December 1, 2010; Source: Charlotte Observer | The U.S. Department of Justice is investigating the state of North Carolina for violations of the Americans with Disabilities act for neglecting to provide proper care and housing for people with mental illness. Over the last decade the state seems to have relived the well-documented problems involved with de-institutionalization starting in the 1960’s.

In an attempt to reform the North Carolina mental health system starting in 2001 the state eliminated long-term care beds before establishing a vital community based system. A lack of training and accountability resulted in the waste of hundreds of millions of dollars and the result is, according to a News & Observer investigation two years ago, that “more than 6,000 severely mentally ill patients are housed in adult care homes that do not provide adequate security or treatment. Some severely mentally ill patients have beaten elderly or sick residents of adult care homes and in some cases killed them.”

The DOJ investigation, which the Charlotte Observer calls long overdue, was sparked by a complaint by an advocacy organization, Disability Rights North Carolina. This points again to the value of advocacy groups since the prospects of the state fixing the system would have been pretty dim without a federal mandate.

Meanwhile, the state, facing a $3.2 billion shortfall, has chosen recently to close the 154-year-old Dorothea Dix Hospital—the best performing of North Carolina’s long-term facilities.

Though it houses, among others, those involuntarily committed because of a crime, Dix reportedly has had, even in comparison to the more up-to-date facilities in the state, the lowest rates of violence and injuries to patients and staff. The North Carolina secretary for Health and Human Services, Lanier Cansler, told the Charlotte Observer that he doesn’t want to close Dix, but must due to budget constraints.

While hospitalization may not be the ideal choice for many patients, the loss of more beds will clearly strain the system and make treatment even harder to access. Ann Akland, advocacy chair for the Wake County chapter of the National Alliance for Mental Illness, says, “As soon as they stop admitting patients at Dix, the intolerable waits will just get longer, with more and more very sick people backing up in the emergency rooms.”

A state of the art hospital slated to replace Dix has been plagued with construction problems, a fire, and design problems that sparked a lawsuit concerning patient safety. It still stands partly empty. Secretary Cansler says that any federal mandate will most likely require additional community based resources rather than hospital beds. Clearly, the short-term prospects for people with serious mental illness in North Carolina are less than favorable but again, the value of aggressive advocacy organizations even in these times of scarce resources is made abundantly clear.—Ruth McCambridge