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RALEIGH — Cases of patient abuse and potential dangers at a new $120 million mental hospital were among the factors that prompted state officials to put key parts of North Carolina's mental health reform effort on hold.

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The John Umstead and Dorothea Dix mental hospitals in Butner and Raleigh had been scheduled to close by the middle of March and replaced by a new Central Regional Hospital in Butner.

Putting that transition on hold for at least 60 days was one of several steps Dempsey Benton , secretary of the Department of Health and Human Services, announced Thursday. Benton said the closings could be delayed further depending on what just-launched reviews of the state mental health system find.

"This doesn't address every part of the mental health transformation," Benton cautioned. He said that efforts in the coming months would be aimed at correcting the most pressing issues and getting requests to the legislature before it reconvenes in May.

Although he declined to characterize the state's mental health system as broken, Benton told reporters that when Gov. Mike Easley appointed him late last year, his instructions were to "fix" the state's public mental health system.

Benton said he would directly oversee the hospitals' administration and consolidation for the time being, taking that responsibility away from leaders at the Division of Mental Health. When asked about potential personnel changes, he said there had not been any decisions about changing leaders at the division.

"The people with the division have their hands full with the community service component," Benton said, referring to a broad spectrum of services that have had their own problems but were largely unaffected by the efforts announced Thursday.

North Carolina's mental health reform, or transformation as it is sometimes referred to, began in 2001 and was a remake of the services provided to clients without the means to procure private treatment or too sick for private mental health providers to handle.

At the General Assembly's direction, county mental health agencies were to largely stop providing services, contracting most work out to private providers. Emphasis was to be placed on keeping all but the most severely ill clients in their communities, even providing in-patient treatment at local hospitals. At the same time, the state was going to streamline its mental hospital system, most dramatically Dix and Umstead into one new hospital.

All has not gone according to plan. Among the foremost issues Benton wants to tackle:

* Broughton Hospital in Morganton lost its ability to collect Medicaid and Medicare payments last summer and is still at risk of losing its accreditation.

* Reported violence and other federal reviews have called into question patient safety at the four largest state-run mental facilities.

* A recent review of the $120 million central hospital found more than 30 hazards in the facility, some of which could allow clients to hang themselves.

* A planned network of local crisis hospital beds across the state has not developed, putting more pressure on state hospitals and creating a shortage of beds for patients in need.

In addition, Benton said, local and state governments, private providers and other elements of the system have had problems working together.

"Part of what I have been concerned about is the lack of clarity of responsibilities, the lack of consistency in the way we are developing services across the state," Benton said.

In addition to delaying the hospitals' consolidation, Benton appointed two committees to study quality issues at the state's own hospitals and to find ways to develop more mental health beds in local communities.

"It's not real clear to the average citizen where they should take their son, their mother or father when that person does have a meltdown," said Patrice Roesler , deputy director of the N.C. Association of County Commissioners.

She is one of those who will be working on the issue of creating local crisis beds.

"Honestly, I'm hoping to get a little bit of clarification on how these task forces are going to work, where their recommendations will go," said John Tote of the N.C. Mental Health Association, another group that has been tapped to help the state.

In an e-mail, Guilford Center Director Billie Martin Pierce said Benton had "objectively assessed" the problems faced by local mental health agencies such as hers.

"The Guilford Center is already working in partnership with Smoky Mountain and Mecklenburg to assure quality and efficiency for the consumers we serve," Martin said.

In December, Easley said the state may have to reclaim some authority given to agencies such as the Guilford Center, a thought that Benton echoed Thursday. Much of mental health reform, he said, relied on those local agencies to smoothly transition from being service providers to administrators.

"The changes were focused on the (local agencies) being a key part of this," he said. "It may be that too much was expected of them, and we need to take another look."

A consulting firm, he said, was already studying that question.

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