The state’s hospitals, businesses, advocacy groups and professional associations sent up an SOS on mental health this week, asking in an open letter for Gov. Roy Cooper and legislative leaders to create a bipartisan plan for improving North Carolina’s mental health system.
The state’s mental health system has been troubled for years, but the letter to Cooper, House Speaker Tim Moore, and Senate leader Phil Berger says it is getting worse.
The NC Healthcare Association, which represents hospitals, the NC Chamber, the associations for doctors, psychologists, psychiatrists, nurses, social workers, Disability Rights NC, Blue Cross Blue Shield of North Carolina, and NAMI NC said in their letter that North Carolina is facing “a second public health crisis: skyrocketing demand for mental health services in an environment where it can’t meet the escalating needs for treatment. Quite simply, the behavioral health crisis across North Carolina has reached a state of emergency, and we urgently need your leadership and collaboration to address it.”
Mental health treatment in the state is inadequate, community mental health services have not met the established needs, and people end up languishing in hospital emergency rooms waiting for psychiatric hospital beds.
Twenty years ago, the legislature passed a law that started the transition from area mental health offices to managed care for mental health services, where local government agencies stopped providing services and instead hired outside agencies with federal, state, and local money. The change stumbled out of the gate. Early on the Legislative Program Evaluation Division in 2009 cited “rampant cost overruns” with hundreds of millions spent on a low-level service called Community Support before state made changes to control the runaway expenditure.
Availability of more intensive community mental health treatment is considered to have fallen short. The arrangement of regional mental health offices, called Local Management Entities/Managed Care Organizations, has been in flux, with multiple mergers and counties switching alliances.
Recently, counties have been fleeing Cardinal Innovations Healthcare, one of the largest LMEs. Cardinal Innovations coordinated care for Mecklenburg and surrounding counties, but counties have been severing ties with Cardinal. Cardinal announced a few weeks ago that it was seeking to merge with the LME Vaya Health, WSOC-TV reported.
The letter references the 2021 Mental Health America report that ranked the state 35th in adult mental health, 45th in youth mental health, and 44th in access to care.
Here’s an excerpt from the letter:
For decades, the criminal justice system and hospital emergency departments have been the default safety net to respond to children and adults struggling to cope with issues like anxiety, depression and suicidal ideation. Despite the state’s recent population growth, North Carolina hospital data underscores continued erosion of community services. As of December 2020, nearly 40% of all ED discharges for children were for behavioral health concerns. Reports also indicate a 91% increase in involuntary commitments in the last decade. This “second pandemic” is also a health equity crisis, with a disproportionate number of uninsured, Medicaid, and people of color relying on emergency rooms for their long-term behavioral health care while also facing barriers preventing them from using telehealth options.
This trend cannot continue. Across the state, healthcare providers, school systems, law enforcement, county governments and other sectors agree that North Carolina’s current approach to providing behavioral health care services is unsustainable. Moreover, building more acute care beds isn’t going to solve the crisis. Given the once-in-a-lifetime federal resources to address health inequities exacerbated by COVID-19, we have an extraordinary opportunity to build the comprehensive treatment system our citizens deserve.
The mental health caucus, a group of legislators from the House and Senate concerned about the issue, met for the first time Tuesday morning.
Sen. Jim Burgin, a Harnett County Republican, said he brought up the letter during the meeting.
If the state were to design a mental health system from scratch, it wouldn’t look like it does now, he said in an interview.
Burgin said he suggested that Berger, Moore, and Cooper get together to decide how to approach the issue, whether it’s through a committee, task force, or some other organization.
“Everybody here agrees we have a huge problem in mental health,” he said. “The question is how do we best deal with it.”
Burgin said early intervention is key. “I think more school nurses, more school psychologist, more people that actually talk about mental health. Everybody in their life will have some issue where they could need some mental health services – the death of a child, or parent or a loved one – a traumatic experience that happens.”
Social isolation from the pandemic has also impaired mental health for many people. “God made us to be people that fellowship with each other, have relationships,” Burgin said. “There are a lot of people that have mental health issues right now because of the pandemic.”
Rep. Kristin Baker, a Republican from Cabarrus County and a psychiatrist, said “wrap-around services” or individual plans that cover a variety of needs, need to be sustained.
“The money needs to follow the patient and I think we are not doing that well now,” she said.