Eight years into mental health reform, North Carolina has thus far dodged a bullet. Much of the postmortem on the origins and unfolding of the reform effort has been done. But how much worse can things get, and what will it take to bring about real and meaningful change?

If recent developments do not mark a turning point in reform, the turning point will be marked by tragedy on a massive scale.

Consider that after all of this time, just three of 24 (12.5 percent) local management entities (the organizations charged with ensuring needed services are available) in North Carolina are meeting minimum standards for routine care. Just 45 percent are meeting minimum standards for urgent care. How bad must things get before we are willing to re-think the fundamental assumptions that the new system was founded on?

North Carolina ranks near the bottom in the nation in per-capita funding for mental health care at $16.80, compared to the national average of $91.12. Yet our problem is much bigger and more complex than under-funding. After the first six months of the fiscal year, the Division of Mental Health, Substance Abuse and Developmental Disabilities reported that only 30 percent of mental health funds and 20 percent of substance abuse funds that had been budgeted had been expended. On the surface it might look like the system is over-funded, but what these numbers signal is that needed services are not being provided because they are unavailable.

A core problem with the new system is that it was built upon a fundamentally flawed assumption that the private sector will always outperform anything run publicly. It is a wildly popular notion and a key reason why this particular plan was able to gain support in North Carolina.

The private sector is far superior in many arenas, but not necessarily when it comes to protecting the poorest and most vulnerable members of society. Private providers pick and choose which services they will provide based on what will best meet the needs of the agency, as opposed to public entities whose first responsibility is to meet the needs of the citizenry. Departments of social service, child protective services and health departments are county-run, why not mental health?

In Orange, Person and Chatham counties, Caring Family Network, the agency designated as the comprehensive service agency (CSA) in our area, determined that it could not financially sustain service provision and ceased providing services. The CSA is the agency designated to provide an array of services including psychiatry, psychotherapy, crisis services, substance abuse counseling, and community support. It is meant to replace our old public "safety net" clinics to ensure that a basic level of service is available to the community.

The new safety net is the criminal justice system. We know what happens when people who need psychiatric care do not receive it. Most suffer quietly, some lose their jobs, are engulfed by addiction, lose their housing, fill hospital emergency departments, crowd jails and prisons, or take their own lives. But Wendell Williamson, the UNC law student who opened fire on Franklin Street on Jan. 26, 1995, with an M1 rifle, killing two and injuring two, tells another story. Alvaro Castillo, who killed his father and fired eight shots at Orange High in 2007 made a convincing argument for the importance of mental-health treatment. Most recently, Steven Kazmierzak made his case at Northern Illinois University.

Calling up these names from the past risks reinforcing stigmatizing stereotypes about people with mental illnesses. When people hear of mental-health disorders, they too frequently conjure up images of the most-severe, least-common cases. They do not think of someone like me, though I represent a more common picture of someone with a mental disorder.

Only a small fraction of people who experience mental-health disorders present a danger to others. But when one considers the scale at which our system is failing, it is clear that a new tragedy is only a matter of time; it's a statistical certainty. The formula is simple: Take a population of 9,061,032, of which approximately 356,000 adults have a serious mental illness and 192,000 children have a serious emotional disturbance. Next, systematically restrict access (either intentionally or unintentionally) to treatment for those who need it. The result equals tragedy on a massive scale.

We will never be able to prevent every tragedy, even with an excellent mental health system. But by restricting access to care for 550,000 of our most deserving and needy residents, we are stacking the odds against ourselves.

Health and Human Services Secretary Dempsey Benton has been called upon to salvage the system. He is by all accounts a capable administrator, and he has taken steps that show he means business. But with less than a year left in Gov. Mike Easley's administration, he will have to be a miracle worker to provide leadership that amounts to something more than too little, too late.

County officials have a rare opportunity to step in and do something that is fiscally responsible, morally right and politically popular. Will they stand by and wait for the state or a private provider to replace the safety net while the system is in free fall? If so we may be in for a very hard landing.