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Fractured: A Public Conversation

From left, Sarah Delia, Richard Wells, Kody Kinsley, Spencer Merriweather and Dana Miller Ervin
Jeff Cravotta
for WFAE
From left, Sarah Delia, Richard Wells, Kody Kinsley, Spencer Merriweather and Dana Miller Ervin.

North Carolina’s mental health challenges and solutions to resolve the crisis were the focus Tuesday night of WFAE’s Fractured: A Public Conversation. The discussion was an outgrowth of WFAE’s ongoing investigative series “Fractured.”

Among the series’ findings:

  • More than half of the state’s jail inmates found incapable to proceed to trial because of mental illness wait more than 300 days for a state psychiatric hospital bed.
  • The state’s three psychiatric hospitals only have a combined 894 beds, but only about 600 are available because of staffing problems. In 2000, there were nearly 1,600 beds.
  • Many people found incapable to proceed never get a bed. Charges are often dismissed because their stays in jail would be longer than the maximum sentence for their alleged crimes, usually misdemeanors. Many return to jail on similar charges and start the process over of waiting for a bed.
  • In 2002, patients with mental illness who to hospital emergency rooms in hopes of getting a state psychiatric bed waiting an average of 16 days — taking scare spots of other people in crisis.

The first hour of the roughly 90-minute discussion can be heard on Charlotte Talks here. The last 30 minutes was a question and answer session with the audience. The panelists:

- Kody Kinsley, secretary of the North Carolina Department of Health and Human Services.

- Spencer Merriweather, Mecklenburg County district attorney.

- Richard Wells, an attorney in Guilford County's public defender’s office.

- Dana Miller Ervin, WFAE reporter for the “Fractured” series.

Listen here: Our fractured mental health system
How do we fix a criminal justice and mental health system that's not getting people the help they desperately need? Listen to WFAE's public conversation here.
North Carolina Department of Health and Human Services Secretary Kody Kinsley

Highlights from the discussion

On making up for “past sin”
Kinsley said it is hard to find people health care in community settings in part because “we have had for the last ‘ever’ 1.2 million people in North Carolina without health insurance.”

He noted that will change when Medicaid expansion kicks in after lawmakers pass a budget.

“But I just want to be clear that we are making up for a past sin here where we have never treated behavioral health like on equal measure with health broadly, and we have never prioritized that as part of primary care. And we've got to rebuild that entire system from the ground up in North Carolina.”

On a “dangerous decision” people must make
Merriweather spoke of his experience after graduating from law school of deciding to spend $60 on a therapist every two weeks when he was waiting tables. His point: It’s tougher for many people to make that financial sacrifice:

“I had a job. There's a lot of people who don't have access to those resources and still have to make that decision about whether or not they should pursue mental health or whether it's a luxury. And I'm here to tell you, that is a dangerous decision to force upon people who live in your community. And it has repercussions that we see at our courthouse every day.”

On the challenge of keeping people on medication when they leave jail
Wells said inmates with mental illness typically leave the Guilford County Jail with a prescription for a five-day supply of medication.

“It gets called into a pharmacy depending upon when you get released at night. Every once in a while, something gets missed and it doesn't get called in. So somebody has to follow up with that. But that supply of meds is for five days. And then the time that it takes to get in and get into — you're referred to a local provider on the outside — to actually get in and get the appointment and maybe get medications can sometimes be two weeks, three weeks out.”

On money the state already spends
WFAE’s Dana Miller Ervin noted the state already spends a lot of money on mental health care in a way that’s not working. She brought up the example of John, the subject of the first "Fractured" story. John was found incapable to proceed and spent nearly five years without a trial cycling between the Mecklenburg County Jail and a state psychiatric hospital, where he’s now a patient.

(Kinsley) told me we spend $1,400 a day on a state hospital bed, thereabouts … He'll probably have spent an entire year in a state hospital … And then you've got the cost of him being in the jail. And so we'll have spent over $1 million on him to make him sicker. What have we done with that money? We've made him now where maybe he's going to always be a ward of the state. Congratulations.”

Kinsley concurred with her point.

The thing is, with behavioral health, the system is currently designed and resourced only enough to keep people in a constant state of crisis at the most expensive point in the process,” Kinsley said. "So the money that we need to spend is not about spending. It's about investing and trying to shift the paradigm of care to get more preventative and more upstream."

"Fractured" is part of a collaboration between WFAE and FRONTLINE, the PBS series, through its Local Journalism Initiative, which is funded by the John S. and James L. Knight Foundation and the Corporation for Public Broadcasting.

A Conversation Series on Mental Health:

These are some of the resources discussed during our conversation series about mental health.