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State in violation of ADA, feds say

By Taylor Sisk
Staff Writer
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, “As the state has acknowledged, individuals with mental illness end up in adult care homes because existing housing programs are woefully inadequate.”

Rather than providing community-based services – which include Assertive Community Treatment, case management, peer support and employment services – 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 “appropriate and effective” environment for persons with serious mental illness.

The state must now take action or be subject to a DOJ lawsuit. “We would prefer, however, to resolve this matter by working cooperatively with the State,” writes U.S. Assistant Attorney General Thomas Perez, “and are confident that we will be able to do so.”

The investigation was launched in November in response to a complaint filed by Disability Rights North Carolina. “Finally, this is a critical step towards true recovery for people with mental illness in North Carolina,” said Vicki Smith, the organization’s executive director.

“Human services in North Carolina have suffered major hits with no relief in sight for too long,” said Julie Bailey, interim executive director of Mental Health America of the Triangle. “I’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.”

An ‘institutional bias’
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 “are not materially different than individuals with mental illness who currently thrive in community-based settings” and that community-based services are “well able” to meet their needs.

The investigators further found that most of these people would not oppose being moved to integrated settings – 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 “institutional bias” in North Carolina.

Reform measures, which began a decade ago, were triggered largely by the U.S. Supreme Court’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 “appear and function as institutions.” They present “significant barriers” to community integration. To the extent that any activities are offered, says the report, “they are largely infantile and consist of activities such as bingo, arts and crafts, puzzles, movie-watching, and board games.”

The report concludes that, “All new supported housing should be scattered site, with no more than 10 percent of a residential setting allocated to persons with disabilities,” and that the state must ensure that the services required for a successful transition to supported housing are provided.

Further: “No 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.”

“I believe that an integrated setting in the community or home is absolutely preferable for the most humane treatment of our fragile populations,” Bailey said. But given the continued cuts to mental health services, she asks how the changes will be supported.

“Can 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?”

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.

  1. Frank Miller MD

    Dear Carrboro Citizen and Taylor Sisk:
    I first want to thank and commend your article above on yet another well intentioned, poorly thought out, destined to ever growing failure boondoggle on the part of the nameless ‘architects’ of NC’s ill fated mental health ‘reform.’ I have a colleague, Dr. Steven Crane director of the Pardee Hospital Family Residency Education Progam in Hendersonville NC, who deserves still to be accorded the credit for naming, labelling and appropriately ‘slandering’ the 10 years of mental health ‘reform’ we have seen in NC as ‘the disaster that keeps on giving.’
    The wholesale placement, parking and resegragation into the New Mental Health Ghettos for the chronically mentally ill, the adult group home, was seen early on by most of the mental health clinicians of all disciplines in the early 2000’s as yet another ill conceived, incredibly stupid delaying tactic, touted as “community based mental health” when all it really was, was another way to hide the mentally ill, perpetuate the cynical bigotry of hiding them out of sight, continuing another two centuries old form of racism, keeping those different and hard to understand away from us lily white well bred, proper upstanding citizens of the South, in order to keep ‘them’ out of sight, out of mind, and preventing us from confronting our moral obligations to serve the chronically mentally ill, down and out, better.
    I know of many group home operators who try their hardest to provide proper nutrition, a clean place to live, some semblance of safety and community for these individuals and those operators are SAINTS. They are not in it for the money, as there is less and less of that thanks to short sighted ‘cut and cut’ policies of governmental services to the least of us, in the these days of the latest reincarnation conservatism damn those who are not fortunate like me the rich Reaganism, the Tea Party radical fanatics who make the 1960’s SDS Weathermen radicals look naive and parochial in comparison to the harsh cruelties of the Tea Party’s selfish underlying prinicples marching under the more acceptable slogans of fiscal conservatism and restraint, ignoring the countless individuals and families they hurt unknowningly and without care, compassion or empathy. Let one of them be struck down by a debilitating mental illness, a brain disease that is not their fault or a product of not ‘believing enough,’ or of being a good enough upstanding citizen; let them feel the ravages of not being able to predict from one day to the next whether your moods will permit you to be civil to your coworkers; let them be beset by the internal distranction of the disordered mental life of the CNS ill person who has little focusing powers or attention left, or worse yet, internal auditory hallucinations that destroy the ability to focus of ordinary outside work and social tasks and roles to the horror and disdain of those around them even their prejudiced families. Let them experiences the ‘social slide’ into unforeseen and undeserved poverty as they lose their ability to perform in the cruel work world of nonstop production, lose their jobs, their health insurance, the bulk of their self identities and self worth and be relegated to the ravages of the present mental health system so devastated by funding cuts that it cannot provide basic supports let alone rehabilitation to a once moderate or high functioning person.
    Let them be stuck in the boring world of the adult group care home, with television and the passersby visible outside the windown as their most frequent companions. Let them feel the quiet ignoring and near total abandonment of them by the outside world once their world too. Let them feel the stares of the ‘normal’ person when they are overwhelmed by the complexities of the check out lane, calculating sales prices, trying to keep up with technology whether it be iPod delivered entertainment, or striving to stay current on the on the complexities of business computer or cloud based computing software that form the basis of the modern evolving changing occupation. Let them feel being “left behind” and left with nothing but a monthly visit from a well meaning mental health service worker who has minimal training, less than half that of mental health workers of just two decades ago, with no resources, no funds, no other better placements, little or no meaningful rehabilitation programs to refer them to other than boring sheltered workshops stuffing envelopes or performing other menial eternally repetitive boring tasks better suited to small robots without brains except a small endless repeating coded program of instructions. Let them feel the misery of realizing one’s life is over and suicide truly does look like the more palatable alternative.
    This is what North Carolina’s system of housing the chronically mentally ill has come to, a system far worse than housing persons in large state hospitals where they could work on farms, in sewing shops, and a myriad of other jobs accepted and prized by their surrounding communities and which gave them what is in all too short supply now, self esteem, work identities and real skills, a sense of purpose and a reason to live and get up everyday and look forward to its activities, content, entertainment, ordinary challenges, camaraderie and accomplishment.