Advocacy

"In the United States, mental disorders collectively account for more than 15 percent of the overall burden of disease from all causes and slightly more than the burden associated with all forms of cancer." Mental Health: A Report of the Surgeon General (1999), citing the Global Burden of Disease Study conducted by the World Health Organization, the World Bank, and Harvard University.

The "mental health story" has yet to be understood by enough members of North Carolina’s General Assembly, executive branch policy-makers, and local officials. That story includes more than the obvious costs in human suffering and in the injustice of discrimination by insurance companies and "managed care" firms:

• When both direct costs for treatment and indirect costs in lost years of productivity are measured, mental illnesses cost society more than all cancers combined and almost as much as all cardiovascular diseases (heart attacks and strokes) combined.*
• At the same time, treatment success rates for mental illnesses are actually higher than those for cardiovascular diseases and cancers.
• Too often, however, mental illnesses go untreated, because of the stigma, the discrimination by private insurance plans, and the lack of appropriate and accessible services. As many as two-thirds of the persons with mental illnesses get no treatment at all. And many of those in treatment have waited until their illness is in advanced stages before seeking help.
• The result is that we all pay too much for mental illness.

NAMI North Carolina has a comprehensive advocacy program designed to tell the story and influence public policy. We employ a Director of Government Relations (former NAMI executive director Beth Melcher, Ph.D.), who has a leadership role in a coalition of 50 advocacy, service and professional organizations which work together to increase state support of the public mental health system. Dr. Melcher presents our case to individual legislators, committees and special task forces in the General Assembly. She has developed an expanding network of volunteer advocates across North Carolina, connected by an email newsletter, Heard in the Halls, which will enable network members to respond to fast-breaking legislative developments in a timely manner. In just one year the network has grown to over 300 email addressees – some of whom forward Heard in the Halls to others. Dr. Melcher has developed an Advocacy Workshop for local affiliates, to help them understand the legislative process and work to establish relationships with their legislators and other local officials.

Implementation of the U.S. Supreme Court Olmstead decision in North Carolina provides a powerful tool for the development of community-based services. NAMI North Carolina provided a leadership role in the development of the state’s Olmstead plan, including the process for assessing the needs of individuals in institutions. The plan includes training family/consumers to conduct a preference survey and be part of the team developing an individualized treatment plan. National organizations reviewing North Carolina’s Olmstead plan have given high praise. The challenge ahead is to ensure that this plan receives the needed support to allow for full implementation.

The public mental health system in North Carolina is at a crossroads, as the General Assembly and state government take on the task of reforming how mental health services are provided in the state. NAMI North Carolina has provided a leadership role in the reform process. Reform legislation was developed, then redeveloped, with a great deal of input from NAMI North Carolina. A major component of the reform legislation is the requirement for development of a state plan by the end of calendar year 2001. Work is well under way. NAMI North Carolina members are well represented on the Advisory Task Force and are actively engaged in the development of this reform plan.

Much remains to be done. Implementation of the reform plan will present critical issues. Too many legislators are willing to solve the State’s budget crisis by cutting vital services to persons with mental illness. The need for advocacy is critical.

You can help! A start-up grant (from the Z. Smith Reynolds Foundation) partially funded our Advocacy program for 2000-01. Now we – the supporters of NAMI North Carolina who see the need – must provide the funding.

^* The Global Burden of Disease study conducted by the World Health Organization, World Bank, and Harvard University in the early 1990s measured both the direct costs of treatment (out-of-pocket payments for doctors and other medical personnel, hospitals, clinics, labs, etc.) and the indirect costs incurred when an illness or injury results in disability or premature death – components of the "burden" of disease. The study thus attempted to measure the common-sense truth that a community pays more of a price – bears more of a burden – when a productive worker dies or is disabled prematurely than we do when death does not occur until after retirement. Murray, C. J. L., & Lopez, A. D. (Eds.), The Global Burden of Disease. A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. Cambridge, MA: Harvard School of Public Health, 1996.