In North Carolina, there are 1.37 million people in need of mental health, developmental disability, and/or substance abuse (MH/DD/SA) services — almost 14 percent of the state population. Of those, 609,087 need mental health services, 122,813 need developmental disability services, and 639,512 need substance abuse services. There are 313,910 children in need of services. These numbers are calculated by the N.C. Division of MH/DD/SAS using national estimates of prevalence — the occurrence of chronic and serious mental health, developmental disabilities, and substance abuse problems in the population — and then applying them to North Carolina’s population.
To evaluate access to mental health treatment, it also is important to look at the number of people that received services through the state’s public system of care. Overall, the state treated 52 percent of adults needing mental health services, 40 percent of adults needing services for developmental disabilities, and 12 percent of adults needing substance abuse services. In fiscal year 2010–11, the state’s system treated 372,995 people: 360,180 (97 percent) were served in the community, and 12,815 (3 percent) were served in state-operated facilities.
State-Operated Facilities for the Treatment of MH/DD/SA
State Psychiatric Hospitals: Treating People with Mental Illness
The state operates 14 facilities serving the MH/DD/SAS population in North Carolina. There are three psychiatric hospitals: Broughton Hospital in Morganton, Central Regional Hospital in Butner, and Cherry Hospital in Goldsboro.
The three state psychiatric hospitals served 5,754 people in FY 2010–11. Of those served, Broughton Hospital treated 1,352 people; Central Regional Hospital treated 2,119 people; Cherry Hospital treated 1,563 people; and Dorothea Dix Hospital in Raleigh treated 720 people before it closed.
Developmental Centers: Treating People with Intellectual and Developmental Disabilities
There are three state-operated developmental centers that treat those with profound or severe mental retardation or related developmental disabilities: Caswell Developmental Center in Kinston, J. Iverson Riddle Developmental Center in Morganton, and Murdoch Developmental Center in Butner. In FY 2010–11, the facilities served 1,355 people, including 1,312 residents and 43 people in respite beds. The Caswell Center served 417 people, the Riddle Center served 337, and the Murdoch Center served 601.
The Neuro-Medical Treatment Centers: Treating People with Disabilities Needing Long-Term Care There are three state-operated neuro-medical treatment centers, serving 1,000 disabled adults needing long-term care in FY 2010–11: Black Mountain Neuro-Medical Center serving 426 people, O’Berry Neuro-Medical Center in Goldsboro serving 299, and Longleaf Neuro-Medical Treatment in Wilson serving 275.
Alcohol & Drug Abuse Treatment Centers: Treating People Addicted to Alcohol or Drugs
North Carolina has three state-operated alcohol and drug abuse treatment centers (ADATCs) that treated 4,590 people in FY 2010–11 for alcohol or drug addictions: Julian F. Keith ADATC in Black Mountain serving 1,610 people; R.J. Blackley ADATC in Butner serving 1,296; and Walter B. Jones ADATC in Greenville serving 1,684.
Residential Programs for Children: The Wright and Whitaker Schools
There are two state-operated facilities that offer residential programs for children with serious emotional and behavioral disorders: the Wright School in Durham serving 62 children, and the Whitaker School in Butner serving 54 children. The Wright School provides residential mental health treatment for children aged 6–12. The Whitaker School is a long-term treatment program for emotionally handicapped adolescents aged 13–17. The Whitaker School has been converted into a psychiatric residential treatment facility (PRTF) so that services provided there will be covered by Medicaid.
Community-Based Services for the Treatment of MH/DD/SA
Local management entities (LMEs) are the agencies responsible for managing, coordinating, facilitating, and monitoring the provision of mental health, developmental disability, and substance abuse services in the area served. LME responsibilities include offering consumers access to services 24 hours a day, seven days a week, 365 days a year, as well as developing and overseeing providers and handling consumer complaints and grievances. They are the basic building block for the state’s provision of community-based services, providing referrals to both public and private providers of care.
In 2010–11, there were 23 LMEs statewide serving 360,180 people. Of those served in the community, 257,364 were mentally ill; 20,637 had developmental disabilities; and 82,179 were treated for substance abuse. Many LMEs are in flux as they merge into the 11 managed care organizations (MCOs) that are expected to exist after the state’s implementation of a federal waiver of Medicaid regulations governing mental health services.
Leza Wainwright knows North Carolina’s mental health system inside and out. In August 2010, she retired from her position as Director of the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services after working in the Division for almost 27 years. She says, “The system served more than 140,000 more people in 2009 than in 1991 because the number of people with all three disabilities served in the community increased by more than 88 percent. This shift toward community services follows national trends and also creates a more consumer-friendly type of care. People can stay at home in their communities and receive most of the services they need.”
Conclusion: Three Important Changes in the System over the Past 30 Years
As Wainwright looks back on her career in mental health in North Carolina, she sees three important changes: the consumer movement, the changes in local service delivery and management, and the evolving role of the state facilities. She believes that the consumer movement changed the provision of mental health services in this state. “Recovery is now the expected outcome for people with mental health and substance abuse issues. For people with developmental disabilities, the goals are self-determination and learning self-advocacy skills. Treatment plans have been replaced by Person Centered Plans, and . . . [c]onsumers’ goals and dreams guide the plan.”
Wainwright says that 30 years ago, practically all community mental health and substance abuse services in North Carolina were delivered by area mental health programs that were part of local governments. She says, “The state’s reform plan, which changed the area programs from service providers to managers of the system at the local level, created a good environment for the growth of private providers. Now there are literally thousands of providers. This has given people needing services a greater choice of provider agencies and has made access to services easier. It also has increased concerns about the quality of the services being delivered since the system is challenged to monitor such a large provider community effectively. And, it has made the system more complicated for some people since there are so many providers and since so many of them deliver only a few services.”
The third change Wainwright notes is the role of the state facilities. In 1991, a large number of the people served by the mental health, developmental disability, and substance abuse services system still were being served in state institutions. “That has changed dramatically over the past 30 years,” says Wainwright. “In 2009, the number of people with developmental disabilities served in the state developmental centers had decreased since 1991 by more than 53 percent. The number of people with mental illness and substance use disorders served in state psychiatric hospitals decreased by more than 10 percent over the same period.”
But advocates think this paints too rosy a picture. Vicki Smith is the Executive Director of Disability Rights NC, a nonprofit advocacy agency working to protect the right of individuals with mental illness or developmental disabilities. She says, “While I agree with the concept of the system being owned by the people it serves, the current system lacks the infrastructure to support such a concept. Unfortunately, the bag with the pretty bow tied around it that was handed to consumers is empty.” Advocates say it is extremely hard to find providers willing to treat the most difficult consumers, and because of the lack of appropriate community-based treatment, many people with acute needs are stuck in limbo — between poor ongoing support and inadequate or non-existent crisis services.
The mental health system in North Carolina is anything but static. The changes in the system can be seen in the numbers of those served and where they are served, but also in the experiences — good and bad — of the consumers.
Editor’s Note: A longer version of this article was published online in March 2011. Click here to view