Failure to secure safe, affordable housing supported by appropriate community services is the greatest barrier to recovery from serious mental illness. Dismantling this barrier will require multiple approaches to increase support of and access to a variety of housing options and provide funding for best practice community services, including appropriate support for implementing the US Supreme Court Olmstead decision.

Severe mental illness places an individual at high risk for homelessness. Approximately one-third of the nation’s homeless persons have a severe mental illness. It is estimated that over 11,000 individuals with mental illness in North Carolina are in need of housing. The primary reason for the lack of housing for people with mental illness is financial status. Many people disabled by mental illness receive Supplemental Security Income (SSI) as their income source. In 2002, an individual living on SSI income in North Carolina received $545 a month, placing them at a statewide average of 18.3% of median income. This places them in the category of "extremely low income" as defined by the federal government, those making less than 30% median income. Not a single housing market area in the United States exists where a person with mental illness receiving Supplemental Security Income (SSI) can afford to rent a modest efficiency apartment. The low-income status also makes it extremely difficult for developers to create housing opportunities for these individuals, even when they take advantage of various state and federal programs.

Changes need to occur at the federal level to expand housing opportunities, but there also are things that North Carolina can do:

The federal government allows states, within specified regulations, to offer state supplemental payment programs for aged, blind and disabled adults. In North Carolina, Special Assistance is funded through state and county dollars. Under federal guidelines, payments could be made to eligible individuals in a variety of living arrangements. In 1974, North Carolina elected to make Special Assistance payments only for care in licensed facilities such as group homes and adult care homes. In 1997, 44 states were providing supplemental payments to aged, blind, or disabled adults. Only six states limit payments to licensed facilities, North Carolina being one of these. As a result, 9,000 individuals with mental illness or developmental disabilities reside in adult care homes in North Carolina, a setting inappropriate for the needs of most.

North Carolina could allow individuals to use Special Assistance funds outside of group homes and adult care homes. The federal government allows special assistance to be used to cover such items as food, shelter, clothing, and utilities and other necessities when SSI benefits are insufficient to cover basic needs. "Uncoupling" Special Assistance payments from licensed facilities could provide individuals nearly $400 a month. When combined with the average SSI benefit of $545, many individuals could afford an apartment and take advantage of supported services provided through the mental health authorities.

There has been strong support in the General Assembly to uncouple Special Assistance payments. Due primarily to opposition from the adult care home industry, legislation to support this has not yet passed. But a pilot study was commissioned by the General Assembly to help determine the costs and outcome of such legislation. The recently completed report to the General Assembly on the pilot suggests this type of assistance can have a profound impact in supporting people to live in their own home.

NAMI North Carolina will work with allied organizations to develop legislation to allow individuals who qualify for Special Assistance to use these funds to maintain an independent residence.

In 2001 the General Assembly established the MH/DD/SA Trust fund with $50 million to provide "bridge" or start up funds for community services. A major portion of the funds were targeted toward the development of housing. Unfortunately, due to unprecedented deficits in the state budget, the Governor took all but about $10 million from the Trust Fund to help balance the state budget. Of the remaining amount, $3.5 million was designated to develop housing for individuals in the MH/DD/SA system by providing revolving loans and/or grants to housing developers to leverage other housing funds such as the NC Housing Trust Fund or Federal housing funding. Using these funds will help support the development of additional housing units, but as one time funding it will not support the sustained expansion of housing opportunities that will be needed to address this problem. Additional funds will be needed.

NAMI North Carolina will support the Coalition 2001 budget request to increase funding to the MH/DD/SA Trust Fund to support the development of housing options, provide bridge funding for start up costs for new community support services, and provide ongoing funding to expand community services.

The ability to maintain a residence is often dependent on the availability of appropriate support services in the community. This includes a broad continuum of services such as crisis response, Assertive Community Treatment Teams (ACTT), case management, medication management, supported employment, peer support, in-home services, etc. North Carolina has not provided adequate funding for the development of these services in our communities. In 2001, the estimated cost of unmet needs with MH/DD/SA services programs exceeded $736 million. Efforts to reform the MH/DD/SA system require the development of a comprehensive continuum of community-based services. To be successful, funding must be available to support the expansion of community services.

NAMI North Carolina will support the Coalition 2001 budget request to increase funding to the MH/DD/SA Trust Fund to support the development of housing options, and provide bridge funding for start up costs for new community support services. But there also is a need to provide ongoing state support for community based services. Current levels of state funding cannot be reduced any further and, in fact, support needs to grow substantially if services are to be offered to those who are waiting for help. NAMI North Carolina supports the Coalition 2001 request to increase state funds for community services.

The Olmstead case was filed on behalf of two women, L.C. and E.W. who were dually diagnosed with mental illness and mental retardation and institutionalized in a Georgia State Psychiatric Hospital. These individuals wanted to live in the community and the professionals providing their treatment had determined that their needs could be met in the community. The state of Georgia, however, did not have any suitable community placement so both women remained hospitalized.

In 1999 the Supreme Court found that unjustified isolation in an institution is discrimination based on disability and a violation of the Americans with Disabilities Act (ADA). States were urged to develop a comprehensive plan for placing qualified people in less restrictive settings and establishing a waiting list that moves at a reasonable pace to place people in appropriate community settings. States also were directed to identify individuals at-risk for being placed into an institution and develop community services to prevent hospitalization.

North Carolina responded positively to the ruling, developing a statewide plan for Olmstead implementation that included considerable input from families and consumers. North Carolina’s plan called for assessing all individuals residing in institutions and developing an individual service plan for each individual detailing the services and supports needed for the individual to live successfully in the community. These plans have been completed and nearly 600 individuals living in the state psychiatric institutions have indicated they desire to live in the community and their treating professionals have agreed they are capable of doing so with support services. Limited funding has been available through the MH/DD/SA Trust fund to develop some services in the community for these individuals. However, the current state budget crisis has reduced the availability of these funds. The concern is that with state budget pressures, individuals will be released from our state facilities without the necessary services identified in their service plan available to them. Further, some have raised concerns that individuals being discharged from the state facilities under Olmstead service plans may be given priority for scarce community services, making it more difficult for those who currently reside in the community to access services.

NAMI North Carolina supports the action taken by the state of North Carolina to assess individuals living in state facilities and developing service plans for these individuals. But we will monitor implementation of these plans to ensure that individuals are not discharged from institutions without services being available in the community at the time of discharge and that individuals currently in the community are not displaced from or lose access to services in order to accommodate the needs of individuals with Olmstead service plans. Services must be expanded to meet the needs of all.