But when that assignment ended, Akland took early retirement, left her six-figure salary behind, and returned home to Knightdale to become a volunteer leader in the cause that she'd come to realize was now her driving passion--reforming the mental health system. And so she has. In a year's time, Akland has poured herself into the rejuvenation of the Wake County chapter of NAMI, the National Alliance for the Mentally Ill, and put the organization at the front of two difficult battles:
It is pushing Wake County to step up to its new responsibilities under the state's mental health reform legislation.
It is also challenging the state's attempt to flee from its responsibilities before the counties are ready to assume them, and it's fighting to keep Raleigh's Dorothea Dix Hospital, a state facility, from being abandoned.
What happened in Washington? Two things, Akland says. First, she found herself stopping almost every day, on her walk to work down Pennsylvania Avenue, to talk to the homeless folk who congregated around a certain street bench. "They could be my daughter," she remembers thinking. One man, in particular, she befriended. She's certain he suffered from paranoid schizophrenia. Her daughter, Kristen's, diagnosis is schizo-affective disorder.
Now 23, Kristen's fought mental illness since early childhood. She's had the best of care because both her parents had good jobs and great insurance (Akland's husband, Gerald, was a career public health officer who, since retiring, works part-time at Research Triangle Institute.) But many with mental illnesses have little or no money and get sub-standard care--or none at all.
The second thing that happened: Akland had the time, weeknights in D.C., to study the state's mental health reform plan, and she saw herself in it. In what capacity, she didn't know. But she'd just had the experience of trying to place Kristen, on the recommendation of her daughter's psychiatrist, in the Wake County mental health system. Akland's conclusion: "There was nothing there."
Kristen, to live by herself, needs a lot of help and regular monitoring, Akland says. In theory, that's what the county system's supposed to provide. In fact, a "case manager" assigned to her daughter met with her once and never followed up.
Just recently, Akland took a nephew who suffers from bipolar disorder to Wake County's crisis center. He'd let his medication prescriptions lapse and was in trouble. But the triage nurse on duty told Akland there was an 11-month waiting list for services there, and Akland was stalemated--until someone else on the staff recognized her. In one year, she's gotten to be very well known. And respected.
"If I hadn't been with him, I'm convinced he would have been sent away without help. It made me so mad," Akland says, pounding her fist on her desk. Well, not pounding. Akland's not loud and she's not angry either, at least outwardly. But she is forceful, her easy Southern manner notwithstanding. She's also smart and well-organized, as you might expect of someone who graduated from the typing pool to the senior executive service of the federal government, where she managed scientists working in labs all over the country.
In fact, Akland's greatest strength may be her ability to draw people together from their different ideological and professional camps. She's liberal herself, but was raised by a very conservative, tobacco-farming family in Knightdale, which helps explain why she gets along so well with Rep. Sam Ellis, a Knightdale Republican.
Her father didn't think she needed a college education, which meant that once she started moving up at the EPA, she found herself working alongside snooty Ph.D's who didn't have much use for other people's opinions in general, let alone someone whose only degree was from Harbarger Business School. (Akland later earned a bachelor degree the hard way with courses at Duke and Barton College.)
In Wake-NAMI, Akland's found herself bridging the divide between an older generation that started the group and younger people, including some consumers, who are its current activists. That effort is going well, as was demonstrated when Akland pulled some 200 people together in September for a day-long "Extravaganza" that was part rally and part strategic planning conference for the organization.
A tougher divide is the one between county officials and the state. The Easley Administration is anxious to downsize the state mental hospitals, mainly because the federal Medicaid program won't pay for patients in state facilities but will pay if they're in privately run facilities like nursing homes. The state wants to close one of the four hospitals, and it's fingered Dorothea Dix in Raleigh, which the Wake-NAMI people think is fatally short-sighted, since Dix is located in the center of the population that needs it and the university-based medical facilities on which the mentally ill also depend.
Fighting to save Dix--or, rather, to replace it with a new, smaller state hospital on the Dix site--emerged from the "Extravaganza" as the organization's top priority, despite the fact that the state NAMI office has adopted a neutral stance on the issue. Since then, Akland's gone to work as "team leader" of an N.C. Mental Health Advocacy Campaign whose first goal is saving Dix and whose larger mission is making sure that the state's mental health "reform" plan actually improves services--something that, so far, it isn't doing.
Akland is blunt in describing the political infighting and deep-seated resentments that are preventing the state and counties from working together. Instead, both are running from any responsibility for the most severely ill people, who either require full-time supervision or else function well enough most of the time but, when a downward spiral comes, need a period of stabilization in a hospital.
"I am determined that they will not be allowed to just dump these people into the community without adequate help and support," Akland says, "because I truly believe that if they are, they will simply end up living on the street, or in prison, when that's not necessary at all."