by Taylor Sisk
Staff Writer
Though the specifics are not yet known, there’s little doubt that mental health care services in North Carolina are going to take a substantial hit in the coming budget. Those cuts may not be as severe as originally feared, but mental health care advocates continue to warn that their effects could be devastating to many of our most vulnerable.
Beyond that concern, and even in the context of the worst recession in decades, many advocates are finding some of the planned cuts hard to reconcile, and are puzzled over decisions legislators appear poised to make.
“I think one of the most remarkable things is that the cuts that are being made are to programs that are working effectively,†said Jennifer Mahan, director of policy for the Mental Health Association of North Carolina.
Among those, Mahan said, are community support services, which the current version of the budget proposes eliminating. These services include assistance with such everyday activities as paying bills, shopping for groceries and picking up medications – assistance that helps those with mental illness be more productive members of their communities.
While the legislative Program Evaluation Division (PED), which assists the legislature in evaluating whether public services are being effectively delivered, has documented extreme waste in the provisioning of community support services, Mahan says the program was restructured two years ago and, though advocates agree it’s still far from perfect, she says “it’s a completely different program†from the one that suffered from mismanagement and a lack of oversight.
A report released last August by the PED led to scrutiny of community support services, and the latest report, released earlier this month, stated that as much as $635 million was overpaid by the state and federal governments for community support services and that between April 2006 and March 2007 those services accounted for 97 percent of all enhanced services expenditures, with 18 other services accounting for 3 percent.
But in a December report, the PED wrote that the Division of Mental Health, Developmental Disabilities and Substance Abuse Services “should continue to emphasize community capacity and quality of care – more needs to be done to bolster community-based services.â€
Yet the community support services program is likely to be razed and then rebuilt – which suggests to Mahan that the legislature is disregarding the recommendation of its own advisers.
Advocates emphasize that it’s going to take time to rebuild those services.
“The legislature is essentially eliminating a program in a very short period of time without allowing anyone to plan for how they’re going to serve the 33,000 people who are currently being served under this program,†said Mahan.
“The legislature has a bad taste in its mouth for the program, and nothing’s going to wash it clean,†said David Cornwell, executive director of the advocacy group North Carolina Mental Hope. “And that’s a huge loss for the state.â€
“Even if they are able to come up with a replacement service,†Mahan said, “more than likely many of those people who are currently getting this service will have simply been dropped.†They’ll end up, she said, either denied service or in a state institution.
The spirit of Olmstead
Which is the opposite of what was supposed to be accomplished with mental health care reform in North Carolina, a reform 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.
Mahan believes community support services are the foundation of the spirit of Olmstead. Community support, she says, “keeps people safe, keeps people in their homes, keeps children with their parents, it keeps people on their medication – all of these things we say we want for people who have mental illness or have developmental problems.â€
“Managing chronic illness of any type can be extremely difficult for anyone,†said Mark Sullivan, executive director of the Mental Health Association in Orange County, but then factor in “an illness that disrupts your ability to think and communicate clearly, makes you fearful, takes away your energy, reduces your ability to take care of yourself and makes you act in ways that lead to social isolation, and you begin to have an idea of why someone with a serious mental illness needs effective services to live independently.
“The alternatives are painfully certain,†Sullivan said. “Homelessness, hospital, prison or death.â€Â
Mahan concurs. To believe that these services can be eliminated without exacting an additional burden on law enforcement and emergency rooms is, she said, “really short sighted.â€
Beyond the human toll, “For the taxpayer, this is a bad deal,†Thava Mahadevan of Chapel Hill-based mental health provider XDS Inc. told The Citizen in a June interview, “because when you don’t provide the services [in the community] it ends up costing you a lot more,†in institutionalization, incarceration and more intensive services.
Beyond that, given that Medicaid pays the majority of the cost of community support services, our mental health care system will also be losing substantial federal dollars.
“Unfortunately, I am afraid that current financial and political realities will lead to cuts that will result in short-term savings at the cost of massive longer-term expense and incalculable human suffering,†Sullivan said.
“It’s like saving money on car maintenance by never changing the oil.â€