Crisis intervention needed for state mental health care

Mark Sullivan, executive director of the Mental Health Association in Orange County, opened the 29th Annual Legislative Breakfast for Mental Health yesterday morning with a sobering statistic: The national average per capita spending on mental health services is $92; in North Carolina, it is $52. "As a state we are ashamed," he said, as he called for "a responsible, compassionate, and effective" system of delivering mental health services.

Writer and Orange County resident Lee Smith led off the session with a moving account of the life and tragic death of her son, Josh Seay, after struggling since high school with schizophrenia. What came through as she recalled the onset of his illness during the summer before his senior year, at a music camp at the Berklee College of Music, and then the years of diagnosis and treatment, marked by steps forward and backward but largely (until the end) forward, thanks to effective treatment programs, was that the fundamental means to treat mental illness are in place: if you can find them, if you can afford them. Yet the story of mental health services in North Carolina is one of dwindling resources. Smith gave credit to her son's ability to progress to the extent that he did--from institutionalization to independent living and employment--"to the resources available in this community." Yet, she continued,

the promise of community health remains unfulfilled. Many people living right now with the most serious and persistent mental illness are not being provided with the treatment they need. Treatment works if you can get it, but many just can't get it. Our family was lucky but we were also persistent, and we had insurance--a key factor--and we were educated enough to figure out how to navigate the system, which is not so easy. . . . In fact it is almost impossible for a seriously ill person to do so.

During the remainder of the morning, a number of points got my attention:

1. North Carolina is one of 13 states that do not require "insurance parity," meaning equal coverage for mental health treatment.

2. More people with mental illness in North Carolina are in jails and prisons than in any other facility. A few counties (starting in Orange County where Judge Joe Buckner has been a leader) have mental health treatment courts. But expansion faces resistance. Some district attorneys actively resist mental health courts, because it means putting fewer people behind bars: "it lowers their batting average."

3. People with mental illness are often not eligible for Medicaid because they are not identified as "disabled."

4. North Carolina is one of only five or six states that does not provide across-the-board special assistance money to support independent living for the mentally ill in their communities. At least 50 percent of the mentally ill are in adult care homes--exactly the wrong place for nurturing independence.

5. Transitional housing is a huge gap in North Carolina.

These facts are especially discouraging to those of us working on the 10-year homelessness plan, for certainly a great percentage of the chronically homeless are mentally ill; and the percentage of mentally ill homeless is bound to rise with the continuation of the state's mental health "divestiture" plans.

With a new legislative session about to begin in Raleigh, the time is ripe to speak out. The good news is that this Chapel Hill session was full to overflowing people from Orange and Chatham Counties who care passionately about these issues. The bad news is that this is the only legislative breakfast scheduled so far in the state--and there are 98 other counties.