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Failure to fix mental-health care dangerous for all of us
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Published: June 28, 2009
As legislators finish work on a budget that almost surely won't contain enough money to correct the state's failed overhaul of its mental health-care system, they should consider how much the broken system endangers both the mentally ill and the people who battle endless red tape as they try to help them. Just ask Cpl. Lori Gortman of the Forsyth County Sheriff's Office.
For six years, a large part of Gortman's job was to drive patients from Forsyth to the state psychiatric hospitals to which they'd been committed. That work, which Sheriff Bill Schatzman has called an "armed-cab" service, is his office's responsibility by law. It's a frustrating, heartbreaking job that eats up both time and dollars -- more than $400,000 for the sheriff's office from May 2008 through April 2009. And one night just before Christmas 2004, the job nearly cost Gortman her life.
Gortman, who is now 35, was working alone, as deputies often do when transporting mental patients. The often solitary nature of the job, brought on by a lack of manpower, isn't the only danger. The officers don't have radio contact with the law-enforcement agencies in the other counties they drive through. Just as many civilians on the road, their only way of calling for help is by cell phone. "You hope there's a tower somewhere that's going to make it work," Gortman said.
She had been with other deputies on a couple of transports where the patients were so out of control sirens were kept on all the way to the state hospital. But those journeys didn't compare to the night in 2004. Gortman picked up the patient in her 20s at Wake Forest University Baptist Medical Center. The woman had been committed to the state psychiatric hospital at Butner. She may have been suffering from bipolar disorder, Gortman said. But on the trip to Butner in a sheriff's office van, the patient was friendly and polite.
Doctors at the state hospital would not commit the woman. They said their records showed that, in addition to her mental disorder, she was mentally retarded, and would therefore need a new commitment order.
Rejections for various reasons are common. They often come after law-enforcement officers have sat with patients in emergency rooms for hours and even days, waiting for a bed in a state hospital.
Gortman locked the woman back up in the van. Being denied entrance to the hospital upset her, Gorman said. "She was not happy about that. She became very agitated and started kicking the cage."
That was on Interstate 85 in Durham. Using her personal cell phone, Gortman called a dispatcher in Forsyth and said that her passenger was endangering herself, and she would have to stop and restrain her. Gortman named the exit she would be taking. The dispatcher called Durham police.
Gortman stopped at the end of the exit ramp. Meanwhile, the woman had broken out of her enclosed area in the van. Gortman and the woman struggled outside the van as Gortman tried to handcuff her. The woman tried to flee. Gortman grabbed her shirt. It came off, and Gortman fell by the roadside. She hit her head on the pavement and was knocked unconscious.
When she came to a few minutes later, she could hear Durham police coming. The patient was on the other side of the road. Durham police took her into custody and took Gortman to a hospital, where doctors determined that she'd suffered a concussion.
Gortman recovered in a few weeks. Today she works in the civil division. Other deputies in her department continue the transports. Like so many other people, including those with mental problems and their families, they work with a broken mental health-care system.
"The doctors here don't want to be responsible for not committing someone," Gortman said. "So they're going to send them down the road and leave it up to the state hospital. And the way they've cut the beds with the state, they keep someone maybe 24 to 34 hours."
"To me, they've not really received any help. They're more interested in getting them out of there, is the way it appears to me. They stabilize them, and then they let them go."
Deputies transport patients back to Forsyth County, releasing them to family and friends -- and sometimes to homeless shelters. "And typically, you're running them back down the road within a week," Gortman said.
She had some training for that work, but not enough, she said. Many officers at rural departments get far less. There's always the possibility that officers and patients can get hurt, including through officers losing their temper. "You have to stop and breathe, count to five," Gortman said. "Most of them (the patients) aren't able to realize and comprehend what they're doing."
Some critics might say the same of the officials trying to correct the mental-health system overhaul, which was supposed to shift the load of mental-health care from state hospitals to community providers. The failed overhaul has taken us all for a ride.
It's past time for the state to fix it.
■ John Railey writes local editorials for the Journal. He can be reached at 727-7357 or at jrailey@wsjournal.com.
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