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Originally published: 2012-09-08 22:14:25
Last modified: 2012-09-08 22:14:57

Adult-care homes not appropriate for mentally ill citizens, DOJ says

by Anna Oakes

As part of an Aug. 23 settlement agreement with the U.S. Department of Justice, North Carolina must provide 3,000 community-based housing slots for citizens with serious mental illness by 2020.

The settlement agreement is the result of a DOJ investigation that found North Carolina’s practice of placing individuals with serious mental illness in adult-care homes “fails to provide services to individuals with mental illness in the most integrated setting appropriate to their needs in violation of the Americans with Disabilities Act.”

“Adult-care homes are institutional settings that segregate residents from the community and impede residents’ interactions with people who do not have disabilities,” the DOJ letter of findings stated in July 2011.

The agreement also outlines a plan to invest in job training and employment assistance for up a comprehensive, 24/7 crisis-care program for people with serious mental illnesses, according to the N.C. Department of Health and Human Services.

“We are at the beginning of what will be a multiyear process to serve persons in the community who have previously been cared for in adult- care homes,” said Christina Carter, chief operating officer for Smoky Mountain Center, replying to an email that was also sent to Charlotte Bridges, care coordination supervisor.

Smoky Mountain Center is the local management entity in 15 Western North Carolina counties. LMEs are responsible for managing, coordinating, facilitating and monitoring the provision of mental health, developmental disabilities and substance abuse services in the area that they serve.

Carter said she did not currently know the specific number of residents in adult-care homes in Watauga County who may be affected.

The practice of placing mentally ill citizens in adult-care homes began with deinstitutionalization in the 1960s — moving mentally ill citizens out of asylums.

“The adult-care home choice of placement has been a historical choice of placement for a very long time,” said Carter.

“For some people that was the placement that seemed to work best to meet their needs,” Bridges said.

The adult-care home model was never such that these facilities would provide treatment or services to the chronically mentally ill, she said.

Adult-care homes have ensured that mentally ill individuals receive supervision, eat regular meals, take their medications and receive some level of interaction, Carter said.

“Even though the care was somewhat minimal, it kept them safe enough,” she said.

But with community-based housing, “I’m living down the block where you live … integrated in my community,” Carter said.

“The system has been reluctant to really develop a better quality of array of services for them,” she said. “It’s 2012, and we still have a tremendous amount of stigma in our system, in our community.”

Currently in Watauga County, a 10-unit facility called The Meadows serves persons with severe and persistent mental illness who can live relatively independently in low-supervision apartments. A program called the Targeting Key program also provides rental assistance for individuals with mental illness.

Carter said at least one area mental health provider has expressed an interest in expanding its services to meet the new housing requirements.

“There are providers already in Smoky Mountain Center’s catchment area whose business is housing; it is a question for our provider network staff to analyze whether this capacity is adequate and if additional capacity will be needed,” she said.

The settlement agreement also provides for enhanced mental health services that “can go into the homes to assist” mentally ill individuals living on their own, Bridges said.

Carter and Bridges emphasized that much is still unknown about the details of agreement implementation and that more information will be provided on the Smoky Mountain Center website once it is available.

“We are very committed to do a tremendous amount of public education,” Carter said.