Mentally ill patients in South Carolina spend days in emergency rooms, wait weeks for therapy and languish for months in jail because of inadequate mental health services.

So local advocates were surprised when the Palmetto State's mental health system was rated among the best in the nation according to a new report card from the National Alliance on Mental Illness, which gave the state a B- overall.

"There is simply no way we can have people stranded in hospital emergency rooms for days and weeks and still get a B," said David Almeida, executive director of the South Carolina chapter of NAMI. "We're in the middle of a devastating mental health crisis."

"I find it difficult to understand how in a state where we have such limited access to care we can get a B-," said Dorit Reichental, executive director of NAMI's Greenville chapter. "The foundation to mental health is access to care."

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The grades were calculated by averaging the scores of 39 factors, such as insurance parity for mental illness, restrictions on antipsychotic drugs and access to inpatient beds, in four categories: infrastructure, information access, services and recovery support, said Steve Buck, one of the report's authors and director of state policy for NAMI.

No one category was given any more weight than another, Buck said. But, he said "services is where the rubber meets the road" and the state got a below-average grade -- a D+ -- for that.

"If somebody needed services, whether or not they are able to get those services appears to be in question," he said.

But the report didn't ignore other concerns. It concluded there are significant problems, including poor access to crisis and acute care because budget cuts led the state Department of Mental Health to reduce psychiatric beds.

"Since 2001, the department has lost $30 million in funding, dropping below its 1998 level, even as the cost of programs increased by more than $45 million," the report reads. "DMH bed reductions went too far, leaving hospital emergency departments and local jails as the only alternative for many patients who need a state psychiatric hospital bed."

It's all had a domino effect, Almeida said. Patients who need long-term psychiatric hospitalization have been moved to beds meant for short-term stays, forcing patients who need short-term care into ERs while waiting for a psychiatric bed to open up.

"Half the short-term beds are now occupied by long-term patients," Almeida said, "so someone in Greenville may have to wait days or weeks for a bed."

DMH spokesman John Hutto said the report at least recognizes the constraints under which the department is operating.

"This report validates our position," he said. "We are down about $31 million, the number of clients is on the rise, and expenses are going up."

DMH is aware of the problems caused by the shortage of beds, Hutto said, and has asked the Legislature for $6.5 million to open 99 inpatient beds and $1.5 million for 100 new beds in the community to ease the situation in ERs and in jails.

"It's a critical situation for everyone," he said. "And we're optimistic it will happen."

The House Ways and Means Committee has proposed to fund those items, along with another $7.1 million in system improvements, on top of DMH's $179.5 million 2006-07 base budget, said committee chair Rep. Daniel T. Cooper, R-Anderson.

"We just realized there have been some critical needs in the department," he said. "And I don't want to see any more news stories about mental health patients being handcuffed to fences or having to treat some of these patients in hospital ERs."

The measure still must be approved by the full House, the Senate and the governor, Cooper said.

The report card commends the state for a number of improvements in the face of budget cuts, including last year's passage of a mental health insurance parity act and expansion of mental health courts.

Dr. Al Edwards, executive director of the Greenville Mental Health Center, said he was pleased South Carolina ranked among the top five states overall, and noted that even the D+ for service delivery is at the national average.

"The state does a pretty good job and has for years," he said.

He agreed with criticisms about budget cuts, though, and said the state needs to pay particular attention to people who have both a mental illness and a substance abuse problem.

"My overall take ... is that the department is trying to do some things they think are important, but due to funding some of the strides we've made may be at risk," he said.

Almeida said the state's grade camouflages some serious problems. But NAMI's Buck said no one should be satisfied with a B-.