Mental health funding
Senate budget
$675,738,286
Shortfall
$31,059,461
• Closes Wright School, saves $2.7 million annually
• Closes three state-operated alcohol and drug abuse treatment centers effective July 1, 2013, saves $88.5 million over two years; gives $30 million of that to community-oriented substance abuse treatment
• Allocates $2 million each year for telepsychiatry, intended to alleviate ER wait times
• Budgets $13.2 million over two years for DOJ settlement
• Reduces funds for local mental health agencies and managed care organizations by $15.2 million in each fiscal year
House budget
$704,703,959
Shortfall
$2,093,788
• Retains Wright School funding
• Keeps open alcohol and drug abuse treatment centers
• Allocates $2 million each year for telepsychiatry
• Allocates $8 million in short-term assistance for group homes
• Budgets $13.2 million over two years for DOJ settlement
• Reduces funds for local mental health agencies and managed care organizations by $15.2 million each year
Diana Marsh used to approach strangers on the street and offer them her autograph. But Diana Marsh is not famous, at least not yet.
“It’s pretty funny today,” she says. “But it wasn’t funny back then.”
At the time, Marsh was having a psychotic breakdown. She heard voices and believed herself to be a celebrity. The frightening symptoms manifested when she was 17 following a bad drug trip, and lasted intermittently for two decades.
“It’s like a switch came on and it never went off,” she says.
Today, Marsh, 46, is a counselor in Greensboro for people with similar symptoms. She occasionally still hears voices and experiences delusions. She may believe bugs are crawling on her or that a person is hiding in the back seat of her car. But after years of treatment, her symptoms are under control.
Other people with mental illness may not have the same chance, Marsh says, unless state lawmakers reverse their course on mental health funding.
Members from the state House and Senate continue to debate dueling budget plans this week. Senate lawmakers had appropriated $675.7 million for mental health, developmental disabilities and substance abuse services in the next fiscal year. The House plan allocates $704.7 million.
According to legislative committee reports, both fall far short of the amount necessary to maintain current service levels. In the House, the shortfall is roughly $2 million, but in the Senate, the difference is $31 million. The gap comes after lawmakers cut about $100 million over the last five years, according to N.C. Rep. Verla Insko, D-Orange.
The implications of the Senate budget plan are potentially devastating. Leaders want to close the state’s three in-patient alcohol and drug abuse treatment centers in Butner, Black Mountain and Greenville.
Senators want to shutter Durham’s Wright School, which treats students from across the state with severe emotional and mental disorders. Also absent in the Senate plan is short-term financial assistance to keep some of the state’s most troubled residents in group homes. The House budget includes $8 million in assistance.
“People have found it to be one of the most difficult atmospheres in Raleigh in many, many years,” says Deby Dihoff, executive director of the North Carolina chapter of the National Alliance on Mental Illness.
Dihoff credited House budget leaders such as Wake County Republican Nelson Dollar for showing greater understanding of the mental health care system in crafting more moderate cuts, but she says Senate leaders’ budget tactics are uninformed.
Case in point: Senate budget writers sought to soften the blow of closing three substance abuse centers by allotting $30 million of the $88.5 million in savings for unspecified community-oriented treatment options. However, Dihoff says such options are not suitable for the intensive, in-patient services that are sometimes needed.
“These are important policy decisions,” she says. “You don’t just look at big targets and take out funding without thinking about the impact.”
Germaine Williamson, a longtime nurse at Black Mountain’s Julian F. Keith treatment center, defended her facility as a vital and affordable service, pointing out private rehab centers are often very expensive.
“This is something that is needed for the regular people in the world,” Williamson says.
The impacts of the cuts will be felt across the state, Dihoff says, from emergency rooms to jails. “It’s so dangerous to our public system to start just removing one domino in this complicated structure,” she says.
But Sen. Louis Pate, the Mount Olive Republican who co-chairs the Senate health and human services appropriation committee, says lawmakers are confined by rampant spending in other portions of the budget.
“Medicaid by itself is just killing what we’re able to do in terms of providing funding for mental health, education, you name it,” Pate says.
The state’s Medicaid spending totaled about $3 billion last year, although the program’s 3.5 percent annual growth was reported to be the slowest in the nation. Pate says cutting taxes for businesses and individuals will help the economy rebound and generate more money from other sources. “We’re trying to get the best possible treatment for people with mental illness and physical illness in the most sufficient manner possible,” he says.
However, Sen. Floyd McKissick Jr., a Durham Democrat and member of the Senate budget committee for health and human services, says GOP leaders are more inclined to privatize these systems than fund public ones.
“As my mother would say, their actions speak louder than words,” McKissick says. “It’s pretty self-evident what their values are, regardless of what they may articulate.”
McKissick says North Carolina was once viewed as relatively progressive among Southern states on mental health care issues.
But as Pate notes, North Carolina’s “progressive” status under Democratic leadership is debatable. State leaders reached an accord with U.S. Department of Justice officials last August over the allegation that, for years, North Carolina has institutionalized too many of its mentally ill residents.
The settlement committed the state to an eight-year, $287 million plan to move thousands of institutionalized residents into community-based treatment methods.
Mental health care advocates say lawmakers need to reprioritize their spending. The Senate plan budgets $770 million for GOP-championed tax reform; the House plan sets aside $528 million, more than enough to fully fund the state’s mental health care services next year.
Marsh says she’s concerned about the real-life implications of these cuts. “I had to work recently with a young man who has issues where he could be ultimately dangerous to the community,” she says. “And we don’t have anywhere to send him.”
This article appeared in print with the headline “The biggest loser.”