Virginia Knowlton Marcus
Chief Executive Officer
North Carolina’s treatment of children with mental health disabilities has become national, state and local news. Investigative reporters and editorial writers are bearing down on the stark, dangerous realities of the state’s routine practice of locking away our kids, sometimes hundreds of miles away from loved ones. Instead of getting the help they need and deserve, these N.C. children are warehoused, traumatized, abused and neglected. USA Today Network–North Carolina and McClatchy are to be commended for shining a bright light on these dark places called psychiatric residential treatment facilities (PRTFs). This exposure has provided an inside view of PRTFs that most people — sometimes not even parents or legal guardians — can get. On Dec. 17 one such facility, Strategic Behavioral Health in Garner, agreed to close after the state found serious care issues.
These disturbing reports came as no surprise to Disability Rights North Carolina. They’re a snapshot of what DRNC has seen and reported regularly to state authorities as the result of our monitoring work in PRTFs. Kids often are not getting the care and treatment they need. Instead, they’re physically and chemically restrained, physically and emotionally abused, and neglected by staff. DRNC is heartened to see public attention growing. Earlier this year, we began our own campaign to build awareness about PRTFs called #BringNCKidsHome so more people could see the financial and human cost of a mental health system built around PRTFs.
Each year, the state pays more than $100 million to institutionalize a little over 1,000 kids. According to recent media reports, North Carolina can’t say if the kids are benefiting from being locked away because they haven’t been tracking outcomes.
Surely, the for-profit owners of these PRTFs are benefiting. The state pays these providers $400-$800 per day, per child, even while they rack up violations of abuse and neglect and failure to provide actual treatment.
According to the November investigative series by Gannett/USA Today, “Locked Away,” more than half of these children are in foster care, meaning they are in the custody and care of the state. Black and Brown children are disproportionately affected, and children sent to PRTFs “are less likely to graduate high school and more likely to go to prison than most other young people.”
North Carolina also sends kids to out-of-state PRTFs as far away as Utah and Arkansas, where it’s not possible for N.C. to provide meaningful oversight. DRNC’s own investigative work revealed that state officials don’t even know where some of these kids are.
So who are these children and why are they being sent to these expensive harmful places? They are kids with mental health disabilities whose families and guardians can’t get them the help they need in their communities because mental health services aren’t available — even though North Carolina has a legal obligation to ensure kids (and adults) can remain in their communities rather than being locked away in institutions that can be more punitive than therapeutic.
North Carolina has the power to change this. Every year, the state gives millions to managed care organizations to make sure services are available to kids (and adults) in their home communities. But the state hasn’t forced these organizations to do that, even though the contracts with these organizations require them to build these community services. These organizations are allowed to keep the money they don’t invest in services designed to support kids and families at home.
North Carolina must do better. Like all children, N.C. children with mental health disabilities deserve hope for their futures.
It is critically important for North Carolina to ensure accountability for our children — and accountability of these managed care organizations. State leaders must develop a laser-focused determination to shift resources away from institutions to community-based care. It won’t be simple, but it is doable. Failure to act is inhumane and inexcusable.
(This op-ed first appeared in The News&Observer on 12/27/2021. DRNC is reposting here for people who cannot access the article in the N&O.)