The state is getting out of the business of treating mental illness and handing it to the counties. This could be a good thing, because the old state hospitals--Dorothea Dix in Raleigh, John Umstead in Butner, and two others--were created with the goal of separating patients from the rest of society, but contemporary medical standards call for treatment in community settings. No reason, in short, why the vast majority of folks with mental diseases should be forced into institutions, and every reason--for their sake--that they shouldn't.
Yes, but what community settings? That's the question every county social services agency is scrambling to answer now, but especially Wake County's, because the Easley Administration has decided to retain just two of the four state hospitals, and Dix isn't going to be one of them. So it was good news indeed when the county's chapter of NAMI (National Alliance for the Mentally Ill), a volunteer group, resolved to create a clubhouse and name it after one of their sons whose recovery from severe illness epitomized what the place would be about.
Derek's Renaissance House would be "a warm, inviting clubhouse for people with severe and persistent mental illnesses." It would be a daytime facility, staffed at a ratio of one mental health professional to eight patient-members, and have a member-run kitchen, thrift shop and game room as well as staff-run programs to help the members find jobs. A place for people to come who are in recovery and living, say, in an apartment somewhere in Raleigh, but whose well-being requires regular monitoring and the understanding friendships of peers.
Try to picture such a place. It will probably look a lot like the house on Poole Road that Wake-NAMI's volunteers chose, and contracted to buy, contingent on getting a variance from the city to use it as a "congregate care structure."
Perhaps you can anticipate what happened next. Neighbors didn't want it. You know that. Mentally ill means dangerous to most of us, and even though that's just not so, the stigma remains a threat to "property values." What you don't know--what Ann Akland, Wake-NAMI's marvelous president, didn't know--was that Raleigh's zoning code is carefully written to exclude the mentally ill.
That's the way it reads anyway. Akland was advised by the zoning office to seek a variance as an adult day-care facility, but the Board of Adjustment found that Derek's didn't fit the classification, which calls for a majority of "participants" to be "in need of care because of decreasing capability brought on by age." Other classifications specify physical illness or handicaps, but specifically rule out "mentally ill persons who are dangerous to others."
What classification would Derek's fit into? Akland asked. Answer: None. In Raleigh, there are rules for using a house as a business, a rooming house or--loose rules--a student pad. But if the mentally ill are involved, according to the Board of Adjustment, there's no way. So, rather than reject Wake-NAMI's application, it simply declined to hear it.
The House: It's big (4,400 sf, plus a full basement), old, solid, but in need of a lot of repairs. (The current owner rents rooms, as her ministry, to women coming out of prison.) It sits on a 1.07-acre lot, with a wooded half-acre also available just behind. Poole Road is four lanes, with buses over to nearby Wake Medical Center and the county health agencies on which Derek's participants would rely; this house is in a residential stretch, but across the way there's a Catholic church, and not far down a funeral home and a convenience store-gas station.
That's the upside. Downside, the house is flanked, close up along the road, by two small houses, and you can well imagine that neither of their owners wants a big crowd coming next door every day, mentally ill or not. At first, Wake-NAMI was talking about Derek's having 100 members, half of whom could be expected on a given day. That number was based on the size of the house and national standards for psychosocial facilities of this kind, Akland says. But her group's willing to limit it to 60 members (expected turnout of 30), the least feasible given the staffing required. Medicaid funding is available, by the way, to help pay the bills.
Done right, a day-facility for 60/30, on this spacious site, would be an asset to the neighborhood, not to mention mental-health care in Raleigh.
Akland met Tuesday with Mayor Charles Meeker, and afterward they agreed that Raleigh's zoning code must be updated to allow for mental-health facilities of this kind in "community settings." City Attorney Tom McCormick was asked to find out how other cities do it. Whether the City Council will approve changes fast enough to help Derek's get into the house on Poole Road is, however, very doubtful.
The only thing that makes it possible at all, frankly, is that this old house on a busy thoroughfare, with an asking price of $300,000, has no future as a single-family house.
"We're not giving up on it," Akland says. "But the big-picture issue is that the code needs to be rewritten so this doesn't keep happening. Because this isn't going to be the last such place we need. It's only the first."