Caring for previously hospitalized consumers : progress and challenges in mental health system reform : final report to the Joint Legislative Program Evaluation Oversight Committee

              Mental Health System Services Report No. 2008- 12- 04
Page 3 of 23
Background Since the introduction of a new array of mental health, developmental
disabilities, and substance abuse services in March of 2006, concerns about
cost and service utilization management prompted the North Carolina
General Assembly to question the effectiveness of mental health services
system reform. In response to these concerns, the General Assembly Joint
Legislative Program Evaluation Oversight Committee directed the Program
Evaluation Division to evaluate Division of Mental Health, Development
Disabilities and Substance Abuse Services ( MHDDSAS) service delivery,
quality, and outcomes.
One goal of reform was to increase community- based services and
reduce hospitalization. The United States Supreme Court’s Olmstead
decision in 1999 provided strong guidance for reform. Delivering the
opinion of the Court, Justice Ginsberg wrote,
States are required to place persons with mental disabilities in
community settings rather than in institutions when the State’s
treatment professionals have determined that community placement is
appropriate, the transfer from institutional care to a less restrictive
setting is not opposed by the affected individual, and the placement
can be reasonably accommodated, taking into account the resources
available to the State and the needs of others with mental
disabilities.
In keeping with this decision, a central goal of mental health system reform
in North Carolina was ensuring all but the most acutely ill consumers would
be served in the least restrictive ( i. e., non- hospital), community- based
settings. Legislation passed in 20013 transformed mental health,
developmental disabilities, and substance abuse services into a community-based
system intended to increase access to appropriate services. The
MHDDSAS State Plan of 20014 describes specific goals for the system with
the intent to provide mental health services in the community to support and
maintain functioning among individuals requiring care. More troubled
individuals at risk for hospitalization would receive more intensive
community- based services, such as comprehensive crisis intervention, with
the potential to keep consumers out of the hospital through local outpatient
care. For consumers acutely troubled enough to require hospitalization, the
capacity in community hospital psychiatric units would be expanded so that
more consumers could remain in their community even when they needed
inpatient care. At the highest level of intervention, the most troubled
consumers with mental illness would be served in state psychiatric hospitals.
Sorely needed substance abuse treatment capacity would be increased,
both with outpatient services and more beds in inpatient facilities.
Reform, then, aimed to reduce hospitalizations overall by expanding and
strengthening community- based services, increasing the number of
consumers served in community hospitals, and increasing substance abuse
treatment capacity. State psychiatric hospitals would be reserved for the
3 2001 Sess. Laws, 2001- 437, § 1.1.
4 MHDDSAS State Plan 2001: Blueprint for Change. Available at http:// www. ncdhhs. gov/ mhddsas/ stateplans.