished a few years ago.

The Cherokee Indian tribe has literally done everything right in my view. They have established one of the most comprehensive, if not the most comprehensive and financially well-supported substance abuse and mental health services of any Native American tribe in this country. Behind the scenes, it is serving as a national example to other tribes send representatives periodically to visit and learn from its set up and accomplishments.

Not every Native American tribe and reservation, however, can be expected to duplicate the incredible set of services at the Eastern and of Cherokee have established in Western North Carolina. Only a minority of Native American tribes have the deep financial pockets that the Eastern Bdate surrounding area Band possesses.

This exists for a number of reasons that are also somewhat unique to the Eastern Band of Cherokee.

First, there existed an entrepreneurial awareness in a number of families in this tribe that started early on even before World War II, a growing tourist-based industry which capitalized on the creation of the Great Smoky Mountain Park during the New Deal era of President Franklin Roosevelt in the southeastern United States that had virtually no competition in that extended geographic region. Out of the nucleus of a number of farsighted families, and over nearly 50 years nascent development the town of Cherokee and Western North Carolina became a huge destination for tourists and their dollars from that entire region.

Second, a larger nucleus of tribal leaders who were very adept businesspeople emerged by the last quarter of the 20th century. This group of leaders forged a very astute bargain the federal government and the state of North Carolina in order to be able to establish, operate and profit from the Harrah’s casino that they started on the reservation. Because they had no casino within the entire southeastern United States, the Harrah’s casino did extremely well making possible the economic and healthcare related development that the Eastern Band of Cherokee Indians has enjoyed.

Consequently, the Eastern Band of Cherokee Indians has not suffered embarrassing public economic catastrophes that other tribes have suffered from establishing casinos in venues with not a lot enough surrounding tourist population to support such revenues or have had so many other casinos nearby that none of them were able to be successful financially.

Still, the Eastern Band of Cherokee Indians and their collective leadership deserve all the credit in the world for shepherding their financial windfalls and resources wisely and benevolently in the service of their members and their unique health care needs. In my opinion, they serve as an example and model that can and should be exported and imitated even in the non-Native American arenas where we continue to fail so miserably in addressing the social and medical problems and needs of our age.

Research Shows NC Still Needs More State Hospital Beds

On December 12, 2015 the newspaper, the major newspapers in North Caroline, Winston-Salem Journal p, The Durham Morning Herald, and the Raleigh News and Observer, all published as article, ” Researchers measure NC psychiatric bed shortage.” In this article, hard data confirmed what has been known for a number of years, the North Carolina, in spite of its unique and laudatory efforts, almost head and shoulders above most states in the US, still needs many more psychiatric beds. North Carolina is unique and to be regarded positively in its almost singular effort to spend hundreds of millions of dollars upgradings its entire state hospital physical plants over the last several years. Almost no other state in the Union is doing this in this time of tight state fiscal budgets, and the lingering slow recovery of the now nearly 10 years banking and housing bubble scandal-induced Great Recession. NC has closed one old hospital, the former John Umsted state hospital in the “institutional” town of Butner NC, just 20 miles or so NE of Durham and replaced it and the now closed famous Dorothea Dix Hospital of Raleigh named after the 19th century’s more famous mental health reformer, Dorothea Dix, with a new nearly 400 bed state hospital , Central Regional Hospital. NC has also nearly finished completing replacing the old “Cherry State Hospital,” in Goldsboro serving the eastern third of the state with another completely new facility.

As an historical and “tourist guide” type aside, the town of Butner is tiny and sprang up in the rattlesnake-infested pine forests north of Durham in WWII when Camp Butner was built by the Army as a major military training center and was the site of a 4000 bed Army hospital for wounded veterans from the ongoing War in Europe. It was the second largest such hospital during WWII on the East Coast. After the war, in 1947, the year I was born it was sold to NC for $1 on the condition it be utilized as a state hospital for the mentally ill. On a persona note, my own training psychoanalyst, who came to NC to help state psychiatry at UNC Medical School, was named its first psychiatric superintendent. Butner is currently also the 30 year site for the famous or infamous “Federal Correctional Facity” where some of the worst federal psychiatrically insane criminals have been housed and evaluated such as Ted Kazsinski, The “Unibombers,” Mark Chapman, John Hinkley and many others.

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The Difficulties of Funding Improved Delivery of Mental Health Care

Today, September 22, 2015, the Raleigh News and Observer newspaper revealed and published some very disheartening and totally surprising news that illustrates yet another dilemma in the ever more difficult tasks in improving mental health care public services in this state, and, likely reflects the kinds of dilemmas that other states are and will be struggling with in facing up to their obligations in this area. The article is entitled: “NC budget cuts $110 million from regional mental health,” and can be read here.

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Closing State Psychiatric HosptalAs: Consequences, Good and Not So Good

As usual I always bow to my internal ethics and try to be as open and transparent as possible about the subject at hand, revealing attitudes, biases, views based on long term experience, and an almost “historical view” of the galloping phenomenon of “mental health care delivery reform” thankfully occupying the attention of the country finally. I am old enough to have practiced in the so called mental health age of oodles of resources, and have watched them atrophy, became extinct, go corrupt and get themselves prosecuted out of existence, lose funding for many many understandable reasons, lose their place of importance, watch the ever decreasing number of bright talented younger generations of “would have been social workers, psychiatrists, and psychologists” shy away from the training programs, and our numbers go down especially in child psychiatry. One could take an inflammatory demagogic view and see is as necessary to prevent th abuse and horrors that indeed happened for decades shuttered away out of the light of public review and knowledge and responsible accountability and oversight. But that approach has nearly led to the old saw of “throwing the baby out with the bathwater because something was wrong with the bathwater, too dirty, too hot, whatever. I have seen the inhumane past and still in more restricted corners, inhumane treatment of patients in poorly run state hospitals that made me so mad I thought i would bomb them into the ground they were so bad, but of course after evacuating the helpless patients. I have helped to de-accredite the abominations of such hospitals, a few but enough to see first hand the decades old cultures of isolated facilities with poor faculty, psychiatrists who could work no where else due to histories of alcoholism, just plain bad practitioners and all the rest. I have had close colleagues since my residency days who presided over the deserved federally mandated dismantling of closure of famous hellholes permitted to exist far too long and heard their stories of generations of horror stories.

But in the midst of all this, or in my case in the last quarter of my career, I still know and hold to the somewhat unpopular certitude that state psychiatric hospitals are needed, good ones and now more than every. One simply statistic is that out country’s population and mental health treatment burden has at least doubled if now tripled since World War II. And we have had new mental health phenomenon syndromes, traumatic brain injuries of unforeseen overwhelming magnitude outstripping the abilities of public and private psychiatric-neurological treatment worlds to receive, treat and comprehensively help them out of our IED head rattling new genre of injuries in the Middle Eastern conflicts we have had to enter, police and try to stabilize at little thanks from much of the rest of the concerned world with some exceptions.

State hospitals across the country have been marked for closure and destructions for decades with the trend accelerating greatly in the last 2o years or so. It was thought and expected the the monies saved from funding these “dinosaurs” would be responsibly shifted to the long known need for massive outpatient services for the CMI, chronically mentally ill for which the state hospitals had long existed and served, and served well in a surprising high number of hospitals. Remember the famous Meninnger family of three generations of nationally recognized humane psychiatrists practiced in a state public hospital, Topeka State in Kansas a venerable training and research facility itself.

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A State Hospital for Sale

One of the former three truly old, historical state hospitals in North Carolina, Dorothea Dix Hospital in the state’s capital, Raleigh, is now cleared for completion of its sale to the city of Raleigh. The huge, many hundred acre site, established in the late 1800’s, and named after one of the early American crusaders for improvement in custodial (institutional) mental health care, Dorothea Dix, will proceed with its long debated and fought over sale. The sale will total somewhere around $52 million according to a very recent news story by WRAL ABC Channel 11, of Raleigh.

Why is this of note in the world of mental health reform in this country?

1. There are literally many dozens of old languishing state hospital properties and campuses in this country; many are almost unbelievably operating after perhaps an average lifespan of nearly 150 years, while many others are abandoned ghostly properties. If you are curiious about these architectural gems, or, monstrous relics of bygone eras of ghastly cruel inhumane care, depending upon your beliefs and attitudes toward the always controversial history of mental health care, please search on my favorite bookseller and go to reading search site, Amazon.com and look for books on asylums and state hospitals in America. Fascinating reading for those interested in this sector of esoteric social history if ever there was one.

So many of these properties need to be sold, preserved or whatever, now and in the future as the still active facilities gradually are “phased out,” and replaced by more modern facilities or closed altogether, depending on the need for inpatient public psychiatric beds in each state.

2. They represent a real source of monies, for state and regional/municipal coffers that could be put to good use.

I have been aware that very few of these properties around the country have been sold and converted to helpful assets or capital. There are a number, though honestly speaking, not many, websites that catalog the numbers of abandoned former state mental hospitals slowly proceeding to ruin through abandonment and fiscal and physical neglect. One website through the genealogy organization of RootsWeb, lists perhaps most of the former and current American state psychiatric hospitals state by state. And it unbelievably it offers information on the phenomenon of the “Asylum Tourist.” Sheesh. I appreciate historic sites and beautiful woodwork, antique furniture as much as a geek can. My late father was a master woodworker and proud owner of a “ShopSmith” all his adult life. [If you do not know what that is, well, Google it, or, don’t bother, it really is information will not make you stand out anywhere except at a woodworker’s convention, or in perhaps a Trivia Pursuit championship. But then again, I doubt even the latter.

State hospitals always have and had fantastic craftsmanship, furniture, architecture, woodwork etc. Much has been salvaged from closed state hospitals. If you are a “preservationist” like Europe seems to have been in their cultures for hundreds of years, this stuff matters. That’s why we go to Rome, to Paris, to Prague, to see the incomparable buildings, art, statues, gardens and on and on. But if you are a modern, [wasteful?] devotee of the disposable, rapidly obsolescent approach to “things,” then all this is likely drivel and unimportant. I certainly am in the former camp, the older I get.

Another historical website devoted to this kind of history, details the history of the “Kirkbride” architecture of state hospitals that totally dominated such institutions for nearly 3/4 of a century. Students of architecture and architectural history still study these, visit them and even go on “tours” of these sites around the country. [I know that sounds perhaps very weird to most, but bear with me].

So I have pondered in recent years, what could old state hospitals be converted to? This is my partial list of charitable causes I could see some of these grand and incredibly sturdy structures devoted to:

community college facilities
public school educational facilities
subsidized housing especially for the elderly, as there are bathrooms galore, and these places were hospitals for goodness sake
public governmental offices [don’t laugh, check out the connection between the former St. Elizabeth’s Hospital in Washington DC and the Department of Homeland Security…
public museums

Now marketing a state hospital even in the best of condition is not an easy task. They are often located in not the most economically active metropolitan centers; they are mostly located out in the boondocks, the isolated countryside, as part of their raison de etre, was to get the disturbed and disturbing mental patient, the insane, out of the public eye. Who wants a facility with many buildings, and hundreds of rooms out of the middle of nowhere? Raleigh, North Carolina’s Dorothea Dix Hospital is one of the fairly rare exceptions, being located in a major modern city.

They are all truly ageing physical plants. Most of the inactive hospitals, if not almost all, have deteriorated markedly through neglect for a few years to decades. They would take huge amounts of money to rehabilitate and bring up to modern building codes.

Though all of them were really sturdily built, they were never the most energy efficient structures even with their three feet thick walls and no wood in their make-up to attract the pest control companies’ best friend, the termite. It is not unusual for an operating state hospital to have utility bills of hundreds of thousands of dollars a month, even in the scaled down facilities. Thier heating plants are aged, and almost always belong to the steam non-electrical eras of heating.

I now am witness to a state’s dilemma of what to do, at a hoped for helpful profit, with a soon to be closed ageing state hospital. How does one market such a huge property that is not a brand spanking new outlet mall on a busy inter-metropolitan interstate highway, that will mint money the week it opens?

At least in Raleigh, Dorothea Dix herself, I think would be pleased with the coming sale of her namesake institution. It will become property of Raleigh, the state will gain a sizeable amount of monies that can be put to good use, and the city of Raleigh will receive a new very large regional mixed use business park out of the deal. That appears to be far better than the site becoming a huge, slowly deteriorating eyesore and environmental blight. A good deal all around.

Introduction to Mental Health Reform in North Carolina

Mental Health Reform began in North Carolina partially out of economic necessity. Other states had had to do so in the Midwest during the decade of the 1990’s for similar reasons, the decline of manufacturing in the so-called “Rust Belt,” but one example used mental health reform undeniably as a nearly vindictive budget slashing measure, singling out more than any other major expenditure category of a state budget for drastic cuts.

North Carolina’s impetus was truly largely driven by a perfect storm [no pun intended but it is one unfortunately nonetheless as the reader will quickly see below] confluence of unexpected and massive budgetary hits to the NC state coffers. In 1999-2000 along with a number of other segments of the economy, the “Dot Com” bubble burst nationally. This affected NC severely as North Carolina had long been building an information economic powerhouse through especially the Triangle area’s [Durham, Chapel Hill and Raleigh which are all within 8 or 15 miles of each depending on which leg of the triangle connecting the three cities you measure] universities, Duke, UNC-Chapel Hill, and North Carolina State University, respectively. NC State at the time and still is the most technically driven of the three and is now beginning to rival Rensselaer, MIT, Georgia Tech and Cal Poly in terms of research, award winning faculty, technical centers and spin off high tech companies. In fact, NC State had already established a new technical campus, the Centennial Campus adjacent to NC State’s campus and on the way to Research Triangle Park toward Durham. That campus has continued to massively grow in the years since the dot com recovery, for instance now housing the headquarters of Red Hat, the world’s leading commercial Linux distribution. This illustrates how much of an economic vortex the RTP {Research Triangle Park) is, generating hundreds of millions of dollars into the state economy. When the Dot Com bubble burst in those days when idiotic Internet companies were starting up, having no real product but promising getting groceries delivered to your house (now perhaps closer to reality), being overvalued in the stock market by unimaginably inflated multiples, the RTP of North Carolina suffered greatly, more so than Silicon Valley which was older, more established, larger and deeper. Jobs by the thousands were lost which were very high paying. High tech personnel left the state, state income tax revenues took a substantial hit. All this was a preview on a mini-scale of what was to come in the 2008 mortgage housing and financial derivatives scandal and bubble/Great Recession, partially still with us.

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We Need the “Asylums” Again Believe It Or Not

On January 16, 2015 the American Medical Association issued a press release giving notice of an article that asserted the current model fo treating the mentally ill as “ethically unacceptable and financially costly.” It was walking about the decades old failure of “de-institutionalization” that in in its second or third cycle of failure, being re-enacted in states all over the country once again, with similar and predictably disastrous results. I have the feeling that its title and byline in the press release was a little bit intentionally inflammatory to call attention to the importance of this issue.

This article was startlingly timely in that this author had just this week launched this blog on the broad topic of “mental health reform” and the state by state and national debacle it has become since the 19990’s in Michigan and since 1999-2000 since the same dishonest cruel blueprint was foisted upon the naive and desperate legislators in those states to save monies. Michigan by the 1990’s was in accelerating economic swandive mode because of the near bankruptcy of the Big Three American auto makers at the end of the second George W. Bush Presidency, forcing the surprisingly opposition to the bail out first of the two USA life saving bailouts that were left to the the new Obama administration. One would think that the Republicans would remember the satirical but emblematic motto of the character of “General Bullmoose,” in the old “Lil’ Abner” cartoon series by the great satirist Al Capp, “What’s Good for General Bullmoose is Good for the USA!” General Bullmoose was a character who represented the auto (GM–get it?) and military interests that dominated the country in those decades from the 1950’s onward. Business was supreme and has always been the organizing ideological center of the Republican Party. Michigan was one of the Rust Belt States losing population by the thousands yearly as families fled the loss of jobs in the auto and allied industries foretelling a trend that continues to this day.

Meanwhile North Carolina in the late 19990’s suffered enormously from the precipitous “Dot .com” bust of overvalued darling companies of stock hucksters on Wall Street that were innovative but made no money and somehow a free Internet based serviced equalled or guaranteed riches in the future. Conservative economists and stock experts who warned in ever darker tones in those years about that folly were lampooned unwisely by the upstarts of the New Economy that no one could define as old fuddy duddies with their economic heads in the sands of progress. North Carolina was perhaps the third most important “Dot .com” economic engine in the country after Silicon Valley and the Boston Corridor because of North Carolina State University’s technical powers and the graduation of the RTP (Research Triangle Park”) into the tech Big Leagues with dozens of start up tech companies who went bust as funding vaporized when results never appeared and tight money clamped down. Then North Carolina got hit with Hurricane Floyd which devastated an Eastern part of the state and cost the state in short order between one and two Billion dollars to helps its citizens rebuild. Then North Carolina lost a very important legal economic case in the early 1990’s that went all the way to the Supreme Court and cost the state over $900B in one year. North Carolina lost its contention that it could, as it had been for 9 or 10 year years, taxing the federal retirement pensions and benefits of retired federal workers living in the state. The loss meant the state had to refund almost a billion dollars swiftly as NC is a state that requires by its own Constitution that its annual state budget always be balanced, no matter what, no funky borrowing or issuing junk bonds as a way out. So the General Assembly was desperately looking for a way to save approximately two billion dollars quickly and fell sucker to the pitchmen from Michigan and before that Massachusetts in the 1980’s who had saved those states huge amounts of monies but slashing the budgets and costs of the mental health systems with a new plan that was called euphemistically “Mental Health Reform.”

Its basic tenet was to close ‘expensive’ out dated state hospitals and their beds, since everyone knew by that time that being in the state hospital environment was bad for your because of the three decade long promulgation of the modern fallacy of “institutionalization.”

The four state hospitals in Nor Carolina, Dorothea Dix Hospital in Raleigh, Cherry Hospital in Goldsboro, John Umstead Hospital in Butner outside of Durham, and Brougthon Hospital in Morganton in the western third of the state and the largest, had their beds reduced by roughly two-thirds each. The bogus reform plan, a several hundred spreadsheet program utilized in other states notably Michigan, promised the building of comprehensive outpatient services as it dismantled and destrroyed the well functioning local county by county mentalh health services. It was also suppposed to build for a start, sixteen smaller, more regionalized (read local and closer to families) less “isntitutional” smaller “mni” state hospitals. None were built for years by the state except one which was placed in the outskirts of the western town of Sylva without a large enough supportive psychiatric cohort staff of practtioners in an old, converted, rennovated nursing home and one unit housed in a small community hospital in Linville NC.

And the results were predictable, patients lost their long trusted psychiatrists and clinicians by the droves and it took years to replace those. Crises with patient ended up in the ERs of small hospitals all over the state, many with any psychiatrists on their staffs OR any inpatient psychiatric units. Patients also ended up in even greater numbers in the jails, at the country and state levels. Counties suddenly had to find staff, resources and medication budgets to care for at least 10-20 times more mental patients than they had ever had, Jail suicides dramatically increased. And the mental health reform took years to try to catch up. A prominent then Duke faculty psychiatrist in the mid 2000’s stated publicly for the media in an interview that it would “take 10 years for the state to replace what we had [in state mental health capabilities] ten years ago. A more damning indictment of the the state’s mental health reform effort could not have been verbalized except the description by a Dr. Steve Crane MD a teaching physician for the family practice residency program in Hendersonville and Asheville as “the disaster that just keeps on giving,” which was a satirical take-off on the then current circulating satirical description of Hurricane Katrina and the failure of the Bush Administration to respond to it in a timely fashion which is now a classical study in government and business schools on how NOT to handle a crisis.

To quote the article in the Journal of the American Medical Association published January 20, 2015, “As the United States population has doubled since 1955, the number of inpatient psychiatric beds the United States has been cut by nearly 95 percent to just 45,000, a wholly inadequate equation when considering that there are currently 10 million U.S. resident with serious mental illness.

Continuing, the authors of the article, Dominic Sisti Ph.D., Andreas Segal MS, and Exekiel Emanuel MD Ph.D, wrote “For the past 60 years or more, social political and economic forces coalescent to ove severely mentally patients out of psychiatric hospitals.” They went on to say that the psychological civil rights movement propelled deinstitutionalization and resulted in “transinstitutionalization” which meant the severely mentally ill hit the ERs, jails and homeless shelters and streets around the country in huge numbers. To further quote, “…most disturbingly, U.S. jails and prisons have become the nation’s largest mental health facilities. Half of all in mates have a mental illness or substance abuse disorder; 15 per cent of state inmates are diagnosed with a psychotic disorder.”

Instead, to quote the press release itself, “the authors suggest that a better option for the severely and chronically mentally ill, and the most ‘financially sensible and morally appropriate way forward includes a return to psychiatric asylum that are safe, modern and humane. They argue the term ‘asylum’ should be understood in its original sense–a place of safety, sanctuary and healing,” and I would add long term care, and long term rehabilitation to permit development of the current mantra ideal goal of “recovery.”