Fixing North Carolina’s mental health care system is a complex problem intertwined with broad financial challenges, substance abuse issues, and lack of access to care. Over the course of a two-hour discussion among elected leaders, caregivers and medical providers on Monday, what was most clear is there are no easy answers.
State Sen. Tom McInnis, R-Richmond, was joined by his colleague, State Sen. Tommy Tucker, R-Union, at the monthly meeting of the Moore County chapter of the National Alliance on Mental Illness, held at the Pinehurst Village Hall. The local NAMI affiliate supports residents of Moore, Richmond, and Scotland counties.
“I cannot express enough my disappointment in the upheavals that have taken place with (mental health care) reform. But it has come full circle and we are seeing change,” Tucker said, who serves on the state’s legislative oversight health care committee.
According to health officials, a half-million adults and a quarter-million children in North Carolina have a serious mental health need, plus an estimated 227,000 who have a substance use problem. Some are on Medicaid; however, many people with behavioral health needs lack insurance and receive services through state-only dollars directed to local managed care organizations, known as LME-MCOs.
Importantly, in the next few years, the state’s Medicaid program is shifting from a fee-for-service plan to being run by managed care companies.
“I’d like to tell you there is a lot of wisdom coming out of Raleigh, but these issues are so complex,” Tucker said, noting he does not anticipate any radical changes in the next three or four years. “We have stopped the state from bleeding (funds), and there was a lot of waste in the system. This is all the upheaval that has gone on.”
But he cautioned that many of the programs in place, he believes, will require churches and organizations in the future to “step up and do what government can’t do: to love and acknowledge and care for these people.”
One particularly troublesome issue is the lack of hospital beds available for mental health patients.
“We can sit in Raleigh to create funds, but if nobody is there to implement the plan, it is a moot point,” McInnis said. “We have a shortage of beds for treatment, and that is something we have to have a conversation about. If we get money, we have to be able to deliver at the end of the day.”
Here in Moore County, there are two residential group homes, and no child or adolescent inpatient hospital services. This means adults who need a structured setting frequently must look elsewhere for help, and a child experiencing a mental health concern must stay in the emergency room at FirstHealth Moore Regional Hospital until a bed is available in another county where services can be provided.
“We have got to start working as a cohesive team with all shareholders and stakeholders sitting at the same table and answer the question, what do we need to do to get the problem fixed?” McInnis said.
He also spoke about the opioid crisis and drug addiction, which are often inextricably linked to unmet mental health care needs.
“Up to four deaths a day are related to overdoses, and one in 100 babies born in North Carolina are addicted to opioids. These children will have prolonged hospital stays and lifelong challenges. Folks, we can’t afford this! It has to be stopped,” McInnis said. “We can’t jail our way out of the opioid crisis because we don’t have enough space in the prison system. We have to get to them before they get there.”
McInnis recommended more opioid prevention education is needed for middle school and high school-aged students, and he also urged everyone to go home and clean out their own medicine cabinets of any leftover prescriptions that could be diverted to illicit use.
In North Carolina, 740 school psychologists serve the public school population of about 1.6 million children, providing a ratio of 1 psychologist for every 2,162 students. According to the North Carolina School Psychology Association, this shortage impacts the state’s capacity for schools to address mental health needs and impacts communities.
“At this ratio, it is just like not having one,” McInnis said.
In attendance at the meeting, local pediatricians Dr. Christoph Diasio and Dr. David Bruton said Sandhills Pediatrics has expanded its services to provide mental health care for local children.
“It is literally the best thing we have ever done,” Diasio said, noting the practice has one pediatric psychiatrist on staff and is in the process of hiring another. “It is the most valuable thing we’ve done, and we do it in spite of the economics.”
He commended McInnis for his work to draft and pass the STOP Act, which limits the number of opioid pills that can be prescribed, and said it was important to consider all of the issues surrounding health care reform.
“We talk about frustrations with funding and why we can’t do this or that. Then we talk about tax cuts,” Diasio said. “I just don’t see these things aligning.”
NAMI-Moore board member George Reynolds also spoke about budget cuts, warning that at some point the money will run out on this trajectory.
“The state is paying a lot of money to expand and pave roads because we think a lot more people are going to come to our communities. With more people come more mental health needs,” Reynolds said. “If we are not willing to do more, what do you think the future will bring all these people coming in? You have to consider the unintended consequences of not funding or under-funding mental health care.
“Early intervention is the key and the focus needs to be on youth. That is where you need to focus a lot of attention, and we are not getting that,” he added.
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Article originally posted on Apr 3, 2018, at thepilot.com