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A 12-year mental health crisis comes to a head

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"Save our homes!" Residents of group homes for people with mental disabilities raised the cry at a rally at the General Assembly in mid-November.

"Our life is in your hands!" shouted James Fountain, a 35-year-old who lives in a group home in Zebulon.

"Group homes can take care of our needs and our wants, and we won't be on the streets or homeless," he said in a brisk monotone. "They make sure that we're on our medication, that we get the food we need and are healthy."

He called out again: "Our life is in your hands!"

What a sorry spectacle, in the week before Thanksgiving, that these men and women felt compelled to go to Raleigh, pleading for a scrap of justice from the few state legislators who attended their rally and promised to listen. Sure, the lawmakers had said this before, but this time they really meant it.

It would be easy to potshot Rep. Nelson Dollar, the Wake County Republican tasked by his party with leading on mental health issues. At the rally, Dollar claimed he didn't know that language in the budget that his party muscled into law last spring—overriding Gov. Bev Perdue's veto—would cripple hundreds of group homes and jeopardize their 1,400 residents.

Maybe, but he should've known: As the Associated Press reported Sunday—and mental health advocates have maintained for months—the Perdue administration warned Dollar about the problem, and put it in writing. The answer that came back, from a consultant to Dollar's committee, was a terse brush-off—also in writing.

Yes, hard to believe, but following a decade in which the Democratic administrations of Govs. Mike Easley and Bev Perdue turned "mental health reform" into a sick punch line, the Republican legislature that gained control in 2010 made it worse by refusing to fund the few existing facilities for the low-income mentally ill.

Reform, you may recall, was supposed to move people out of psychiatric hospital beds and into more humane, community-based housing with supports—including employment programs—to help them live full lives. In 1999, the U.S. Supreme Court ruled in the case Olmstead v. L.C. that states must place persons with mental disabilities in community settings if certain criteria are met: "If the person affected approves ... the placement can be reasonably accommodated, taking into account the resources available to the state and the needs of others with mental disabilities."

Today, Raleigh's Dorothea Dix Hospital is closed and slated to be a park; fewer hospital beds means the state saves money. But North Carolina never followed through with the community housing and supports, leaving the low-income mentally ill to scrounge for beds in privately owned group homes (facilities licensed for up to six residents) or in larger adult-care facilities designed for the elderly.

Or, failing that, in a shelter or jail.

Enter Gov.-elect Pat McCrory, a Republican who harshly criticized the Democrats' mishandling of mental health issues but left us guessing what he would do differently.

McCrory will need to straighten out the group homes mess, without straining. A mere $7 million—$5,000 a month per resident—will keep the homes afloat through the end of the fiscal year, June 2013. But the money can't be spent until the budget language—the same language Dollar claims he was unaware of—is repealed.

After that, much bigger questions loom. Will McCrory and the Republicans opt in to the Medicaid expansion authorized and paid for under Obamacare? This is a huge issue, but it's especially vital for mental health because of the federal requirement that mental disease be accorded parity with physical illnesses in all insurance plans.

If McCrory and the GOP say yes to Medicaid expansion, an additional 500,000 North Carolinians with incomes less than $15,000 will be eligible for coverage starting in 2014, according to N.C. Policy Watch. The federal government will pick up the entire tab for the first three years and 90 percent of it after that.

For the mentally ill, it means doctor visits instead of emergency rooms, and preventive care instead of crisis care.

Republican antipathy toward Obamacare runs so deep, however, that McCrory has ducked the matter.

The second question is whether McCrory and the Republicans will spend the money needed to comply with a settlement reached this year by the Perdue administration and the U.S. Department of Justice.

In it, the state agreed to do in the next eight years what it failed to do in the last 12: provide appropriate housing and programs for 3,000 of the estimated 6,000 people with mental illnesses now living in the inappropriate settings of adult-care homes.

The settlement came in a lawsuit filed by Disability Rights North Carolina, a nonprofit advocacy group created with federal funds in 2007. Its executive director, Vicki Smith, says the state's mental health system, 13 years after the Supreme Court's order, is "beyond broken."

The Republicans, Smith says, "have an opportunity to fix it. They have a choice, unlike a lot of people with disabilities. And we're going to be watching."

This article appeared in print with the headline "A statewide 9-1-1."

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