Shortly after the new system was put in place, numerous problems occurred. Many highly trained mental health care workers left the field as private providers took control of service delivery, decimating the professional public-sector workforce. Furthermore, the fragmented system created through privatization had a tremendous negative impact on the quality of services provided to clients. Many times, important mental health services were no longer even available to clients. Private providers engaged in "cherry-picking," offering only the most profitable services, such as "community support" services. These services include basic assistance and mentoring, and such tasks as running errands for a client or helping with a child's homework. They could be performed by low-paid, unlicensed personnel. Many providers focus on these highly profitable community support services and left seriously ill clients without the more costly care they needed.
Reports of cost overruns estimate that the state wasted at least $400 million in community support services offered by private providers that were unnecessary for the client or not even performed. As a result of the in treatment offered by the private providers, the number of North Carolinians with mental illness who ended up in emergency rooms or jails significantly increased.