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6 <br />MENTAL HEALTH TASK FORCE REPORT <br />The consensus view throughout the mental health community is that from the outset, system <br />transformation was under-resourced, poorly planned and monitored and bereft of skilled, coherent <br />leadership. By 2005, with adult admissions to state hospitals actually UP and per capita mental health <br />spending on the decline, criticism (e.g., "runaway train", "lack of accountability", "failure's was extensive in <br />all quarters. <br />By 2008, when several concerned members of the community began to talk with the Mayor, it was dear <br />that the vision of aconsumer-responsive, community-based network of care had not been fully realized in <br />Orange County. As was true elsewhere in North Carolina, the void of transition had been partially filled by <br />providers whose practices increased the instability of the local system of care. Most notable had been the <br />failure of the Caring Family Network as the primary operator of outpatient mental health clinics. <br />The following perceptions and observations regarding the state of reform in North Carolina capture what <br />the Task Force considers to be the state of mental health system reform in 2009: <br />• The envisioned transformation of the system has not occurred; the system is fragmented and <br />complex; it is characterized by "silos of care", .as well as service and access gaps; <br />• State leadership has been weak and "reactive"; <br />• Providers are losing money; <br />• The indigent care system is inadequate; <br />• Funds get siphoned off in many ways, leaving a landscape with many inequities; <br />• There are many under-served individuals, including those... <br />a. ...lost from the system during reform and never found again; <br />b. ...whose care is funded through Medicare; <br />c. ...at risk of homelessness or already homeless; <br />d. ...whose care is not already funded through Medicaid or private insurance; <br />e. ...in the 18-22 age group. <br />III. Mental health service delivery in Chapel Hill and environs <br />As part of its work, the Task Force reviewed and discussed the state of mental health services in the <br />greater Chapel Hill area. Individual Task Force members and guests representing a variety of agencies and <br />interests within the system made presentations and at two public "Listening Sessions", citizens and providers <br />talked with us. Notes from all these presentations are available at the Task Force webpage at <br />http://www.ci.chapel-hill.nc.us/. In addition, as noted above, the work group that focused on visually <br />4 <br />