Point of view

Mental health services: It's the state's choice

November 27, 2011 

— North Carolina's historic underfunding of community-based mental health care and related supports has received a lot of media coverage. Time and again, policymakers have made decisions that make it harder for people with disabilities to live in community-based settings, relying instead on costly institutional placements.

The result is inadequate services and supports that force people into overcrowded emergency rooms and unnecessary institutional settings - in effect warehousing our neighbors and loved ones with disabilities. Far too often people with mental illness end up in jails, state prison or homeless shelters because they are not getting appropriate treatment. This deplorable situation is expensive and wrong-headed.

And it's against the law.

We know what to do. Task forces and study commissions have laid out the remedy for our state's leaders in report after report over the past decade. By implementing "best practices," we can support people with mental disabilities safely in the community. Using recovery-based approaches, people can reach their potentials and live meaningful lives. This is what the Americans with Disabilities Act and the landmark 1999 U.S. Supreme Court decision in Olmstead v. LC promise.

In the Olmstead case, the Supreme Court held that failing to provide community-based services to persons with disabilities when such services are appropriate can "severely diminish the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement and cultural enrichment." This is the tragic situation in North Carolina.

Now our state's patchwork of inadequate services has the attention of both the U.S. Department of Justice and federal Medicare and Medicaid officials, who are questioning how North Carolina provides services to people with mental illness. The state is facing potential litigation over violations of the Americans with Disabilities Act and the community integration mandate in the Olmstead decision.

The Justice Department says North Carolina is violating the law because it administers its service system in a way that needlessly segregates individuals with mental illness. If North Carolina won't make changes to bring the state into compliance with the law, the department will ask a federal judge to order the state to do so. Other states in similar situations have entered into settlement agreements rather than face costly and protracted litigation; such states include Georgia, New York, Illinois, California and Delaware.

We are at a crossroads, and Gov. Beverly Perdue has a choice: She can negotiate an agreement that will make the promise of Olmstead a reality in North Carolina, finally providing people with mental health and other disabilities the opportunity to live and participate in our communities with adequate and appropriate supports, or she can delay the lifesaving relief to which our sons and daughters, mothers and fathers, aunts and uncles, brothers and sisters are entitled and wait for the Justice Department to take the state to court.

Allowing the federal government to sue will needlessly divert resources from service provision to litigation. It will open up the state to court-directed remedies and the appointment of a "special master" to keep watch over our state.

What would choosing the second option say about our state? Is it really better to "wait and see" what a federal judge will do rather than address this problem head-on and ensure that every person is given the opportunity to live a full and meaningful life with choice and dignity? Shouldn't North Carolina choose to participate in negotiations that will provide help sooner rather than later and at a much greater savings to our state?

What people with mental health disabilities need and deserve is also what the law requires - options enabling recovery for meaningful futures.

South Carolina Gov. Nikki Haley understands what is required, saying recently: "We've got to start dealing with the problem. We have to prioritize it because what's happening now is these victims of mental illness are ending up in jail or in the hospital, and what they really need is treatment. These are people who can function on a day-to-day basis if they just get the services they need. And by not giving them the treatment they need, it's only costing taxpayers more money later."

This is the right approach for North Carolina to take, too. It is right, not only for North Carolinians with mental illness, but also for all the taxpayers.

Change is finally coming. The only question is whether Perdue will choose to have a voice in determining what it will look like - how it will be implemented and when - or wait for a federal judge to order the change and direct the specifics. Let's hope the governor seizes the initiative to address a deplorable situation that has gone on way too long.

Vicki Smith is the executive director of Disability Rights NC.

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