DOJ Settlement Good for People with Mental Illness, but May Leave People with I/DD Out

From The Arc of North Carolina

DOJ Settlement Good for People with Mental Illness, but May Leave People with I/DD Out

[ view at ArcNC.org ]

While it is too soon to know what the U.S. Department of Justice (DOJ) Settlement will mean for people with mental illness, now is the time to begin thinking about the effects it will have on our Mental Health/Developmental Disability/Substance Abuse (MH/DD/SA) system.

We appreciate the N.C. Department of Health and Human Services (DHHS) and DOJ finding a way to avoid costly litigation by reaching a settlement. While people can argue about the settlement’s details, there is really no question that NC’s placement of people with mental illness [and people with I/DD] in adult care homes is not appropriate. These settings were designed for people who are elderly, and are not settings where individuals who are young and have a disability will thrive. Spending large amounts of money defending a federal lawsuit would have been a true waste of taxpayer money.

The settlement does several things. The core of it requires the state to create new housing options [defined as slots]. These housing slots will include rental assistance and support services for 3,000 people, 2,000 that currently live in adult care homes, and 1,000 that are in jeopardy of being placed in adult care homes (or rest homes, as they are sometimes called) by 2020. It also requires the state to create, or increase, the availability of community services for people with mental illness including supported employment and additional Assertive Community Treatment Team services. The effort will have an independent monitor who will hold the state accountable. If the state fails to meet timelines, the DOJ can take the State to court.

One of the most disappointing parts of the Settlement is its lack of inclusion of people with developmental disabilities. Though the original complaint was about people with mental illness, there is no doubt that NC continues to rely upon similar institutional settings for people with I/DD. That people with I/DD were leftout of this settlement is concerning. Not only is the state allowed to continue its bias towards institutional settings in placements, community options made available to people with mental illness could come a the cost of community options for those with I/DD, given the State's limited resources.

Creating “scattered-site housing” is a great idea for all people with disabilities. The Arc continues to develop housing options that meet this criteria, but it is a slow process. We are also concerned that policy-makers in Washington and NC are adhering to conflicting policy in terms of housing and people with disabilities. One example is the HUD (US Dept. of Housing and Urban Development) funded properties The Arc manages for people with mental illness. Many of the properties are apartments that will not meet the scattered-site definition, yet have rental assistance vouchers as part of the project. Under the settlement agreement, very few of these properties will be available for people coming out of adult care homes. The changes that would be needed to make them available for these people currently run afoul of federal HUD regulations. We hope the DOJ and HUD will work together so future efforts will not exclude housing options promoted by federal agencies.

While the state has agreed to this promising settlement, we have significant related problems in our service system that must be addressed. One such problem is the crisis that will be created if we do not find a solution to the personal care issue. While the state will be creating community housing options for one group of individuals, others will be losing services and potentially their housing. This is not the way a system should work. While it is impressive that the General Assembly found funds to support the settlement, it should be noted that critical services are being sliced because of budget cuts at the same time.

While this settlement agreement is a step in the right direction, it is far from perfect. It does much for people with mental illness who have faced institutional bias, but at the same time it does nothing for people with I/DD facing a nearly identical problem. This is an opportunity for the leadership of the General Assembly and Administration to proactively take the spirit of this settlement and apply it to other populations. The best possible outcome is a more responsive system for all.

On Wednesday of next week the legislative Blue Ribbon Commission on Transitions to Community Living will hold its first meeting. Hopefully this committee will be the catalyst to create such change.

NC-DHHS Settlement Agreement Dox w/ US DOJ

Settlement Documents (123KB pdf)

The above link will prompt a pdf download of the full settlement documents between the North Carolina Department of Health and Human Services and the United States Department of Justice, Civil Rights Division;

Documents to include:

• Complaint for Declaratory and Injunctive Relief 
• Joint Motion to Dismiss Without Prejudice and Retain Jurisdiction
• Proposed Order
• Settlement Agreement (Exhibit A)
• Memorandum in Support of the Joint Motion

See the Press Release from Disability Rights of NC

See the DHHS Press Release via The Arc of North Carolina

Hubert H. Humphrey said, "The moral test of government is how it treats those who are in the dawn of life . . . the children; those who are in the twilight of life . . . the elderly; and those who are in the shadow of life . . . the sick . . . the needy . . . and the disabled."

On behalf of so many, THANK YOU North Carolina!! 

Disability Rights NC Applauds North Carolina’s Settlement with U.S. DOJ

From Disability Rights of North Carolina

FOR IMMEDIATE RELEASE

Thursday, August 23, 2012

[ download pdf version ]

Disability Rights NC Applauds North Carolina’s Settlement with U.S. DOJ

Raleigh – Governor Beverly Perdue took a major step today toward resolving one of the greatest challenges facing our State’s mental health system by signing a settlement agreement with the U.S. DOJ. The agreement addresses findings made July 28, 2011, that the State violates the ADA by segregating North Carolinians with mental illness in Adult Care Homes rather than allowing people the choice to live and be supported in the community.

“Disability Rights NC applauds the Governor and the Secretary Delia for their leadership. This agreement will protect the rights of people with disabilities and help the State avoid costly litigation,” said Vicki Smith, Executive Director.

The agreement provides for the creation of appropriate community mental health care, employment services and housing options for people with mental illness in our State. “This agreement will improve the lives of N.C. families – our brothers and sisters, mothers and fathers. Disability Rights NC pledges to remain vigilant, ensuring the agreement’s promise is permanent,” said Smith. “North Carolina has seized an opportunity to cultivate a robust system of care for people with mental illness which all of us can be proud of.”

Background on North Carolinians with Mental Illness Housed in Adult Care Homes

In July 2010, Disability Rights NC filed a complaint with the US DOJ alleging that the State of North Carolina is in violation of the Americans with Disabilities Act (ADA) because the State has a bias towards placing people with mental illness in Adult Care Homes (ACHs) rather than supporting them in more integrated settings in their home communities. ACHs are institutional settings that do not provide appropriate services to support recovery and meaningful community integration. Disability Rights NC alleged that the State, in relying on placements in these types of Adult Care Homes, is violating the ADA. Please see the Report: Trapped in a Fractured System - People with Mental Illness in Adult Care Homes on the website (www.disabilityrightsnc.org). Under the ADA the unjustified segregation of persons with disabilities is an illegal form of discrimination. The integration mandate allows individuals to interact with non-disabled persons to the fullest extent possible so people with disabilities are not isolated from their communities.

The US DOJ, Civil Rights Division, issued a letter of findings on July 28, 2011, concluding that North Carolina "fails to provide services to individuals with mental illness in the most integrated setting appropriate to their needs in violation of the ADA," and that "[r]eliance on unnecessary institutional settings violates the civil rights of people with disabilities." The central finding of the US DOJ is that North Carolina lacks an adequate community support system for people with mental illness. As a result, individuals are institutionalized in more expensive and more restrictive settings in Adult Care Homes. "Most people with mental illness receiving services in adult care homes could be served in more integrated settings, but are relegated indefinitely and unnecessarily to adult care homes because of systemic State actions and policies," wrote U.S. Assistant Attorney General Thomas Perez. "Reliance on unnecessary institutional settings violates the civil rights of people with disabilities.”

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NC DHHS, US DOJ Reach Agreement on Community Based Care for Only Citizens with Serious Mental Illness

From The Arc of North Carolina

Breaking: NC DHHS, US DOJ Reach Agreement on Community Based Care for Only Citizens with Serious Mental Illness

[ view release at arcnc.org ]

Press Release from NC Dept. of Health & Human Services:

Raleigh — The North Carolina Department of Health and Human Services and the United States Department of Justice today reached an agreement on the state’s plan to offer more choices of where and how citizens with serious mental illness receive care and supportive services.

The plan, which was announced last month, will create housing slots in the community to offer the choice of community-based care for many adults with serious mental illness. It will also invest in job training and employment assistance for those citizens and will set up a comprehensive, 24/7 crisis care program for people with a serious mental illness.

This agreement will modernize our mental health system and ensure that North Carolina is providing the best possible treatment for adults diagnosed with severe mental illness. It will also provide the opportunity for many of these individuals to live in community settings if they choose to do so, and ensure that North Carolina is fully complying with the Americans with Disabilities Act and other federal laws.

This agreement is similar to ones signed by governors of a number of other states including, among others, the governors of Virginia and Georgia.

DHHS Secretary Al Delia agrees that more should be done to ensure access to community-based treatment for those with mental illness. “North Carolinians who have a serious mental illness have a right to choose the very best care environment to meet their personal needs,” he said. “That choice – whether they live in the community or in an adult care home – will be supported with access to mental health and other support services that will be available in part due to this agreement. Moving forward with a solution to help them identify and access those choices is the right thing to do,” he said.

“Disability Rights NC applauds the Governor and Secretary Delia for their leadership on this matter. They have not only done the right thing to protect the rights of people with disabilities, they have helped the state avoid costly litigation and destabilizing uncertainty,” said Vicki Smith, executive director of Disability Rights NC.

The agreement outlines DHHS’s plan of action to provide community-based services to people with mental illness. The budget the General Assembly passed in July expressly contemplated a settlement and appropriated funding to make this agreement possible. The timeline for completing the plan is eight years; this transition period will enable people who want to move to community-based settings to do so on a workable timetable and will allow sufficient time for North Carolina’s mental health infrastructure to implement this agreement.

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