Mental Health Association in North Carolina

Statement on gaps in services and supports for people with mental illness for Division of MHDDSAS Gaps Analysis

December 2009

There are numerous needs and gaps in our service system, so these priorities MHANC has listed should not be taken as the only gaps that exist, simply that these items are our highest priorities at this given time.

• 1) Services and outreach for people who are deaf and hearing impaired who have a mental illness. Advocates through The Coalition have been asking for additional funds for services and outreach for this population for many years. The requests have been small and yet have been ignored. We propose at least 7 million additional dollars over the next two-three years for outreach to this population, funds for direct services (including funds for interpreters and or technology to bridge the language gap). Additional funds may also be needed for specialty housing for people with mental illness who are deaf

• 2) Residential: This is divided into two areas 1) funds to develop additional low income housing for people with mental illness both independent living and group homes, with a prioritization on moving people out of adult care homes and family care homes. 2) supportive services for those residents, including additional support for room and board, residential managers, and transportation of people residing in these low income units. We support 10 million per year for "Housing 400" type projects, but we must also look at allocating an additional 2-4 million per year for services that help keep them in housing and/or to move them from adult care homes.

• 3) Basic levels of service that come to the individual rather than being office based: Many people can live successfully in communities with a basic level of support that is a step up from outpatient treatment and a step down from ACTT or CST. We need to assure that we have a well thought out service that is monitored, incorporates evidence based practices, and achieves good outcomes. MHANC believes that is unrealistic to think that outpatient providers will suddenly deliver home based services, or that individuals with mental illness will suddenly find the resources to go to outpatient clinics when past experience shows a high no show rate. Or that peer support and case management alone will be sufficient for them (once enough peer support workers are trained). Its not clear what the dollar figure would be for this, but at a minimum there are 10-15,000 people who are being removed from Community Support who still need a similar type of service.

• 4) Transportation: We need to find better ways to ensure that people with mental illness have access to transportation so they can get to appointments, pick up medication, go to work, to school and participate in their communities. Low income individuals with mental illness need to be part of the larger discussion about a 21^st century transportation system for North Carolina communities. There are many options that have been used in communities to serve the elderly and other low income persons. We need small grants to establish and maintain transportations programs. 10 million to 1) explore options 2) start new pilot programs 3) pay existing programs that offer transportation to expand their reach. 10 million per year to start.

• 5) Medication Access: Not everyone has Medicaid or insurance; in fact about 60% of those we are serving with mental illness do not. Despite the good work that North Carolina does to help people get free medications through pharmaceutical companies, many people stop using medications, use less than therapeutically recommended, or use them intermittently because they cannot afford to buy them. We need to ensure that people with mental illness have access to a variety of medications while they wait for free programs, to qualify for Medicaid, or when they simply have no health coverage. The program should be carefully managed and include something similar to CheckMeds NC. 2.5 million per year to start.