Chris Fitzsimon is the executive

Published 6:05 am Sunday, June 22, 2008

By Staff
director of NC Policy Watch.
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Mental-health choices
are in the final budget
The Senate gave final approval to its budget Thursday morning and the House promptly rejected it, kicking off the final phase of the state budget process, the work of a conference committee to work out the long list of differences between the House and Senate spending plans.
There are likely to be heated battles about big issues like who should benefit from tax credits and how much to spend on children’s health care, and smaller ones, like how much to include for the university system to support Biopolis, the North Carolina Research Campus project in Kannapolis.
There hasn’t been much talk about the differences in mental-health spending in the two budgets. During the floor debate in both chambers, House and Senate leaders pointed to investments in mental health as a top priority.
And there are plenty of noteworthy investments, including funding for crisis services, in-patient beds in local hospitals across the state, more slots in the community assistance program for the developmentally disabled and money to reduce the staff to patient ratio at the troubled state hospitals.
There are all sorts of administrative changes and directives in both budgets, too, some that seem ill-advised and some that make sense, like delaying the opening of the new hospital in Butner until it meets national accreditation standards for safety.
But both budgets actually spend less in the Division of Mental Health, Developmental Disabilities and Substance Abuse Services than in the current year by making deep cuts to the community support program that a News &Observer series estimated has wasted $400 million, a number that is cited in virtually every discussion of mental-health services.
The House budget slashes community support funding by $86 million by tightening eligibility and adding new restrictions and limits on services. The Senate slashes the program’s funding even more, while providing some one-time money to help with the transition.
The News &Observer made a compelling case that community support was poorly managed and that the state was paying far too much for services performed by staff members without advanced degrees or expertise.
Part of community support involves helping patients with socialization and life skills, like learning how to shop for groceries or feeling confident enough to go to the mall and other public places, both essential in helping people with a mental illness or disability remain at home or even on their own and out-of-state institutions.
But anecdotes in the series about trips to the movies or the mall, combined with the paper’s estimate of $400 million in waste has lawmakers scrambling to crack down on the program and answer charges by political opponents that they are wasting taxpayers’ money.
The program does need an overhaul, but many advocates for the mentally ill and disabled are now understandably concerned that the new restrictions go too far and will prevent people who need community support services from getting them.
Ironically, the most well-known patient affected by the cuts may be Phil Wiggins, a 64-year-old man with schizophrenia, whose struggles with the mental-health system have been compellingly presented by Ruth Sheehan of the News &Observer in a series of columns over the past few years.
Sheehan’s latest report on Wiggins described how he had improved dramatically when he began receiving community support services after leaving Cherry Hospital, learning to use a computer and read more often. The services helped him with basic life skills.
But Sheehan reports that the state kept reducing his hours of community support and his behavior worsened and old compulsions returned, prompting a psychiatrist to write a passionate appeal to the state to restore the hours.
Wiggins will be cut off from community support completely at the end of June. That’s what the new restrictions in the House and Senate budget will do, end services for people like Phil Wiggins, whose struggles we only know about because of a talented columnist’s persistence.
At the very least, House and Senate leaders ought to keep whatever money is saved from gutting the community support program in the Division of Mental Health, maybe in the Mental Health Trust Fund.
The House and Senate have several differences to resolve in their mental health budgets and let’s hope budget negotiators come to their senses and realize both budgets are wrong.
They may not realize it now in their rush to defend themselves politically against charges that they wasted $400 million on trips to the grocery store, but the quality of life for hundreds of people like Phil Wiggins depends on those trips and other community support services and anybody with a sense of decency would make sure they get them.