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To: Members of the Dorothea Dix Hospital Property Study Commission From: Beth Garriss
Hardy, Ph.D. Date: March 25, 2004 Re: Recommendations Regarding Mental Health Trust Fund NAMI-North Carolina is most appreciative of this opportunity to comment on your recommendations regarding the disposition of the potential proceeds generated by the sale or transfer of the Dix property. We congratulate the General Assembly for having the foresight to establish the Mental Health Trust Fund, and applaud the Commission for recognizing the importance of directing these funds to the development of community-based services for citizens of North Carolina with mental illness. We want first to reaffirm our position outlined in our letter to you in February that the proceeds from the sale of the Dix Property be targeted to build community based services that are proven effective and that address the critical need to develop community capacity to meet the demands of our mental health reform process. We are currently facing huge deficiencies in the ability of many communities to provide adequate services. Many communities simply do not have programs in place to serve persons with severe and persistent mental illness. Nor does it appear likely that an adequate network of service providers is being developed in many parts of our state. Specific needs include Housing, ACTT, Psychosocial Rehabilitation, Jail Diversion, Crisis Intervention Training, Training that is specific to state reform, and appropriate services for children and adolescents. The number of crisis beds available for acute care for adults and children continues to shrink while the need continues to grow. Many communities lack the short-term crisis units that are needed. As we decrease our reliance on state hospitals, it is imperative that this General Assembly provides adequate support for the development of community based services. While we understand that Trust Fund dollars are non-recurring and must be used for one-time expenditures, we ask that you consider that these one-time expenditures might not necessarily be limited to bricks and mortar. The building of an adequate array of services in our local communities depends on the availability of resources to support up-front planning and establishment of programs. We recommend that a significant portion of Mental Health Trust Fund dollars be used as start-up funding for community based services. While capital expenditures might occasionally be appropriate, we respectfully suggest that bricks and mortar be given a lower priority in relation to support for the development of services in the community. In addition to funding for the development of adequate services, support for training related to these services is critical. We recommend that Trust Fund monies be used to support the training needed to change the way the system works. To assume that current training approaches and protocol are adequate is to ignore the extent to which we must change the way we do business if our state reform plan is going to work. The need for housing for persons with mental illness is one of the most often cited barriers in our efforts to help our loved ones have a decent life. NAMI North Carolina continues to have grave concerns about the lack of supported housing opportunities available in our communities. Indeed, for an individual with brain disease to be discharged from our hospitals to the streets, or to a homeless shelter, or to an “unknown” location, is unconscionable. There is information available about how other states and communities have addressed this glaring need. We suggest that the issue of housing be considered a top priority as decisions are made regarding the disposition of Mental Health Trust Fund dollars, with the recommendation that some MHTF funds be used to examine available research on the various housing models that have demonstrated success. We recommend a collaborative decision making process that use this research to inform decisions, and disburse funds NAMI North Carolina is actively engaged in many various coalitions, councils, task forces, and working committees that address the challenges of North Carolina’s mental health reform process. Ongoing dialog among the various stakeholder groups supports the widespread belief that there are serious flaws in the decision-making process regarding the use of available resources. Members of the advocacy network continue to hear concerns about how decisions are made in the disbursement of Mental Health Trust Fund monies, including excessive use for capital needs. The Division has worked more closely with the advocacy network to identify priorities, which is much appreciated, but closer collaboration as decisions are made would result in decisions that better represent community, consumer and advocate priorities. To this end, we recommend that the legislative language be modified to include a requirement for a review process, established collaboratively with stakeholders, that governs the disbursement of Trust Fund monies, and that this process is adhered to for all expenditures. NAMI North Carolina believes that this one addition to the statute will provide the setting in which an effective RFP process can be constructed to ensure that Mental Health Trust Fund monies are appropriately and wisely used. We believe that a more streamlined process for the disbursement of funds will result in better and more collaborative decisions being made regarding the use of these non-recurring funds. This RFP process should articulate recommended services and selection criteria related to the funding of such services. NAMI North Carolina would welcome the opportunity to be involved in the design and implementation of such a process. Again, NAMI North Carolina appreciates the opportunity to offer this input as the Commission addresses these critical needs for this most vulnerable group of our citizens. We trust you will make strong recommendations and move them forward to the General Assembly as legislative changes are made to improve the lives of persons with severe and persistent mental illness in the state of North Carolina.
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