SOUTHPORT, NC (WECT) – Cara Oathout has difficulty getting around right now. She hobbles around using crutches, recovering from a broken ankle that makes walking along a pond in Hugh MacRae Park a challenge. But the 38-year-old is also fighting against something most people cannot see, which is the never ending struggle against her own mind.
"The thoughts just take over your mind, and sometimes you can hardly move," Cara says while sitting on a bench in the bright sunshine. "Things just kind of get mumbly and you have make-believe friends in your head. Sometimes they are friendly voices and sometimes they are scary voices."
Cara is a paranoid schizophrenic. She says she began hearing voices in her head about the time she was 15 years old.
But, a breakdown in 1999 led to the diagnosis.
"I've been homicidal before, and that's scary," Cara says. "I was in an institution in Wilmington for it, but I am now able to function with those kinds of thoughts and delusions and suicidal tendencies. I'm just starting to learn how to deal with it. You can't beat it, but you can cope with it."
Cara does remember being restrained once in a mental hospital, and she has had some struggles with drugs. The same medications intended to help her condition can also end up hurting her.
"The medications are poison, absolute poison, necessary poison but absolute poison to the brain," said Stan Oathout, Cara's father. "So, not surprisingly to psychiatrists and others, and to us, her situation has declined."
Cara became a danger to herself and others. Stan and his wife Kitty had to put their daughter in the care of experts. For the past two and a half years, Cara has lived in an adult care home, where Cara says she feels safe again.
"Sometimes I listen to music or I knit," said Cara. "I am still trying to fill my time, because as I improve I have a lot of time on my hands. But I know I'm in a good, safe place, and I want to stay there."
"Cara has been happy where she is now," said her mom. "To see that might not be where she gets to stay, is devastating. It's heartbreaking."
That is where the Oathouts have become champions for Cara's case.
The federal government threatened to sue North Carolina in 2011, over the way the state "warehoused" mental health patients. The settlement agreement brought some changes to the state's rules. That included changing the benchmarks for patients to qualify for Medicaid funding. To see the settlement, click here.
"North Carolina chose to go with more stringent criteria," said Stan. "That put our daughter and about three thousand others in jeopardy of losing the Medicaid subsidy, which amounts to about 40% of the rent that goes to the nursing home."
Cara received a letter in December, alerting her she would not qualify for the same amount of Personal Care Services after January 1, 2013. An independent assessment of Cara's condition said "your assessed needs do not meet the minimum PCS program requirement of unmet need for hands-on assistance", meaning she did not need as much help to perform daily tasks as she once did. In the expert's opinion, Cara had improved. But that means a cut in
Cara's funding, which helps pay about half of the costs for her to live where she is now. Cara and her parents are appealing that assessment, hoping to have it overturned and to have her Personal Care Services restored.
"Clearly, the people who write the rules don't understand mental illness," said Stan. "What they don't understand is that people who cannot manage their medications, our daughter included, as soon as you take away the med management, you lose all of those functions. They look at the person and say, 'Can they feed themselves? Yes.' It's true today. But if you mess up their med management, that's no longer true."
The goal of the state's new plan, which came out of the federal settlement, is to transition patients like Cara into more independent living. When asked if her long-term goal is to live on your own again, Cara is unsure.
"I get intimidated about living on my own, because when I cook my hands shake, so I don't think I'm ready yet," Cara says. "I wouldn't be against it, but I wouldn't be for it. I would be mixed up in the middle."
When Stan and Kitty are asked if it hurts to watch their daughter's struggle, they admit that it does. "We've had times when you think 'I can't do it another day'," Stan says. "Then you think, she's too precious."
As advocates for mental health reform in North Carolina, the Oathouts are also concerned about the thousands of patients who, like Cara, could lose their Personal Care Services, and the Medicaid funding they receive. "Many will fall into that crack, but our daughter will not," Stan vows. "We have the resources to strongly appeal this, and we have alternative housing. If push comes to shove, we will relocate to a state that does provide better opportunities."
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