By Taylor Sisk
The U.S. Department of Justice has told the state of North Carolina that its failure to make community-based accommodation for people living with mental illness is in violation of the Americans with Disabilities Act.
Having completed an eight-month investigation, the department sent a letter of findings to state Attorney General Roy Cooper on Friday stating that thousands of people living with mental illness who could be served in their communities are needlessly institutionalized.
The services and supports these individuals need can and should be made available in the communities, but, the report says, â€œAs the state has acknowledged, individuals with mental illness end up in adult care homes because existing housing programs are woefully inadequate.â€
Rather than providing community-based services â€“ which include Assertive Community Treatment, case management, peer support and employment services â€“ the state subsidizes the cost of stays in adult care homes, which is just under $1,200 per person per month. This money, says the Department of Justice (DOJ) report, should be redirected to community-based settings.
State officials have acknowledged that integrated, community-based housing is an â€œappropriate and effectiveâ€ environment for persons with serious mental illness.
The state must now take action or be subject to a DOJ lawsuit. â€œWe would prefer, however, to resolve this matter by working cooperatively with the State,â€ writes U.S. Assistant Attorney General Thomas Perez, â€œand are confident that we will be able to do so.â€
The investigation was launched in November in response to a complaint filed by Disability Rights North Carolina. â€œFinally, this is a critical step towards true recovery for people with mental illness in North Carolina,â€ said Vicki Smith, the organizationâ€™s executive director.
â€œHuman services in North Carolina have suffered major hits with no relief in sight for too long,â€ said Julie Bailey, interim executive director of Mental Health America of the Triangle. â€œIâ€™m anxious to see the next action plan rolled out by the state in response to the ruling. I want to be hopeful, but history causes me to be a bit cynical.â€
An â€˜institutional biasâ€™
The DOJ brought investigators to North Carolina to visit adult care homes and review resident records. They concluded that most individuals with mental illness who are in adult care homes â€œare not materially different than individuals with mental illness who currently thrive in community-based settingsâ€ and that community-based services are â€œwell ableâ€ to meet their needs.
The investigators further found that most of these people would not oppose being moved to integrated settings â€“ to the contrary, most would welcome it.
But despite the fact that the objective of mental health reform in North Carolina was to move people out of institutional settings, a state-funded report has acknowledged there remains an â€œinstitutional biasâ€ in North Carolina.
Reform measures, which began a decade ago, were triggered largely by the U.S. Supreme Courtâ€™s 1999 Olmstead ruling. In that ruling, the court stipulated that, in keeping with Title II of the Americans with Disabilities Act, Medicaid-eligible individuals should not be discriminated against by being forcibly institutionalized when they might otherwise be provided services within their communities.
According to the DOJ, adult care homes â€œappear and function as institutions.â€ They present â€œsignificant barriersâ€ to community integration. To the extent that any activities are offered, says the report, â€œthey are largely infantile and consist of activities such as bingo, arts and crafts, puzzles, movie-watching, and board games.â€
The report concludes that, â€œAll new supported housing should be scattered site, with no more than 10 percent of a residential setting allocated to persons with disabilities,â€ and that the state must ensure that the services required for a successful transition to supported housing are provided.
Further: â€œNo one who is qualified for supported housing should be placed in an adult care home, or other congregate setting, unless after being fully informed, he or she declines the opportunity to receive services in supported housing.â€
â€œI believe that an integrated setting in the community or home is absolutely preferable for the most humane treatment of ourÂ fragile populations,â€ Bailey said. But given the continued cuts to mental health services, she asks how the changes will be supported.
â€œCan it be implemented in a way where consumers of services actually are supported in ways that help them reach their full potential? Or will we be forced to recycle more band-aids with this plan?â€
The state Department of Health and Human Services released a statement saying that it hopes to complete its review of the findings within the next few weeks in order to respond.