02/07/05 — Treatment of disabled and mentally ill will change under state reform

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Treatment of disabled and mentally ill will change under state reform

By Barbara Arntsen
Published in News on February 7, 2005 1:55 PM

New state mental health laws will change the treatment of disabled and mentally ill people by using more community-based resources and less institutionalized care.

That's what Michael Moseley, the Director of the Division of Mental Health Substance Abuse Services for North Carolina, told the Wayne County Mental Health Association last week.

Moseley said that a Supreme Court decision in 2001ordered that disabled people be placed in community settings, rather than institutions, where possible.

"The Olmstead decision spoke of the need to involve consumers in their own health care decisions, and on the over-reliance on institutional care," Moseley said.

After that Supreme Court decision, President George W. Bush formed the Freedom Commission to eliminate inequality for Americans with disabilities.

From June 2002 to April 2003, the 22 Commissioners met monthly to analyze the public and private mental health systems. The commission received comments and suggestions from nearly 2,500 people from all 50 states.

The Freedom Commission then came up with a list of key items that needed changing in the mental health and disability areas. Those items included: Integrating Americans with disabilities into the workforce, expanding telecommuting, implementing a 'ticket to work' program where disabled people can choose their own support services and maintain their health benefits when they return to work, providing innovative transportation solutions, and promoting full access to community life.

The commission's report prompted the President to issue an executive order, which was passed on to all states. Any mental health funding from the federal government would be looked upon in relation to the Freedom Commission's report.

"There were also dictates from the federal grant source level and instructions slated toward community systems," Moseley said.

Those dictates prompted the North Carolina General Assembly to develop a plan for mental health system reform, House Bill 381.

"We are required now to look at providing assistance out of institutions and looking more at local agencies," Moseley said. "We have to look and engage the consumer and their families in the process."

The new system needs to be in place by 2007.

The programs should now become more "person centered," and programs will be developed to keep mentally ill or disabled people in their community.

"Placing them in an institution will be the last resort," Moseley said. "We want to try and serve them as close to home as possible."

Moseley said that an "evaluation structure" would also be a part of the new system.

"We want an outcome-oriented system," he said. "We've had some programs that didn't have evaluation services, so we didn't know they weren't working."

Moseley has spent 10 months traveling around the state visiting all of the state and local mental health facilities.

He said that the mental health "landscape in North Carolina was not the same from the mountains to the coast."

"There's different availability of staff in different communities, and though we're looking at a divestiture of services from public to private, that might not be able to happen in the rural areas," he said. "We just want to make sure consumers don't fall through the cracks, and that is a challenge."

He said that while North Carolina had always been a shining model for folks with mental illnesses and disabilities, there was always room for improvement.

"Reform is hard work, it's going to be a tough effort, but we're striving to be better," he said.