RALEIGH — The U.S. Justice Department has opened a formal investigation into North Carolina's struggling mental health system, the first step in a process that could trigger a federal edict for sweeping reform.
The probe is the result of a complaint filed in July by the advocacy group Disability Rights North Carolina, which contends that the state is violating the Americans With Disabilities Act by failing to provide proper housing for people with mental illness.
Nearly a decade after the state Department of Health and Human Services closed thousands of beds in government-run psychiatric hospitals as part of a reform effort, more than 6,400 people with severe mental illness are housed in adult care homes scattered across the state, living in sometimes squalid and dangerous conditions.
The mental patients, their care typically paid for with taxpayers' money, are often far younger than the elderly residents with whom they are housed. In the last two years, at least four residents with mental illness have been killed by fellow patients who had histories of severe mental illness and violence.
Vicki Smith, the executive director of Disability Rights, said the federal investigation could force the state to address the mistakes it made after launching reform in 2001. Since the state reduced the number of beds in state psychiatric facilities, people with mental illness have routinely languished for days in emergency rooms.
Word of the federal investigation also comes as the state is moving to close Dorothea Dix mental hospital and debating further cuts to the state's mental health system.
'This is huge'
"Now DHHS is going to have to answer a whole series of questions about why mental health reform has failed," Smith said. "This is huge, from our point of view. Huge."
The Justice Department informed the state of its pending investigation in a five page letter that DHHS administrators in Raleigh received last week. The department revealed the news in a three-sentence release Wednesday, hours before the Thanksgiving holiday started.
Renee McCoy, a spokeswoman for the state agency, said there would be no comment beyond the news release, which said the state will "work with the Department of Justice to provide all necessary documents and information in response to the complaint."
Officials at the Justice Department headquarters in Washington would not comment other than to confirm that an investigation has been initiated. Their letter to the state, dated Nov. 17, outlines 31 detailed questions and extensive requests for documents. The state has 30 days to respond.
Smith, the Disability Rights director, said that as a result of the new investigation the federal government could force the state to make sweeping changes in the state's mental health system similar to those recently imposed in Georgia.
U.S. prescribes changes
Last month, Georgia officials reached a settlement with the Justice Department that requires the state to spend tens of millions of dollars in coming years to help people with mental illness and developmental disabilities receive better community-based services.
Providing community services and decreasing reliance on state-run psychiatric hospitals was a key tenet of North Carolina's 2001 reform plan, but the state closed inpatient beds without waiting for the needed services to materialize. As a result, thousands of people in crisis went without the help they needed.
Then, in 2002, then-Gov. Mike Easley and legislators plugged a hole in the state budget by raiding the Mental Health Trust Fund, which had been established the previous year to pay for the community services called for in the reform plan. More recently, the struggling system has once again been hit by deep budget cuts as a result of the recession.
Smith hopes the federal government will now force the state to stop taking money from critical services for people with mental illness.
"This is what has needed to happen for a decade," Smith said. "We've talked about the problems with mental health reform. The state has not been able to fix it or have the resources it needs. We think this may be the beginning of a fix."
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