It’s not a subject we talk about openly, but with few exceptions, every family experiences the issue. Some 1 in 5 adults and 1 in 6 children under 17 in North Carolina suffer from mental illness. Half of them did not receive any treatment last year, according to NAMI, the National Alliance on Mental Illness.
The way our state treats those with psychiatric problems is criminal. We rank fifth in the prevalence of mental health problems and 37th for access to mental health care. Ninety-four of our 100 counties are designated as professional shortage areas. And sadly, there are few champions who can or are willing to do something about this illness that affects such a large percentage of people in our state.
There was a time when our state became a leader in treating those who suffered from mental illness. Dorothea Dix, a New Englander, was appalled by the treatment of women with mental illnesses and became a crusader for reform and better care.
All but two states had created hospitals for mental patients — Delaware and North Carolina. Dix brought her campaign to North Carolina in 1848 and lobbied our legislature to build a public psychiatric hospital. Simultaneously, Dix had been tending Catharine Dobbins, the wife of a prominent North Carolina legislator. Catharine’s dying request was that her husband see to the passage of the bill Dix had championed. The original measure failed to pass but, due to Dobbins’ influence, the N.C. House reconsidered and passed the measure, creating what became known as Dix Hospital.
Opening in 1856, Dix expanded to include 2,500 acres serving thousands of patients annually, with Cherry and Umstead hospitals later added. But a 1999 Supreme Court decision (Olmstead v. L.C.) decreed that segregating mental health patients in institutions like Dix was discrimination, according to the Americans with Disabilities Act, and that states were to offer care closer to the patient’s home. The efforts to deinstitutionalize patient care was forced on our state before we had either the facilities or personnel to treat those with mental illness, a fact that continues to this day.
We closed Dix Hospital, redirecting patients to the Central Regional Hospital in Butner. As of early this year, the three state-run facilities had 900 in-patient psychiatric beds available. However, due to staffing shortages, only about 600 are operational; patients have to sometime wait weeks or months for a bed to open. In 2013, we treated a total of 3,210 psychiatric patients, but in 2025, that number dropped to 875 patients, mainly because of a law passed by our legislature requiring that those who lacked the mental capacity to understand what was happening to them in court or who had a criminal history were to be involuntarily committed to a psychiatric facility while awaiting their trials.
There are private (non-government) providers, but they are too few, grossly underfunded and desperately understaffed.
NAMI says that without sufficient outpatient or in-patient facilities, those with mental issues make up a large percentage of the reported 9,280 homeless people in our state. One in four are trapped in an endless cycle of being arrested, thrown into already crowded jails, later released and arrested again. They roam our streets begging for help.
There were 1,557 people who committed suicide in 2024 in North Carolina, and another 358,000 say they had thoughts of suicide.
And the most tragic news is the growing number of our young people who report having anxiety issues or who suffer from depression.
Twenty-plus years after the court decision that essentially directed psychiatric care away from state facilities, it is time to declare that mental health reforms are a dismal failure. We made a tragic mistake closing Dix Hospital. Unlike Broughton in Morganton and Cherry in Goldsboro, Central Regional is inconvenient for large numbers of families to have contact with inpatient loved ones.
In the meantime, our state is growing in population by some 100,000 people per year. The problems of mental health care are only growing with it.
We need some new champions for mental health care, people who have a well-conceived strategy for how to proceed and who will fight for sufficient funding to attract and pay professionals to administer any plans we design.
Here are some questions worth pondering. Do we want to restore the concept of having state-owned and operated hospitals or continue with the concept of having local/regional care facilities? How do we develop those facilities? With only about 1,000 psychiatrists located in our state, how can we maximize their effectiveness, especially since most of them live in urban areas? How can we pay mental health professionals sufficiently to attract and keep them? How can we increase funding reimbursements to Medicaid patients that will provide money for their care?
Here’s what we do know. The longer we wait, the greater the problems will grow and the more it will take to solve them. We won’t find solutions if we don’t begin.
Tom Campbell is a North Carolina Association of Broadcasters Hall of Fame member and a columnist who has covered North Carolina public policy issues since 1965. Contact him at tomcamp@ncspin.com.