Setting the Record Straight

Dix TRO heralds a welcome sea change in the debate over mental health, developmental disabilities and substance abuse 

There are a lot of wonderful groups and individuals in North Carolina who work in the world of mental health, developmental disabilities and substance abuse. For decades, a variety of doctors, nurses, therapists, family members of patients, care providers, housing providers, advocacy groups, journalists and patients themselves have worked hard to reform and modernize our public systems for serving these vulnerable populations.

Unfortunately, despite their many successes through the years in eliminating at least some of the more ghastly practices that once were common in the past century, some basic, unpleasant and vexing truths remain:

#1 - People with mental illness, mental disabilities and substance abuse problems remain an unpopular and weak constituency. No matter how often or how much elected officials pay lip service to the idea of devoting the kind of attention and resources to these issues that they require, common political sense tells us that it is mostly just that: lip service. Most of the people struggling with these challenges are poor and/or politically marginalized. Save for the occasional person of wealth and influence that happens to have a suffering friend or family member, there simply isn't much real political influence in the MH/DD/SA population. If there were, state leaders simply wouldn't be allowing North Carolina's public treatment systems to be suffering the kind of Wall Street-like meltdown they're currently experiencing.

#2 - The nonprofit MH/DD/SA advocacy community is not well-equipped to aggressively confront the established powers that be. Though they do lots of fabulous, often heroic work, most of the established nonprofits at work in these fields are not set up to raise heck with governmental officials who fund and oversee these systems. Whether it's a matter of skill sets and orientation or, in some cases, the fact that they are themselves service providers who are dependent upon government appropriations to run their operations, most of these groups cannot or will not go to the mat in the way that is necessary to make our public systems work as they are intended to work.

As a consequence of these truths (and others), the MH/DD/SA service system remains woefully and scandalously underfunded and thousands upon thousands of North Carolinians suffer needlessly.         

A breath of fresh air

Happily, as the temporary restraining order issued in a Wake County courtroom this week to halt the planned evacuation of Dorothea Dix Hospital indicates, change is in the air. The change comes in the form of the state's new, official "protection and advocacy" organization (a function that had long been filled by a state agency). The new and important advocacy group is called Disability Rights North Carolina (or DRNC). Founded just last year as a successor to Carolina Legal Assistance (a long-time advocacy group for persons with mental disabilities that did valiant work despite chronic underfunding), DRNC is a vibrant and incredibly important addition to the MH/DD/SA scene.

Here, for the first time in years - maybe ever - is a well-funded, well-staffed team of crack attorneys and advocates with the skills, commitment and independence to force state officials to live up to the requirements of the Constitution and their own statutes.

Unlike other nonprofits in the field, whose mission is often divided between advocacy and service provision and fundraising and public relations and many other objectives, DRNC is the ideal kind of organization to shake things up in such a complex and politically challenging area: a private and independent non-profit with guaranteed federal funding and a simple straightforward mission - to champion equality and justice for people with mental illness and disabilities. 

In pursuit of this mission, DRNC has established a short and sweet set of goals and priorities - namely, to: 

• Investigate claims of abuse, neglect and exploitation of any person with a disability.
• Investigate, and where appropriate, provide representation to persons with disabilities who have experienced discrimination.
• Protect individuals with disabilities through age 21 who experience disability-related exclusion from services and ensure a free appropriate public education in the least restrictive setting.

Hitting the ground running

Though still very much a new kid on the block, DRNC has wasted no time in making a real and important difference. In April of this year, DRNC released a special report entitled "Deadly Transitions" in which it documented at least three suspicious deaths linked to inadequate discharge planning from the state's psychiatric hospitals.

In addition, however, to issuing multiple reports and other publications, the group has quickly gotten about the business that makes it unique: challenging and suing public officials to force them to comply with the law - even when it comes to the rights of the politically powerless.

Earlier this month, the group brought suit against the Wake County schools seeking access to information over alleged mistreatment of autistic children at a middle school.

This week, the group brought a much bigger (and successful) action against the state to halt its plan to transfer 170 patients from Dorothea Dix Hospital to the new Central Regional Hospital in Butner. The complaint and accompanying papers documented that there are more than a dozen significant safety issues at the new hospital that make it unfit (the hospital is already housing a large number of patients).

Problems include: inadequate staffing and staff training, structural building problems including hazardous roof leaks, troubles with the hospital's all-wireless communications system, troubles with the pager system, troubles with the phones and duress alarms, inadequate supplies and work space, troubles with preventing patient access to sharp instruments, troubles with electronic doors, and many others. In short, Central Regional is rife with precisely the kind of basic health and safety problems that one would expect to find in an old and obsolete facility, not one that is brand new.

DRNC's argument was strong enough to convince Superior Court Judge Allen Baddour to rule in its favor - notwithstanding the hardball tactics of the representatives from the state Attorney General's office who tried to have the case thrown out on procedural grounds. On Thursday of this past week Baddour issued a temporary restraining order against the state forbidding it to relocate the patients and setting a hearing for October 6 to consider the lawsuit further.  

Going forward

The recent developments in the Dix-to-Central Regional case call into question many of the fundamentals of the state's system for delivering these essential health services. If the state can't even muster the resources to make its newest facility adequate, one can only imagine what things have been like for people in older facilities. We already know that the state's ill-conceived and poorly executed privatization scheme has resulted in what amounts to the dumping or many, many patients who were simply released (some even at homeless shelters) with no meaningful plan or local safety net.

Had DRNC not been there to play the role of watchdog, it's entirely likely that all Dix patients would be at Central Regional by now. Even if some group of concerned patients or doctors had managed to find a private attorney or law firm to cobble together a lawsuit, it's hard to imagine that they would have done as well - especially given the Attorney General's office apparent willingness to put its commitment to zealous adversarial lawyering ahead of the best interests of the patients in question.    

All of which leads to the conclusion that DRNC's arrival on the MH/DD/SA advocacy scene came not a minute too soon. North Carolina's broken system of care is in desperate need of the group's advocacy.

Let's hope that the new action regarding Central Regional is just the beginning of a new wave of aggressive activism to reform and rebuild the state's MH/DD/SA system. After decades of neglect and years of an ill-conceived attempt to dismantle and privatize the programs and services that were in existence, it seems all but certain that the courts will be required to play an important role in forcing state officials to do what is right for such a politically powerless constituency.       

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This entry was posted on Saturday, September 27th, 2008 at 12:17 pm and is filed under Setting the Record Straight. You can follow any responses to this entry through the RSS 2.0 feed.