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N.C. prosecutors decry erosion of the state’s mental health services

Source: By Michael Biesecker |  McClatchy Newspapers

North Carolina’s prosecutors say they are increasingly concerned about the erosion of state services for people with mental illness who are accused of crimes.

In a letter sent last month to Gov. Bev Perdue and her secretary of Health and Human Services, Lanier Cansler, the N.C. Conference of District Attorneys said its members are worried by a lack of available beds in the forensic unit at Central Regional Hospital in Butner. Evaluations are performed there to determine whether defendants are competent to stand trial.

The pre-trial evaluations have long been done at Dorothea Dix Hospital in Raleigh, but the unit is set to move to Butner early next year.

“As North Carolina’s mental health system has evolved over the last decade, we have seen an alarming trend; forensic bed space has been significantly reduced, while the demand for pre-trial forensic beds has been increasing,” said the Oct. 19 letter, signed by 27 of the state’s elected prosecutors. “We feel that if this trend is not reversed, the criminal justice system, criminal defendants, and our citizens will suffer the consequences.”

Though the letter was sent more than two weeks ago, conference director Peg Dorer said Wednesday the group has not received any response from Perdue or her administration.

Cansler said Wednesday he had been out of work for personal reasons, and that the letter sat on his desk until he returned. He has assigned staff to gather information and respond, he said.

Cansler said he disagreed that access to pre-trial forensic beds has been in short supply.

“Based upon everything I’ve heard so far, we’ve not had a problem because we’ve actually had plenty of capacity,” he said.

The unit is staffed to accommodate eight patients in the Dix unit, and that capacity can be doubled to 16 if needed. Over the last year, Cansler said the unit had averaged seven patients a day. There were 13 patients in the Dix unit Wednesday, he said.

Jim Woodall, the district attorney for Orange and Chatham counties and president of the statewide conference, said the unit at Central Regional may not be full all the time because the state is more often performing outpatient competency evaluations, rather than admitting the defendant to the hospital for long-term observation.

Woodall said the conference is concerned that, in a climate of tight budgets, the state will look to cut the remaining inpatient beds. That could make it more likely that a defendant faking mental illness could fool an evaluator during a one-day assessment, he said, as well as make it tougher to get help for those who need it.

Overall, the number of beds in the state’s psychiatric hospitals has been cut by half since 2001, when North Carolina launched an extensive effort to reform its mental health system to decrease government-provided services in favor of private providers.

The implementation of that reform is now widely regarded as a disaster, leading to chronic shortages of inpatient treatment beds and the lack of quality outpatient services in wide swaths of the state.

“We’ve always dealt with defendants in the criminal justice system who are mentally ill,” Woodall said.

“But we’ve been seeing an increase in the last few years, since the state made the changes. The [reforms] have had a significant impact.”

The district attorneys contend in their letter that they are increasingly reliant on sending defendants to the Department of Correction psychiatric unit in Raleigh or finding qualified professionals to evaluate people while they stay in county jails ill-equipped to meet their treatment needs.

“While we understand that reverting to local services has been a trend within the mental health system, it is not a practical solution in these circumstances,” the prosecutors wrote.