The mental health and substance use crisis in America continues to rise.
Approximately 41% of Americans report symptoms of depression and anxiety. This number has increased by nearly four-fold since 2019. Drug overdoses are also on the rise with 106,000 individuals in the U.S. dying from a drug-involved overdose death in 2021. Unfortunately, these numbers have been increasing significantly for far too long, causing a lot of preventable, premature deaths. These conditions can also have large economic and social impacts on those affected, causing an increase in societal costs, incarceration, and loss of earnings. Last year, the U.S. acknowledged the national mental health crisis, with President Biden emphasizing it as his primary concern in his 2022 Presidential Address, followed by the opioid epidemic. Still, there is a substantial amount of work that needs to be done at the macro- and mesosystem levels to make healthcare more accessible for all.
Recently, Governor Roy Copper of North Carolina released a comprehensive plan to address the state’s mental health and substance use crisis. The state will invest $1 billion into behavioral health and resilience investments so that North Carolinians are able to get the essential mental health care and support services they need. The plan outlines three primary focus areas of behavioral health care, including making behavioral health services more available in communities, building stronger systems to support people in crisis, and enabling better health access and outcomes with data and technology. Each of these elements will help to expand community-based care for children and adults. This program will be an integral part of enhancing the accessibility and affordability of care in N.C.
Why This is a Really Good Thing
A makeover of our behavioral health services in North Carolina has been long overdue. In some instances, such as Medicaid reimbursement rates, there have not been any updates since 2013. As a North Carolinian myself, I have seen firsthand some of the shortcomings within our behavioral health system through the experiences of my friends and family members trying to access these services themselves. Oftentimes, individuals are positioned on a long waitlist, wedged in an insufficient referral process, forced to relocate out of state to receive treatment, or simply cannot afford these services. If it is not one door closed, it’s another. What makes this process even more challenging is that in many cases, individuals seeking these services are already under significant stress or discomfort, which can make it even more difficult to stay motivated in seeking out behavioral health services. Currently, not enough resources are available in local communities to help support these individuals navigating this system. Unfortunately, this can often cause people to forego treatment which can lead to poorer physical and mental health outcomes as well as increased unmet needs.
According to Mental Health America, more than half of individuals with mental illness do not receive treatment. Without treatment, individuals are at a higher risk of experiencing homelessness, incarceration, emergency visits, comorbid health conditions, and suicide. This new plan will help to address these disparities and provide more accessible resources by expanding access to behavioral health support in schools, and community behavioral health clinics. Not only will this plan provide resources to a broader range of individuals, but it will give providers the ability to deliver better, more specialized behavioral health care. One of my favorite components of this section is the extension of mental health education to the public. This element is valuable because normalizing conversations about mental health and substance use will help to decrease the stigma and discrimination that can encompass these challenges, and help more individuals seek care. Although some nonprofit and community-based organizations are already working towards this in communities, such as Community Impact NC (CINC), who partners with their community to bridge gaps through direct support, and evidence-based practices to help minimize and prevent harm caused by substance misuse, are one of many who strive to help more individuals seek care. CINC and other organizations’ efforts will be even more impactful with the state’s support behind their initiatives.
The plan will also encourage the improvement of behavioral health crisis infrastructure such as the 988 hotline, mobile crisis teams, and facility-based crisis centers. This will allow for more efficient response times to individuals with urgent needs, and will hopefully improve emergency response and diversion from incarceration.
Another benefit of the plan is to enable better health access and outcomes with data and technology. According to a report from the American Medical Association, approximately 60 percent of U.S. counties do not have a single psychiatrist. This component will help expand telehealth services to rural communities, enhance the online centralized bed registry, and assist under-resourced behavioral health providers use electronic health records. These initiatives will help increase the accessibility of care and provide greater reach to individuals who may not have as many resources available in their communities.
Recommendations for Further Expansion
Although I am very impressed by this new behavioral health plan thus far, I do think it falls short in some areas, especially related to providing comprehensive care to all.
For instance, one of the key points is expanding re-entry programs to support individuals reentering society after leaving prison. As mentioned by NC Health News, in March of 2021, the Bureau of Justice Statistics released a report that approximately 38 percent of state and federal prisoners across the country reported at least one disability in 2016, with cognitive disabilities being the most common. The report highlights that the prevalence of disabilities in prisons is about two and a half times higher than the 15 percent of individuals with disabilities in the general population of the United States. Though I find re-entry programs to be a beneficial addition to communities, an improvement could be made to ensure all persons have more support. This recommendation comes from expanding re-entry programs to include individuals in in-patient or residential treatment programs. Oftentimes, these persons face similar barriers when reintegrating into a community, such as difficulties finding employment, housing, and social support. It would be beneficial to expand the re-entry programs so all individuals have wholly provided support throughout the transitional period.
Another recommendation would be to provide greater reach of prevention and harm reduction services. The plan mentions increasing early intervention and prevention services, with a prioritization of implementing these programs in schools. Though beneficial, it is also important for the state to consider students who are homeschooled or located in more rural communities as they may not have access to as many resources. Expanding telehealth into rural communities is a start, but partnerships with organizations that could aid in outreach programs and educate in harm reduction would enable all communities to be given the opportunity to live healthier and more fulfilling lives. As the initiative states, drug overdose deaths have skyrocketed 72% in two years. Increasing access to harm reduction services such as increasing availability of naloxone and needle exchanges can greatly help reduce the impacts of the substance use crisis.
Another population that appears to be overlooked in the plan is older adults, who have unique health needs and may not have as great of access to social support. The importance of providing prevention and holistic services for these individuals is paramount, as they are part of the statistic from 2019-2021, 41% of Americans reported they suffer from depression and anxiety. In an effort to expand telehealth services to rural communities, a recommendation here would be to not only expand to those affected by location but also affected by their support system.
Overall, I think this new behavioral health plan is a step in the right direction for N.C., and I am looking forward to seeing how this new initiative will be able to help support more community members and their families.
Read the Whitepaper on N.C.’s Plan to Invest in Behavioral Health and Resilience
