NC Budget and Tax Center

North Carolina has failed to make progress on mental health issues for 10 years

[Note: As was explained earlier this month in a post entitled “North Carolina needs help to meet strategic health objectives by 2020,” North Carolina is at real risk of failing to meet a series of objectives identified in 2010 as part of the “Healthy NC 2020” initiative. This post is part of a summer series that is providing in-depth coverage of some of the focus areas in which we are falling short.]

In 2010, the state of North Carolina identified 13 major health focus areas and established 41 decennial health objectives and targets to meet by the year 2020. As part of the state’s ‘Healthy NC 2020’ improvement plan, the state identified a mental health focus area and developed three measurable objectives for it, recognizing that this area is an essential part of individual health throughout one’s lifespan.

Unfortunately, analysis of new data shows that North Carolina has not made any progress on its three mental health objectives since 2008. Today, the state’s suicide rate is higher, the number of poor mental health days among adults has gone up, and the rate of mental health-related visits to the emergency room has increased.

In other words, the state of mental health in North Carolina has only gotten worse since 2008.

Moreover, despite our state’s opioid crisis and increased prevalence of mental health conditions, analysis also shows that state funding has fallen by 18 percent since 2013 for the state’s Division of Mental Health, Developmental Disabilities, and Substance Abuse.

Worsening mental health conditions is a problem that affects all North Carolinians as it significantly affects people in many ways, including their sense of wellbeing, interpersonal relationships, and productivity in the workplace and in school. Furthermore, mental health conditions are also associated with increased health care costs and service utilization. Given the fact that our state has failed to make progress on mental health issues for 10 years, policymakers and health stakeholders must do more now to break down the barriers that people face in accessing mental health care and needed services.

A good place to start is by effectively addressing the mental health gaps that we have known about for almost a decade, as our ‘Healthy NC 2020’ plan states:

“Identified gaps in necessary services in the state include a lack of public awareness regarding service availability, a need for increased services in rural areas, lack of culturally competent services, and a dearth of mental health service providers.”

 Luis A. Toledo is a Public Policy Analyst for the Budget & Tax Center, a project of the North Carolina Justice Center.


  1. Ralph

    July 22, 2018 at 6:48 am

    I don’t know of any major outpatient mental health provider except for Monarch. The last major for profit was CNC Access under ResCare Homecare but ResCare handed everything over to Monarch in 2013. The loss was unbelievavble and many good people were laid off and a lot of clients in rural areas were cut off from access. One client in the Outer Banks managed to get a hold of the CEO and chew him out. The rate cuts are too staggering for anybody to enter this field plus you are dealing with providers having to go to the clients in the field which can be very dangerous. Only nonprofits can survive in the market but they are bleeding money. The MCO is nothing more than a middle man that either mismanages our state tax dollars (Western Highlands, Cardinal, Eastpointe, and Smokey I am looking at you) or acts as the provider already instead of referring patients over that are contracted with State Medicaid. Before the LME/MCO transition however it was so easy for providers to sneak false claims by the state. All you needed was a doctor or therapist’s provider number and a patient’s Medicaid number andyou could bill any MH CPT code with no one on the other end checking to see if it was a legit service that actually took place. I found this out when I accidentally billed a few claims and reversed them out. The only way to fix NC Mental Health services is to 1. Eliminate all chances of accidental and corrupt billing practices. 2. Everything is still fee for service. Pay per patient not per service. 3. Eliminate waste by turning MCOs in referral and quality assurance only. 4. Require all doctors and therapists to serve Medicaid clients with ability for them to retroactively seek reimbursement for their patient. All providers from family physicians to hospital nurses should be required to be ready to handle mental health. Just my views from my experience in this failed field.

  2. Emily Christensen

    July 22, 2018 at 10:03 pm

    This does NOT come as a SHOCK By any means! It’s just another way the state falls short and let’s so many down!

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