Feds probing North Carolina's mental health system

A federal investigation of the state mental health system could cause the U.S. to order big changes

Staff WriterNovember 25, 2010 

  • The story so far

    In 1999, the U.S. Supreme Court ruled in the Olmstead decision that the Americans With Disabilities Act bars states from the unnecessary institutionalization of people with mental illness, mandating that they be treated in their home communities whenever possible.

    The following year, North Carolina legislators approved an ambitious reform plan aimed at bringing the state's mental health system into compliance with Olmstead by downsizing state hospitals and launching new community treatment programs through private companies.

    In 2001, the Easley administration closed about half the beds in state mental hospitals, although the planned community treatment system was not in place. The governor and legislators then raided the trust fund set up to pay for mental health reform to close a hole in the state budget.

    In 2008, The News & Observer published "Mental Disorder," a week-long series chronicling the failure of North Carolina's reform effort. The newspaper's stories showed that the state had wasted more than $425 million in community services that either weren't provided or weren't needed, while patients desperate for help were swamping the now downsized state hospital system. The series also revealed the questionable deaths of 82 patients in state hospitals, as well as documented cases of patients' abuse and neglect involving 192 state employees.

    In the last two years, state legislators have passed new laws that increased the review and disclosure of deaths in state mental hospitals. But during the recession, deep budget cuts have been imposed on the already strained system.

  • As part of its federal complaint to the U.S. Justice Department, Disability Rights North Carolina pointed to four recent deaths in adult care homes:

    In May 2009, Jeremiah Love, 27, was beaten with a metal cane by another patient at David's House, a rest home in Surry County. No staff members were present at the time of the beating, which other patients said lasted several minutes, according to a state review. When told of the assault, the staff gave Love a bag of ice for a lump on his head. He later died as a result of blood pooling in his brain, according to his autopsy.

    Daniel East, 56, a schizophrenic patient with a record of assault charges, pleaded guilty in April to voluntary manslaughter and was sentenced to 13 years in prison. Police said he beat Love because he thought the other patient had kicked his dog, according to a story about the court hearing from the Mount Airy News.

    In December 2008, Levi Montgomery, 69, was found facedown in his room at the Countryside Villa Nursing Home near Fayetteville with his roommate, Muncie Grimes, sitting on him. Grimes, 60, was charged with second-degree murder, according to court records.

    A resident of the home since 2000, Grimes had previously been diagnosed with schizophrenia and dementia, according to a review by state regulators after the death.

    In July 2009, Roland Simmons, 70, was beaten to death with a stick at the Walden House Assisted Living Center in Hickory. Police charged Dennis Scherzer, 43, with second-degree murder. Scherzer, diagnosed with paranoid schizophrenia, is awaiting trial.

    In October 2009, Walter Davis, 66, was beaten to death by another resident at Cedarbrook Residential Center near Asheville. Kenneth Hayward, 43, was charged with murder and is awaiting trial. The county sheriff said Hayward, who had a history of mental illness, beat Davis during a dispute over $4.25, according to a report from The McDowell News.

— 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."

michael.biesecker@newsobserver.com or 919-829-4698

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