The State Auditor's Report is out!

Before going to the full report you might want to first read the press release "DHHS SECRETARY DR. DAVID BRUTON'S STATEMENT ON MENTAL HEALTH STUDY"

You can click here to go right to the report.  It is a very large document (over 400 pages) in Adobe Acrobat format.  The Summary Report, Section I,  is contained in the first 35 pages.

Adobe tip:  If you don't already have it, you will need to download the free Adobe Acrobat Reader software.  The Adobe Acrobat Reader will allow you to browse any page in the report on demand.  However, you may find it more convenient to save the entire report to your hard drive.  Once stored on your hard drive, you can quickly move around the document.  The report is about 3.5 megs and will take about 15 minutes to save at 28.8 K modem speed.

The Executive Summary (page 2 from the report) is reproduced below.

This report calls for the major changes outlined below. Many more recommendations are found in the report summary that follows. The details are in the full report.

1. A transformation of the governance structure is recommended, so that the responsibility of local management is shifted to counties and to groups of counties, acting under long-term contracts with the State to manage services. Local County Programs will coordinate all mental health, developmental disabilities and substance abuse services in community networks.

2. Benefit packages for community assessment and acute care services are recommended for all mental health and substance abuse clients entering the State system.

3. Specialized services are recommended for target populations which have been served in the State Hospitals inappropriately, for lack of appropriate services. These include individuals with serious and persistent mental illness; those with dual diagnoses of substance abuse and mental illness; clients who are geriatric; children; and adolescents.

4. The new County Programs are encouraged to increase local services to target populations through a matching process which will provide additional State funds for service expansion.

5. A new Developmental Disabilities Division is proposed. It should attract strong leadership, focus management resources on providing innovative and less costly community services, and restore confidence in the public developmental disabilities system.

6. It is recommended that the State hospital system be reduced by 667 beds over the next five years, with the savings going directly to community services. This involves the closure of Dorothea Dix Hospital and the substantial renovation and rebuilding of Broughton, Umstead and Cherry Hospitals.

7. The study projects that reduced reliance on State hospitals will save the State $51 million in operating costs. The savings can be leveraged to over $95 million in total resources from all funding sources.

8. Most of the resources necessary for the system's transformation should be achieved through State hospital savings and through the reconfiguration of current services, financial operations and administrative costs through the new County Programs. At first, however, "bridge" funding will be needed to strengthen the community as the primary locus of care. Additional funding for target populations may be necessary once the system is better aligned in the new County Program structure.

9. The Department of Health and Human Services, the State agency legally responsible for managing the State's Medicaid program, must restructure and unify Medicaid policy and operations across the three agencies responsible for services to persons affected by this report: the Division of Medical Assistance (DMA), the new Division of Developmental Disabilities (DDD), and the new Division of Mental Health and Substance Abuse Services (DMHSAS).

10. The State should establish a Blue Ribbon Implementation Commission to oversee and provide guidance for these changes over the next five years.

We sincerely hope that this report and its recommendations will stimulate a productive and lasting public discussion that will lead to the transformation of North Carolina's system of services for persons with mental disabilities.

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