The U.S. Department of Justice 2012 settlement with North Carolina might appear to be a good thing, but it has only complicated the housing landscape for the mentally ill by requiring those living in adult care homes be moved to independent “supported” housing in the community.
Martha Knisley, an independent mental health expert charged with reviewing North Carolina’s program for compliance, found that after three years the state has successfully relocated only 400 people (about 50 percent of the target), although another 100 people (25 percent) tried living independently and failed. Of those who failed, approximately 20 percent died, others were evicted (without follow-up), some moved back to adult care homes, while others ended up in jail and state psychiatric beds.
The reviewer pointed out that there was not an appropriate level of community services to support these people. In fact, most received only one visit per month. Furthermore, the settlement only provided one housing option for people wanting to move from adult care homes into permanent supportive housing in the community, in spite of the lack of state funding to provide the appropriate level of help. For example, some people might have preferred to move to a smaller, family-type setting where they would receive similar help as in the large adult care homes. However, the DOJ agreement rules out both group homes and family care homes as an option.
Without safe, affordable, supported housing, the mental health system cannot and should not expect to see improvements for those living with mental illness. The DOJ settlement is hailed as a major victory by many advocates. It calls for assertive “in reach” or visits with seriously mentally ill people to convince them that they can live in the community.
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Most are people with major deficits in their cognitive ability who have little insight about the services being offered or their own ability to fend for themselves. Many are convinced to leave an assisted living center, maybe not a perfect place, to fend for themselves with only minimal help from the state mental health system. They are leaving a place where they have medication management, prepared meals, transportation to appointments, no financial worries and other people to talk with.
The DOJ independent reviewer’s report cites lack of cooperation of family members and guardians as a major challenge to getting more people to move out of the homes. With all the system failures, there is good reason for them to be concerned. Convincing more people to move into an abyss where there is no one to stop their fall will only create more hardship as another failure of the mental health system unfolds.
Unlike the mental health system that has eliminated at least 50 percent of the state psychiatric hospital beds, the correctional system has legal mandates that require jails and prisons to provide adequate beds for prisoners. This will be the fate for many people who have a brain disease unless we, as advocates along with state and federal systems of protection, stop the magical thinking that all you have to do to help a person “recover” from mental illness is to get them out of psychiatric hospitals and adult care homes and into community housing with a token level of service. It is time for North Carolina to commit to a Medicaid waiver for people with mental illness that provides an adequate level of support to help people live in the community.
There are far too many things wrong with the current mental health system for most of us to understand, let alone navigate in times of need. Furthermore, the system lacks stability due to continual changes to procedures, service definitions, Managed Care Organizations and funding for services for complex needs.
However, housing with the appropriate level of community mental health services must be the highest priority if we hope to improve the mental health system.
Gerry Akland is president of the Wake County chapter of the National Alliance on Mental Illness.