By Ellen S. Holliman

Guest columnist

We are all painfully aware of the negative impact the economic climate in our state and our nation over the past year has had on every one of us. Our state legislators and county commissioners have had the untenable task of addressing unprecedented budget shortfalls, and few if any public agencies have come through their funding cuts unscathed.

Sadly, the effect of these cuts has been especially extreme for many of the citizens of Durham County who experience mental illness, developmental disabilities and substance use disorders. Across North Carolina, $55 million was eliminated from FY2010 state-funded support for community treatment and support services for people with no other means to pay for them -- those not eligible for Medicaid or Medicare and without other health care coverage -- who make up the largest proportion of those needing mental health and other services.

The Durham Center is the local agency that manages publicly funded services for these people. We have been faced with our share of these cuts in state funding in addition to the same kind of dramatic reductions in county government funding that other agencies and our public schools have absorbed.

I'd like to tell you today how these funding cuts have affected the treatment and services offered in our community and how The Durham Center has strived to make sound and compassionate decisions about the use of its scarce resources.

Anticipating the budget shortfalls, The Durham Center began months ago to proactively plan for reductions in our spending to offset anticipated funding cuts. We conducted a transparent and inclusive collaboration with our Area Board of Directors, Durham's Consumer and Family Advisory Committee (CFAC) and the service providers in our community. We sought their input and counsel on how to respond to our fiscal realities in ways that would help us maintain the highest quality care possible for the citizens we serve, while allowing the providers of this care to keep their businesses afloat.

In the end, The Durham Center made its funding decisions based on identified community needs and the priority of preserving "safety net" programs and services for individuals with the greatest need, most notably crisis services. Here is a summary of the programs that were significantly impacted:

- Child Mental Health Flex Funds were reduced. These funds are used to support children and families with the temporary help needed to keep families together.

- Funding for developmental disability programs such as Day Activity, Job Development and Training, and Early Intervention for Children was reduced, and funding for the Voucher Respite and Community Bridging programs was eliminated. These services assist individuals with developmental disabilities to live as independently as possible.

- The number of substance abuse transitional living beds in halfway houses was reduced. These homes provide temporary housing for individuals with substance abuse disorders who are seeking treatment.

- Funding for Assertive Community Treatment Team and Community Support Team services was reduced. These community-based services are designed to treat individuals with severe mental illnesses.

Downsizing of some valuable programs and services and elimination of others was inevitable across all of the disability areas that we work with. All providers saw the amount they are paid for providing services decrease. However, the choice was made to continue to provide a clinically sound level of service to as many consumers as possible, rather than to try and provide an ineffectual level of service to a greater number.

As a result, many programs now carry wait lists and more than 300 people in Durham County find themselves forced to wait for services. We know that the availability of fewer services in the community will result in increased burdens on our hospitals and emergency departments, our jails, local homeless shelters and our crisis facility -- places that often are not the most appropriate or cost-efficient destinations for people in need.

We deeply regret that the funding decisions we have been forced to make will further compound the already heavy burden carried by some, and we look forward to the time when an improved economy will allow programs and services to be restored. In the meantime, The Durham Center promises to continue to use innovative thinking and emphathetic hearts to ensure that the people we serve receive the best, most effective care that our extremely limited resources can provide.

Ellen S. Holliman is area director of The Durham Center.