The U.S. Department of Justice should butt out of North Carolina’s mental health problems, since it is partially responsible for getting us into the situation we now face. If you’ve never had family member or friend with mental illness be thankful. I can tell you first-hand that the way we treat many of those with severe mental illness today is unconscionable.
It was a federal court decision that determined that the states should get out of housing the mentally ill, favoring community based care instead. North Carolina began mental health reforms in 2001, reducing or eliminating beds in state-operated mental health hospitals. The concept of caring for patients in local hospitals or community support agencies may have been good in theory but it was a train wreck in practice. Local hospitals didn’t have and weren’t willing to dedicate sufficient numbers of beds to mental patients. Local or regional health agencies didn’t have established services; even worse, there were too few psychiatrists available in many regions.
Most families are not able to deal with these patients either, no matter how much they might love them. At some point the family has exhausted so much financial and emotional capital they simply can’t continue without severely affecting the rest of the family. With no place to take them many mentally ill patients end up on the streets or in jail due to their unstable conduct. The best solution available is to turn to adult care homes.
The Supreme Court has said that states treat those with disabilities as if they were “incapable of or unworthy of participating in community life.” Under duress, North Carolina made promises to provide community-based services wherever possible. The well-intentioned group Disability Rights correctly asserted that North Carolina wasn’t living up those promises. After a yearlong investigation, in 2012 the U.S. Department of Justice forced the state, along with 19 other states, to sign a settlement agreement, setting compliance benchmarks. That agreement required our state to offer people with serious mental illnesses more housing subsidies and job training, using MCOs or managed care organizations that contracted with the state.
Because the mentally ill have so few effective advocates and because of state budget problems our legislature has woefully underfunded care for them. The N. C. Department of Health and Human Services has dealt with one crisis after another, a long litany of problems including IT programs, Medicaid cost explosions and personnel turnover, rendering it ineffective. There is also evidence the mentally ill have not been a high priority at DHHS. The MCOs, often for-profit groups, have not been as effective as envisioned and have been poorly supervised.
Strong-arm tactics by the feds, unachievable target goals, poor administration and insufficient funding aren’t a formula that will provide the care desperately needed by our mentally ill. To be sure there are many who can live alone and hold jobs, but there are large numbers who cannot care for themselves and must live in group homes.
Now is a time to stop the finger pointing and the blame game, substituting instead honest discussion, cooperation, compassion and realistic expectations. If a society is judged by how it treats those unable to care for themselves we owe the mentally ill nothing less than our best efforts.
Tom Campbell is the Executive Producer and Moderator of N.C. Spin.