New housing ordered for mentally ill

North Carolina must find homes for thousands of mentally ill people in communities and stop housing them in adult-care centers, where residents say their lives are regimented and boring, the U.S. Justice Department told the state this week.

"Adult-care homes are institutional settings that segregate residents from the community and impede residents' interactions with people who do not have disabilities," said the letter, dated Thursday, that was sent to Attorney General Roy Cooper.

Keeping the mentally ill in adult-care homes violates the Americans with Disabilities Act, the department said.

The state not only places the mentally ill in such homes, but it also encourages them financially to stay there instead of going to communities by providing about $550 to those who live in adult-care centers, the letter said.

"Basically, the Justice Department is saying to the state that 'reform your way is over, reform the right way will begin,' " said David Cornwell, founder and director of advocacy group N.C. Mental Hope. "Obviously, it's great, great news.

"The department said the state will need to revamp its system and allocate the needed resources to provide community-based treatment and resources. It's an embarrassment that the state has released more than 7,500 individuals directly from psychiatric hospitals to adult-care homes in the past decade."

The news was welcomed by Laurie Coker, a Winston-Salem behavioral-health advocate and the director of the N.C. Consumer Advocacy, Networking and Support Organization. She said she has spent a lot of the past two years driving to Raleigh to speak with legislators about the problem.

"The systematic forcing of people into these settings where they have stayed often for years is certainly a travesty," Coker said. "Certainly, the warehousing of so many fellow citizens in these large institutions has shown our dark side as a people and a state."

Coker said that an alignment "of too many negative factors has perpetuated this long, miserable chapter in North Carolina's history.

"It has involved a cadre of legislators, former Department of Health and Human Services officials, lobbyists, non-empowered state hospital case workers, local mental-health directors who have looked the other way," she said. "It has forcibly dehumanized many of our peers. Perhaps the efforts of our legislature and our administration, and the challenging work ahead, will bring out what is the best in us."

Justice officials toured adult-care homes in 13 communities in March and April, including Greensboro and Wilkesboro, talking with residents who said they wanted to return home.

"Throughout our investigation, residents emphatically expressed their desire to leave their adult-care home and become members of their communities again," the letter said.

One resident said he "would do anything to get out; this is a prison," while another said the residents spend their days vegetating and smoking because there's nothing else to do.

The state doesn't disagree with the letter's basic thrust — that the mentally ill shouldn't live only with other mentally ill people or with elderly people who may be frail — and Justice officials relied on the state's own findings to help reach its conclusions.

But about 5,800 people with mental illness live at 288 adult-care homes with at least 20 beds where people with mental illness constitute at least 10 percent of the population, the letter says.

Many landed in the homes when North Carolina reduced the number of beds available at three state mental-health hospitals, Dix, Cherry and Broughton, said John Rittelmeyer, litigation director for Disability Rights North Carolina, an advocacy group.

The Justice investigation arose from a complaint filed last year by Disability Rights N.C., which said the homes are dingy and dangerous, violating the rights of mentally ill residents.

"We couldn't be happier" with the decision, Rittelmeyer said Friday. The decision is proof "that the state of North Carolina can do a lot better in offering people with mental illness the choice of living in the community and not in a large institutional setting like an adult-care home," he said.

The state keeps the mentally ill in the adult-care homes partially because that's convenient, Rittelmeyer said. When a psychiatrist visits an adult-care home, he or she can treat many patients at the same time instead of just a few.

Officials with the state Attorney General's Office and the state Department of Health and Human Services are reviewing the letter.

While some parts of the ruling may need to be challenged, the state now has to find community-based homes for the mentally ill, said Rep. Nelson Dollar, R-Wake.

"We have to find adequate and suitable housing for these individuals," he said. "That has to be our No. 1 concern at this point in time."

In addition to the Justice investigation, the state may have problems with the federal government over Medicaid payments, which aren't supposed to go to what's called "institutions of mental disease," which are facilities that predominantly care for people with mental illness.

North Carolina has identified as many as 41 adult-care homes that house as many as 2,000 people that might qualify as institutions of mental disease, Rittelmeyer said.