From Vicki Smith, executive director, Disability Rights NC, Champions for Equality and Justice:
Last year, 2007, was a dangerous year for individuals living in the state psychiatric hospitals. A veteran lawmaker was skeptical of the abuse recently reported at John Umstead Hospital, saying, "Well, I seriously doubt that it happened, but if it did, it certainly is a travesty and should be addressed." Asked to elaborate, he said, "We just don't usually beat folks. It's not the kind of thing that usually goes on in our mental hospitals."
He is wrong. Cherry, Broughton and now Umstead have been cited by the federal government for treatment conditions so poor that residents have been abused and in some cases died.
So, who is responsible for the increased violence in our state hospitals? Umstead Director Stephen Oxley was quoted as saying, "This is not a problem of our hospitals screwing up, of just not doing what they're supposed to do. ... We're being confronted with a significant increase in violence in our facility." If it's not a problem of the hospitals, then what is the problem? Apparently, one solution would be to blame the victims of this violence, residents with mental illness who are in the hospital, often not voluntarily, to receive treatment.
There are more suitable places to look for the cause of this systemic problem. First, the inevitable consequence of understaffing, overwork and low wages is poor employee morale. Poor employee morale often results in staff turnover, making it even harder to ensure that workers are appropriately trained. Poorly trained workers provide poor services. In a health care system, this translates to poor patient care -- in state hospitals that means increased abuse and neglect. This is the fault of the system that provides the staffing ratios of patients to health care workers and establishes employee salaries. It cannot be resolved by isolated after-the-fact firings.
Secondly, there must be adequate community-based services including crisis facilities to prevent, when possible, the necessity for hospitalization. Without appropriate community services, especially crisis intervention, people with mental illness can experience rapid escalation of symptoms. Added to this dangerous lack of services is the long transport from local neighborhoods to overcrowded state hospitals. Now it is beyond crisis. It is a tragedy waiting to happen.
A community-based service delivery system for people with mental illness, substance abuse issues or developmental disabilities cannot be built by simply closing down institutions. There must be an array of regionally based community services. There must be adequate housing, supported employment opportunities, safe recreation and other service options readily available across the state. As people move through the service delivery system, there must be crisis services including trained first responders.
But most importantly we have to stop thinking the bottom line is preceded with a dollar sign and recognize that what we are really spending -- not saving -- is human lives.
The views in For The Record are the writer's, and not necessarily those of the Observer editorial board.