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RALEIGH — Some mental health patients find it hard or impossible to get the services they need because government officials and private providers have struggled to keep up with the rapid pace of changes demanded by North Carolina's mental health reform effort, according to a consultants report released Wednesday.

The 91-page document does point to some successes, but is clear that the state needs to move rapidly to fix "gaps" in the system.

Most of its criticism revolves around a central theme: The pace of change has focused state and local governments on remaking the bureaucracy while leaving some mental health consumers unable to find care.

"In the rush to complete structural changes, the public partners have lost sight of the effect on consumers," the report says. "(T)here has been insufficient joint effort at resolving consumer access problems."

The report was drafted by Alice Lin, a consultant for the state Division of Mental Health. She was at one time a staff member at the General Assembly and helped write the original reform law in 2001.

That remaking of the state's mental health system was in part an effort to save money and was aimed at plugging gaps that prevented some people — for example, substance abusers and the very poor — from getting services. The idea was to better target public money to those in need and to allow government agencies to focus on oversight. Private providers, many of them nonprofits, would be leaned upon to provide the actual treatment.

Lin's report points to some things the state has done well, such as providing more money to the mental health system and giving consumers a voice in structuring the system.

"For 85 percent of consumers, things have gone well," said Leza Wainwright, deputy director of the Division of Mental Health.

The report compares North Carolina's efforts to those of other states that have taken on reform. It points out that other states such as Georgia, Ohio, Pennsylvania, and Texas have spent decades to perfect changes in their mental health system.

"It was somewhat comforting to read the pieces about what other states have done and how long it took them to do things," Wainwright said. "That makes me feel a little bit better about where we are."

But, she quickly said, the report's more critical findings also were correct.

"There are some areas where there have been some slippages," Wainwright said. In particular, she acknowledged the pace of change has forced the agency and its county partners to focus more on process and structure and less on how policies have affected individual consumers.

"That is a valid criticism," she said.

There are 25 local management entities, or LMEs, that work with the division throughout the state. They are local agencies responsible for channeling consumers to the right care. Some are made up of several counties while some, like Guilford County's, stand alone.

Because it was released Wednesday, no one at the Guilford Center had a chance to review or comment on it, said Penny Casto, a spokeswoman for the agency.

Guilford County was not one of the seven local agencies studied directly by the report's author, but the findings are thought to hold statewide.

"From our perspective, this report was way, way past due," said John Tote, executive director of the Mental Health Association in North Carolina, an advocacy group. A comprehensive checkup on how mental health reform was going should have been completed one or two years into the process, not six years on, he said.

Tote said that he, too, was still reviewing the report's findings but said at first blush the report was consistent with problems his agency has seen.

"You've got providers that can't keep up with the pace of reform," Tote said.

Contact Mark Binker at(919) 832-5549 or mbinker@news-record.com