State struggles to find homes for mental health patients

North Carolina Department of Health and Human Services Secretary Lanier Cansler says there’s not enough individual housing to place all the people now living in adult care homes.

And if it can find enough, putting those with mental illness in an individual or small-group housing will end up costing the state a lot more in Medicaid.

Cansler was in Catawba County on Wednesday for several appointments, including speaking at a school. Cansler grew up in Catawba County and went to school at Lenoir-Rhyne College. His daughter teaches school in the county, he said, and his parents still live in the county.

Mental health is one of the biggest issues Cansler and his department are dealing with at the moment.

Wait times for those with mental health issues for admittance to a hospital and where they will live once they’re released, as well as in-home assistance is what Cansler termed a perfect storm now facing the state’s mental health system.

Some adult care homes in the state could be forced to kick out patients with a mental illness diagnosis out or risk losing Medicaid payments for all its clients. The US Department of Justice has told the state it is not complying with the Americans with Disabilities Act because it services the mentally ill in large, adult group homes, segregating residents from the community and away from those without disabilities. It says there are adult care homes in the state that are acting as an Institution of Mental Disease. Any facility with 16 beds or more that has 50 percent or more of its residents with a diagnosis of a mental illness and provides diagnosis, treatment or care, including medical attention, nursing care and related services, is considered an Institution of Mental Disease, according to federal guidelines.

If someone has been placed in an adult care home because of a medical issue but also has an accompanying mental health issue, that person is not considered a mental health patient, Cansler said.

The state is now charged with determining whether there are such places and which ones are an IMD. There are 52 adult care homes on the state’s latest list for determination, with about seven within the Greater Hickory Metro area.

On Wednesday, Cansler said once the state makes that determination, the federal government could challenge it.

Putting people with a diagnosis of a mental illness in an adult care home was never a policy of the state. When someone was ready to leave a mental hospital or ward, those discharging the patient would call around to find them a place to go and adult care homes usually were the ones who were willing, Cansler said.

The question is what to do with those who could potentially be kicked out of an adult care home. Those working in the social services and adult care industry fear those with mental illness diagnosis turned out from an adult care home will end up on the streets or in the jails.

“That’s a great concern for me because I don’t want to put anyone on the street,” Cansler said.

The federal government wants them to be placed in small, scattered housing such as a single-family home or apartment. The trouble is, there isn’t enough of that type of housing in the state to meet the demand, Cansler said. And to do that would end up costing the state a lot more money, which the Justice Department disputes, he said.

Cansler said the state is in the process of doing an inventory of available housing. The lack of the needed housing is worse not in the larger cities but in smaller cities and towns, he said.

As for cutting wait times for help, Cansler said he has worked with legislators for the state to contract with hospitals in communities to open up beds for those going through a mental health crisis. Once a patient has been released, the treating physician can follow up with them, as well as Local Management Entities, he said. Mental Health Partners is the LME for Catawba and Burke counties. The LME plans to merge with two others to serve eight counties.

Contracting for beds at community hospitals for those going through a mental health crisis would free up beds at state mental hospitals to be used for more difficult, long-term or chronic cases, Cansler said.