An Open Letter on the State of North Carolina's Mental Health System

ONE ADVOCATE’S PERSPECTIVE...

Greetings! My name is John Tote and I am the Executive Director of the Mental Health Association in North Carolina, Inc. I am writing this open letter in April 2007, at the beginning of what will surely be some of the darkest days that the North Carolina’s public mental health, developmental disability, and substance abuse system has ever seen. North Carolina’s mental health system, now some 5 plus years into a massive community reform initiative, sits on the brink of going from a mild failure to total collapse.

Is this not an exaggerated overstatement? Absolutely not! Our state envisioned its new array of community-based services that were implemented some 12 months ago to begin to take our state’s community system in a new and positive direction. In an age of institutional downsizing, we have actually seen higher admission rates than in any other time in our state’s history. In a time of drastic community program overhaul, the one initiative that our state repeatedly pointed toward to cure many of our current ills was an initiative called Community Support. Many of us in the advocacy community along with our consumer, family members, professionals, providers, and colleagues felt that while community support may not be an end all or be all, it had potential to move us in a better direction.

Once again, our state’s leadership, under the unwatchful eye of Governor Mike Easley, has overreacted to a situation and has, once again, thrown the baby out with the bath water.

Make no mistake; the changes that will take place in community support are at the behest of the Office of the Governor; not the Secretary of the Department of Health and Human Services and not the Directors of our state’s Medicaid System or our Mental Health System. This decision, as well as reform as a whole, belongs to the legacy of Governor Mike Easley.

Governor Easley, and his budget minions, supposedly saw a financial hole caused by this new initiative. In truth, this service has cost more than was originally envisioned. Why? Many reasons, but the main one is that there are few other options for our state’s citizens that have mental illness, developmental disabilities, or substance abuse problems. Once again, that can be laid at the feet of our Governor as well. So what does our Governor do? Instead at taking a look at audits that have been conducted and coming up with a realistic assessment, there is an over-reaction that says this must be a (dollar) rate issue, so let’s cut the rate by one-third.

Community Support is a uniquely defined set of services under one umbrella. The Governor’s decision was that too much was being spent on it. In reality, this is not a dollar issue; this is a service definition issue. I believe that when the audits are realistically assessed, which they have not been yet, we will see that many providers have not been providing the service correctly. That is an entirely different issue than the rate being too high.

The Governor, along with all of his subordinates, will say the job was getting done but we were paying too much for it. Nothing could be further from the truth. Those agencies, like the Mental Health Association in North Carolina, that were following the definition accurately and providing the array of services under the Community Support umbrella found, in reality, it was difficult to make ends meet at the old rate. Therefore, it will be impossible to make ends meet at the new rate. So, what will we have in North Carolina? We will have marginal providers providing what will, in essence, become a watered down service. This is not what our state’s citizens with severe disabilities deserve.

Individuals with mental illness, developmental disabilities, and substance abuse disorders did not ask for these disabilities. They do not want them. For those of us that work in these fields we have our jobs solely because individuals have horrible illnesses and conditions. Being from a multi-generation advocacy family I have seen this battle fought for decades. I can only imagine for those that experience one of these disabilities or have a family member that does, how disheartening this must be day after day, and year after year. The lack of leadership in our state from the administration and the legislature is incalculable in this major health issue. It is time that North Carolina stands up and says the emperor has no clothes. The Governor must reverse this horribly short sighted and, indeed, cruel and inhumane decision. Looks at the hundreds of millions of dollars that our state spends in corporate welfare and business tax breaks. The lives of our citizens should be more valuable than that. We must shine the bright light of reality on the needs of our state’s most disabled, and we must hold those that we elect accountable and let them know when they have let people with disabilities down. Now is the time to unite. Now is the time to reverse the course and create the system that our citizens need and deserve. Thank you.

Sincerely;

John Tote

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An Open Letter on the State of North Carolina's Mental Health System