LOC: Tell Us Again: Now Why Are We Closing Dix?

Continued from the Home page . . . The discussion began when Senator Allran stated that Dix had been the sited as the most responsibly managed of all the state hospitals as far as dollars go, while having its excellent reputation for model programs.  He questioned why one of the less well managed hospitals had not been considered for closure instead.

For those of us who share his concern about making dollars go farther while yielding better outcomes (as many consumers I know do), we are reassured to hear such questions.  However, we also realize two things.  We need hospitals in the east and the western part of the state!  And we need one that is in the central area.  And this is what Cansler told the legislators.

The Secretary then reviewed with the LOC that there had been a mandate by the legislature early in the last decade to reduce numbers of hospitals and beds by rebuilding a new, updated hospital that would accomodate persons from the central region while closing John Umstead and Dorothea Dix hospitals, whose buildings were out of date and having multiple maintenance issues.  He added that while it had been a long time in the coming, this plan was a culmination of efforts in response to a legislative mandate.  The trouble was that the local community service systems were not sufficiently developed to prevent the need for the hospitals, a factor in the length of time it was taking to close Dix.  And unfortunately, for almost two years, the funds for operating Dix were coming from other parts of the human services budget, including the funds that could have been paying for services in our communities that could prevent crises.

The Secretary also stated that there would be higher expectations of improved programs across all the state hospitals now  (What about state-wide service and outcome standards across all state operated facilities and the LMEs?–the writer).

This vigorous discussion regarding the hospitals, fiscal responsibilty, and program integrity occupied most of the morning.  Many of the legislators participated.  And they publicly thanked the Secretary for finally explaining the entire scenario to them so that they actually understood the basis of the decision.


The meeting was interesting from this consumer’s standpoint.  It reminded me of when I had to make copies of our local business plan to give to our LME board again because they had forgotten and abandoned what they had agreed to do in the plan.  And I learned that most of them had tossed their plans or didn’t know where to find them.   Time passes quickly, and people forget details.

Cansler, who is still relatively new to the administration, needed to review the legislated mandate re: the hospitals before leaders could feel comfortable with decisions of the state.

Perhaps we are entering a time that a thorough review of many things will be necessary because the economy and the outcomes indicators in our state.  Something is not working effectively if we are having to hospitalize so many people or if many people are going to emergency rooms even when they are deemed not needing to be placed in a hospital bed after all.  And what about the handcuffing of so many of our citizens in waiting rooms sometimes for days?    I think we have at least all agreed that we should be building a broader, more solid community service infrastructure.

Hopefully, careful review of where we have been will help all of us to think, think, think.  It is time for “the little gray cells” (Hercule Poirot) within multiple stakeholders, INCLUDING system customers and others who experience the complexities of living with mental illness, addicive disease, or developmental disabilities, start working for solutions.  Because we need the right kinds of services now.  The days of throwing money at things that aren’t truly working are over.

Dr. Beth Melcher Shares With Readers

Introduction For people who experience psychiatric symptoms, addiction problems, or developmental/intellectual disabilities in our state, the upcoming year may seem like a scary abyss as far as publicly funded services go.  But while the “anticipated unknown” causes anxiety, it can also offer us opportunities for growth and progress.  In fact, with regard to our public services, leadership at all levels will all face the future with the same angst or optimism.  Just like our readers must.   The choice is ours as service recipients, family members, friends, providers, administrators—and much depends, in our minds, on the kind of leadership we now have at the Department of Health and Human Services as well as decisions of North Carolina legislators.

With this in mind, NC CANSO has interviewed Dr. Beth Melcher, Assistant Secretary of the Department of Health and Human Services over Mental Health in North Carolina, so that readers can feel just a little more informed about the potential of the upcoming year.

Just among NC CANSO’s board members, we generated around thirty questions and realize that if there had been time, we could have had much input from others.  But to be practical, we selected the ten questions discussed in this article.

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TURNING UP THE HEAT!  Reinforcing OLMSTEAD as Law (originally posted mid-November)

Recently, the U.S. Department of Justice revisited Georgia’s response to the Olmstead ruling.  The Supreme Court decided in 1999 to reject Georgia’s attempt to appeal an earlier law which stated  that people should be permitted to live in the least restrictive setting possible unless they chose otherwise.  Georgia had hoped it could continue to retain people for long periods in state hospitals.  This way, the state would not have to use its resources to develop effective service systems out in communities that would prevent need for long-term institutionalization.

Like many other states  Georgia has been very slow in developing the system to reduce long-term inpatient care.  So the Justice Department has turned its attention back to Georgia.  As you will read in the following excerpt from an article posted by National Public Radio, North Carolina and other states have required federal attention related to breeches in the civil rights of consumers.  It will be good for us to learn from how our neighbors implement new requirements by the Justice Department.    Here are its new requirements:     1.)  Ending all admissions of people with developmental disabilities to the state hospitals by July 2011.   2.) Moving people with developmental disabilities out of hospitals to community settings by July 2015.   3.)  Establishing community services, including supported housing, for about 9,000 people with mental illness.  4.) Creating community support teams and crisis intervention teams to help people with developmental disabilities and mental illness avoid hospitalization.

Excerpt below.  To read full article, go to www.npr.org  

Enforcing A Previous Ruling                                                          NPR in Washington.                                                                                  The Justice Department action demonstrates broader enforcement of the Supreme Court’s landmark Olmstead decision from 1999. In the case, which originated in Georgia, the court ruled that unnecessary institutionalization of people with disabilities is a form of discrimination under the Americans With Disabilities Act.

Lewis Bossing, a senior staff attorney at the Bazelon Center for Mental Health Law, a Washington, D.C.-based advocacy organization for people with mental illness, said the “ground-breaking” settlement in Georgia capped a flurry of federal legal activity in disability cases during the past 18 months.

Indeed, Justice has filed briefs and joined Olmstead-related lawsuits in several states, including New York, North Carolina, Arkansas, California and Illinois. Over the past year and a half, Department of Justice attorneys:   1.) Filed a brief in support of North Carolina litigation seeking to keep two individuals with developmental disabilities in community settings. A proposed cutoff of funds jeopardized the housing for the two. Perez said in an April statement about the case, “We will not allow people with disabilities to be a casualty of the difficult economy.”   2.)  Filed a motion to intervene in a lawsuit in New York, seeking supported housing units for thousands of residents of “adult homes.”   3.) Filed briefs in existing lawsuits in Florida, Illinois and New Jersey against what the agency called “unnecessary institutionalization” of people with disabilities.

“We will continue to aggressively enforce the law, and we hope other states will follow Georgia’s example,” Perez said.

Bossing said the Justice Department, by spelling out an array of community services required to meet Olmstead criteria, “will make it more likely that states will change the way they do business with people with disabilities.”