August 15, 2005                                                                                          ITEM # 12



Item Title:      Dorothea Dix Hospital Downsizing Funds to Expand Community-Based



Specific Action Requested:       

That the Board of Commissioners accepts $396,800 in recurring funds from the State of North Carolina to serve adults with both substance abuse and mental health disorders and that the Board approves the appropriate budget revision.


Item Summary:  

Because Dorothea Dix Hospital is being downsized in phases and eventually will be closed, the North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services have provided funds for developing community-based alternatives to inpatient psychiatric hospitalization. 


For each phase of the downsizing, the State has made available funding to serve the specific populations affected. In the first three phases, Wake County received a total of $1.41 million in recurring revenue. With this money Human Services established community-based services that have successfully transitioned adults from institutional care to community settings.


This is the fourth phase of the downsizing, and the State has set aside funds for developing community alternatives to the use of the 18 adult acute admissions beds that are being closed.  Adults with both substance abuse and mental health disorders (“dual diagnoses”) account for many Dix admissions; also, these consumers tend to have multiple admissions, with subsequent failure to engage in community-based treatment. To provide ongoing services to dually-diagnosed adults, the State has allocated Wake County $396,800 in annually recurring funds for the County’s proposed “Integrated Dual Disorders Treatment” (IDDT) program. 


The IDDT model is a federally-sanctioned, evidence-based practice for this population. Multiple research studies have found that it effectively reduces inpatient psychiatric hospitalization. Because Mental Health Reform encourages the County to be an “assuror of care” rather than a direct provider, Human Services would provide the IDDT program through a contractual vendor selected through a competitive Request for Proposals process. The Local Management Entity (LME) would oversee and monitor clinical outcomes and contractual performance. 



1.      Wake County Human Services Funding Summary

2.      State Hospital Downsizing Schedule

3.      Budget memo