When I first read it yesterday, the significance of the Department of Justice’s report on its investigation into North Carolina’s mental health system escaped me. But 16 pages later, the DOJ’s message to the state was clear: “Reform your way is over; reform the right way will begin.”
“The State fails to provide services to individuals with mental illness in the most integrated setting appropriate to their needs, in violation of its obligations under the ADA and Olmsted. As a result of the way the State administers its mental health service system, individuals with mental illness are unnecessarily institutionalized in adult care homes throughout the State.”
And according to the DOJ, at the heart of both the problem and solution are supportive housing and quality community-based treatment and resources. Other significant points from the report include:
• Adult care homes are essentially institutions, with rigid rules and practices and often with wards, video monitoring, curfews, locked doors. There is virtually no privacy, DOJ states, and there are often up to 3 people assigned to a small room.
“To the extent activities exist, they are largely infantile …” with many residents reporting they spend their days “smoking and napping to pass the time.” In my mind, what pages 7 and 8 of the DOJ report describe is prison.
• An “institutional bias” exists, including state subsidies of approximately $550 a month that goes to adult care homes for each individual with a disability housed there.
• The state continues to use adult care homes as places to discharge individuals from psychiatric hospitals, with more than 7,500 such placements in the last decade.
• “Serving people with mental illness in integrated settings can be reasonably accommodated.” Needed services already exist, and the state can redirect the Special Assistance subsidy and Medicaid funds it already spends to support persons with mental illness for community-based supports. The $550 presently spent on the subsidy is roughly equivalent to what it would cost to support a person in supported housing.
Time unfortunately won’t allow a better synopsis than this, and I’m sure there are likely major points I’m missing, including the recommended remedial measures. But take my word, like many good novels, the report may start out slow, but by the end, it’s riveting.
North Carolina Mental Hope