Raleigh, N.C. — Some local providers think that a gradual approach to reforming North Carolina's mental health-care system would best ensure that patients continue to receive care during a major restructuring.

Deborah Tanner, operator of Family Home Life in Roanoke Rapids, said local providers will need clearer guidance from the state than they received during the last round of reform in 2001.

"There was so much confusion, because we got so many changes and we were struggling to figure out just what it was they were trying to tell us to do," Tanner said.

The state's mental-health system has struggled recently amid accusations of wasted money, inadequate services and neglected patients. Some critics blame the 2001 reforms that were intended to create a cost-efficient system that would serve more patients at a lower cost and provide more choices in services.

The decentralized system required shifting patient care from state institutions to private providers. But those providers did not get adequate training before they had to implement new, community-based programs in 2006, Tanner said.

A spokesperson said the state Department of Health and Human Services had anticipated there would be a learning curve as it tried to start up an array of programs.

Some providers overcharged for services, the DHHS spokesperson said.The federal government is withholding more than $130 million in reimbursements, citing concerns that the state mismanaged Medicare funds in the past.

Tanner said that while that might be true for some providers, her agency offers its patients services for which it is not always reimbursed.

"We're still doing it without getting paid for it because we're not going to just let people out there without any help," Tanner said.

Some state lawmakers say they want the DHHS secretary to have more than a year to create a plan for major restructuring. However, the Governor's Office and a legislative committee have already identified some reforms for which they will push during this year's General Assembly session.

Tanner said that at whatever speed changes are made, she hopes state officials will remember who should benefit from any reform – patients such as 21-year-old Bernard Powell, who gets care for Down syndrome at Family Home Life.

"They have the same needs that we do," Tanner said. "They just need a little bit of guidance on how to carry out the day-to-day."