"Every year, the state's had some sort of crisis, some critical need, and we've been told that next year will be our year," says Beth Melcher, director of governmental relations for NAMI-NC (the National Alliance for the Mentally Ill) and last year's coalition chair. "Well, we are the crisis now."
That's the case for two reasons. First, a series of reports by consultants, the state auditor, and one newspaper after another have found that services for the most vulnerable people in our state are spotty at best, in large part because North Carolina clings to a 19th-century system of behemoth facilities and resists moving to community-based programs. People with mental illnesses, for example, end up warehoused at places like Dorothea Dix Hospital in Raleigh rather than getting the help they'd need to live independently in their own hometowns.
Which leads to the second reason: the U.S. Supreme Court, in the 1999 Olmstead case from Georgia, ruled that states cannot continue to warehouse people who are capable of living--and want to live--in community settings. The states must see that such folks, meaning people with mental handicaps, physical handicaps or both--can get the help they need locally, the Court held.
Reform advocates believe that, in the long run, the state can save money by decentralizing services and closing some or all of its aging, institution-style facilities. But the transition will cost money, if for no other reason than that it will expose North Carolina's little secret: the warehouse system leaves out thousands of people who need assistance but aren't getting any.
According to Dave Richard, executive director of The ARC of NC (formerly the Association of Retarded Citizens), the state's five big centers for people with mental disabilities have about 2,000 residents--but 6,000 others are on waiting lists all over the state, most of them getting no help at all.
"Some have been waiting six or seven years," Richard says. "We're talking about some desperate situations--older families with aging children who've been living at home, but now the family can't continue to take care of them, or families with young children with serious physical, developmental or medical needs."
As in previous years, however, the crisis in social-service needs is bumping up against another crisis: the state is broke.
As the newly-elected General Assembly starts its two-year session, and Gov. Mike Easley settles into office, they're finding that their predecessors left the cupboard bare and stole away with the piggy bank. Tax cuts totaling some $1.4 billion a year--10 percent of the state's annual budget--combined with former Gov. Jim Hunt's policy of opposing any tax increase to pay for Hurricane Fran reconstruction or the nearly $1 billion the state was ordered to refund as the result of taxpayer lawsuits, have wiped out every surplus account. Meanwhile, the slowing economy is cutting into future revenue projections, so that the state faces a deficit of some $400 million or so just to keep funding existing programs.
That deficit is likely to handcuff Easley as he attempts to keep campaign promises to raise teacher salaries above the national average, cut class sizes in the public schools in grades K-3 and pay for preschool programs for tens of thousands of poor children in the state. Easley also talked about following through on Hunt's initiative to preserve an additional 1 million acres of open space and start a prescription-drug subsidy for needy senior citizens.
To pay for some of these programs, at least, Easley said he'd push for a state lottery, which could be expected to yield about the same amount of money as Virginia's--about $300 million a year. But as the election neared, Easley seemed to distance himself from his own plan, and nothing's been heard about it since.
Nonetheless, George Reed, executive director the N.C. Council of Churches, expects the lottery issue to come up in this legislative session. "I assume it's still on [Gov. Easley's] agenda," Reed says. "And we will continue to oppose it."
The lottery idea went nowhere the last two years because it never had majority-support in the House of Representatives, and if anything, the 2000 election results leave it with even fewer votes there now, Reed thinks. Even if the legislature did pass a lottery, most supporters are committed to putting it to a public referendum before it could start up, meaning that it would be at least two years before any money came into Raleigh. That won't ease Easley's--or the state's--financial woes.
On the other hand, several of the initiatives that top the Council of Churches' legislative agenda wouldn't cost the state anything. One such initiative is extending the moratorium on new or expanded hog farms past its scheduled expiration this summer. The Council wants it continued until the industry adopts a better way of getting rid of hog wastes than the current cesspool (or "lagoon") system. Another: a moratorium on the death penalty until the question of whether it can be applied free of racial bias is resolved. The Council also supports legislation that would bar the execution of defendants who are mentally retarded.
The Council's agenda also calls for "tax justice," including closing loopholes in the tax code that let the wealthy avoid paying their fair share. One example: airplanes, boats and automobiles are subject to sales taxes, but only at half the usual 6 percent rate, and only up to $1,500. Thus, the tax rate on a Porsche is less than on a Geo Metro. Cost to the state treasury: about $25 million a year. "Our position is that a tax increase wouldn't be the end of the world either," Reed says, "as long as it was done in a progressive way. Our biggest fear, when there's no new money in the budget, is that the legislature will start cutting back on good programs."
New money or not, that's what's happened every year to what's called MHDDSA funds--money for the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services. Coalition 2000 asked for $70 million in additional funding two years ago. It got $30 million. Coalition 2001 is expected to seek about $100 million this year. The Council of Churches' delegates put that request at the top of their list when they met in the fall, Reed says, calling state services "woefully inadequate."
According to the ARC's Richard, almost every other state is moving at a faster pace than North Carolina to convert from the old centralized-facilities model of service delivery to community-based services. Eight states have closed all their big facilities, and Michigan is on the verge of becoming the ninth, he says. North Carolina, with four big psychiatric facilities, five centers for the developmentally disabled and seven others that serve persons with multiple handicaps, substance abusers and children, is behind 42 states in all.
The Supreme Court's decision in the Olmstead case, though, has advocates hopeful that change is coming, if not in 2001, then by the end of the legislative session in 2002. A joint Senate-House oversight committee is studying what to do, with Rep. Verla Insko, a Chapel Hill Democrat, as one of its co-chairs. Insko says the commission is concentrating first on reforming who's in charge of services. She expects a bill to pass this year that will replace the present, somewhat blurry system of 39 "authorities" across the state with one that spells out specific responsibilities for state government and the social-service units of county governments.
Counties would be expected to pay for "core" services, Insko says, with the state funding available to pay for expensive, specialized services and to assist low-wealth counties.
Meanwhile, Insko says, studies are underway to look, first, at how many people in state facilities could live in community settings with appropriate care, and second, at the full range of services needed both in central facilities and community settings. The latter will include housing subsidies, doctors' and therapists' fees, vocational-training services to help the handicapped find work, and "respite care" to help families who are taking care of members with special needs.
Senate President Marc Basnight wants the "total picture" studied, Insko says. She likens his request to the study of the state's university system that laid the groundwork for last year's successful $3 billion bond issue.