Mental Health, Developmental Disabilities, and Substance Abuse Services

A Policy Statement Adopted by the House of Delegates, North Carolina Council of Churches, November 9, 2000

The Issues

In North Carolina, over 1,000,000 people are directly affected by mental illness, developmental disabilities, or substance abuse.[1] In recent years, the state and area agencies responsible for providing assistance have been plagued with a host of problems, including woefully inadequate funding, unconscionable delays in services, and appearances and allegations of mismanagement.

Providing the needed supports and services for vulnerable individuals is a critical role for state government and society in general.  Without needed resources, people with disabilities and substance abuse problems go unserved or untreated.  Not only does this create untold suffering amongst the individuals and their families, but it also places enormous strain on other institutions and systems (prisons, hospitals, homeless shelters, etc.).  Proper support, service, and treatment can and will change the dynamics of our families and communities.

Mental Health. In North Carolina, over 150,000 children and adults experience serious mental illness and emotional disorders. Mental health services in North Carolina fall well below even the most conservative estimates of what is required.  There are severe deficits in necessary support services, including crisis services, housing, supported employment, and community mental health treatment services.  For some, these deficits mean infrequent and hurried care from mental health professionals, resulting in inadequate treatment and incomplete recovery.  For some individuals with mental illness, the result is homelessness, even imprisonment. An antiquated state hospital system struggles to provide adequate care to those whose needs have not been met in the community.  The closure of private psychiatric beds has only strained the system further.

Developmental Disabilities. More than 100,000 North Carolinians have mental retardation or other developmental disabilities.  Many of these people are capable, with minimal supports, of living independently in our communities.  Those with the most serious disabilities are unable to care for themselves and must have ongoing supervision and assistance.  Over 7,000 individuals with developmental disabilities are on waiting lists for services that are currently unavailable through the community system.  Basic services such as housing and employment support are not available due to lack of funding.  North Carolina still institutionalizes more people than most other states.  Lack of quality community services is the primary reason for such high institutional rates.

Substance Abuse. A 1997 study by the Research Triangle Institute estimated there to be 372,000 North Carolinians in need of addiction treatment.  Substance abuse is a major factor in the growing populations in prisons.  The Department of Corrections estimates that 80% of those in custody are there because of alcohol- or drug-related crimes, and 48% of those now entering prisons come with addictions to alcohol and/or other drugs.  Study after study point to the abuse of illegal drugs and alcohol as the reason for many societal ills.  Yet, lack of adequate treatment and support programs is a constant in our communities.  Substance abusers who want help face waiting lists in our public system. The private system, due to insurance regulation, faces a growing shortage of treatment programs.

While the lack of adequate funding is the primary reason for lack of services, it is not the only one:

• Our state Mental Health/Developmental Disabilities/Substance Abuse Services system is in crisis.  A recent report by the State Auditor called for major systemic reform in order to meet the challenges of the 21^st Century.
• Many insurers do not cover mental health or substance abuse treatment as comprehensively as they cover the treatment of physical ills.  This lack of parity is a major concern, for it causes people to forgo needed treatment.  In addition, when those with insurance face severe limits on mental health/substance abuse benefits, the public sector is left to pick up an unreasonable burden.

An Issue for People of Faith

There are several reasons why people of faith should be concerned about the needs of people with mental illness, developmental disabilities or substance abuse problems.

• The Bible calls us to work for justice for vulnerable people. Those affected by mental illness, developmental disabilities, or substance abuse have often been the forgotten members of our communities, kept in figurative or literal backrooms because of embarrassment and fear (theirs and ours).  For a variety of reasons, they are often unwilling or unable to serve as advocates for their own needs.
• The Bible stresses the importance of health and wholeness.  In fact, the New Testament word often translated “to save” also means “to heal” or “to make whole”.  This concern for wholeness can be seen clearly in Jesus’ many encounters with people with disabilities.  How can we call for adequate and affordable health care for all and not support adequate treatment and services for people with mental illness, developmental disabilities, and substance abuse problems?
• On a more pragmatic level, faith communities, and especially clergy, see first-hand the impact of the needs of these individuals.  It may be a Sunday school teacher who is severely depressed, elderly parents desperately concerned about what will happen to their adult child with mental retardation after they die, or a church member trying to help her brother, who is a cocaine addict. While we in the faith community should do all that we can to meet human needs, many of these needs are beyond the scope of our expertise or capacity.  Therefore, in addition to the direct ministries that we can provide, we also need to serve as advocates for readily available services for all who need them.

Recommendations

In our churches – Churches and their members play an important role in community life.  People with disabilities and those with substance abuse problems often face social isolation.  Churches need to welcome all people, including members of these groups.  Active support groups and educational and worship programs designed to include them are important methods of welcoming them into our communities through our churches.

As advocates – Broadly speaking, we will support legislation which reduces discrimination against people with mental illness, developmental disabilities, or substance abuse problems and which helps them obtain needed services.

Three issues concerning people with disabilities and substance abuse problems will be of priority in the 2001 General Assembly:

1.       Adequate funding for the community Mental Health/Developmental Disabilities/Substance Abuse Services system – It is especially important that community-based programs be adequately funded.  Community-based programs, where appropriate, permit people to remain in their communities, in their own homes or in home-like settings, and are less disruptive to their lives and their families.  It is critical that these community programs be adequately funded, not just that institutional placements be reduced.  Otherwise, people with very real needs will be dumped into communities that lack the financial resources to assist them.  For specific guidance, we will look to Coalition 2001, a group of 50 organizations supporting people with mental health, developmental disabilities, and substance abuse needs, which will put forth a funding request designed to assist people living in the community.

2.       Mental health and substance abuse parity in insurance coverage – Parity would require health insurance policies to cover mental health and substance abuse services just as they cover physical health (i.e., same exclusions, deductibles, limits on visits, etc.).  Parity legislation makes sense for millions of North Carolina citizens who would use their private insurance to receive mental health or substance abuse services.  Increased costs of insurance, if any, are minor, in large part because preventive care early on is much cheaper than acute care after a problem has become a crisis.  The North Carolina State Employees’ Health Plan includes parity and has shown no increase in rates because of the parity provisions.

3.       Mental Health/Developmental Disabilities/Substance Abuse Services system reform – Efficiency and effectiveness of government are critical if this system is to succeed.  Recommendations from the Auditor’s report will be reviewed and may be acted upon by the General Assembly.  These issues need our attention so that the General Assembly acts now and doesn’t ignore these important recommendations.

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[1] While the needs of those in these three categories are often different, the state lumps them together in the Department of Mental Health, Developmental Disabilities, and Substance Abuse Services (MH/DD/SAS).  Because legislative efforts will be directed at MH/DD/SAS, we will consider the three together in this policy statement.