Over six years ago, North Carolina embarked on the very important mission of reforming our state's mental health care delivery system. The ideas of reform were founded on two basic principles:

• In caring for our citizens with mental illness, developmental disabilities, and suffering from substance abuse, we should minimize our dependence on state psychiatric hospitals and institutional care by creating and expanding a strong and effective community based system of care based on best practices, consumer choice, and person centered planning.
• Building the capacity to provide needed services in communities across our state would allow consumers to remain close to family and friends, and substantially eliminate the need for consumers and their families to travel long distances seeking services.

When House Bill 381 was enacted to set the system reform wheels in motion in 2001, the instructions were to complete the reform effort in a five-year timeframe. The legislative timeline for reform arguably rushed the effort into mistakes, including:

• Improperly timed, poorly planned, and failed implementation of initial changes in the care system and services.
• Poor planning and communications led to misunderstandings of responsibility and premature divestiture of mental health services previously provided by Area Mental Health Programs prior to the development of solid replacement services.
• The lack of consistent structure, processes, and application of rules across the State and among LME's.
• A provider reimbursement and regulatory system that fails to adequately promote the development of the necessary community service capacity.

Failures in the implementation of the reform plan have resulted in:

• Inconsistencies and loss of services to some of our most fragile citizens.
• A substantial loss of public confidence in the reform effort especially among consumers, their families, and care providers.
• A current service delivery system that is extremely fragile and incomplete.

Since long promised reforms have failed to meet the needs of our mental health care delivery system, it is important that we move forward with a plan that creates a structure of clarity, certainty, and confidence, providing appropriate leadership and a plan that more clearly identifies the roles and responsibilities of the State, the Local Management Entities (LME's), and the care providers. To accomplish this we must:

• Place clear responsibility on the State for providing care for the long-term and more difficult chronic cases of mental illness and disabilities that cannot be appropriately served in the community and require the expertise and services provided through our state psychiatric hospitals and facilities for the developmentally disabled.
• Develop the community capacity for short-term acute psychiatric care by working with our LME's, community hospitals, and other providers to establish and reinforce our abilities to serve consumers in crisis, providing a hub around which to build community services while reducing dependency on the State's psychiatric hospitals.
• Develop the community capacity to provide individuals with mental illness, developmental disabilities, and substance abuse with appropriate on-going assistance and services necessary to provide the greatest opportunity to live a productive and quality life.

Building a strong system of community based mental health services is not going to happen as a result of increased and constantly changing state rules and regulations coupled with poorly developed and sometimes inadequate provider reimbursement policies. Building community access and choice is going to require leadership focused on understanding the needs and identifying and addressing the barriers to success. This requires a willingness and devotion to working closely with our community hospitals and other care providers, the LME's and local governments, consumers, families, and advocates to find solutions.

Accomplishing our goals in mental health reform is not something that can wait. It is important that successful completion be achieved as quickly as possible, reducing the negative impact on consumers from a system in crisis. Our success at reform will help ensure better lives for many in need, providing new confidence that appropriate and effective care will be available for our citizens with mental illness, developmental disabilities, and those suffering from substance abuse.

Until real progress is demonstrated in the development of adequate community capacity across North Carolina, we should not reduce the State's capacity to provide services in our state institutions. This is not only important for those individuals currently being served, but also to meet the needs of the rapidly growing population in North Carolina.