In an open letter to Gov. Roy Cooper and Republican legislative leaders, 11 health-care groups and the N.C. Chamber warn that the state is nearing a mental-health services crisis in the wake of the COVID-19 pandemic and ask for help to combat it.
The letter was submitted to Senate leader Phil Berger, R-Rockingham, and House speaker Tim Moore, R-Cleveland.
Cooper responded on June 24, saying he agrees "that this is a crisis our state must address with the most important step being to expand Medicaid now."
Cooper challenged the letter sponsors to "redouble their efforts" to get Medicaid expansion passed, while the N.C. Chamber "needs to take a strong position in favor."
"My administration is committed to doing everything we can with limited resources to prioritize mental health in healthcare delivery. We will continue our commitment to creating an innovative, coordinated and whole-person centered healthcare system."
Cooper also cited that the Republican-controlled Senate state budget proposal contains funding to take about 1,000 individuals off the state's Registry of Unmet Needs, while there are 15,000 on the list waiting for expanded services..
"The historic unmet need in North Carolina's behavioral health system has only been compounded by the pandemic," Cooper said.
"Unfortunately, we expect these numbers to continue to worsen as we witness the pandemic's full impact."
Berger's office said that the senator "has received the letter, but has not sent a formal response to it or scheduled a meeting."
"Sen. Berger is open to meeting with the organizations to discuss the letter and their concerns."
Representatives for Moore could not be reached for comment about the letter.
The groups said they are experiencing “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.”
The groups requested that the three leaders support bipartisan efforts to address the crisis.
“We are calling on you to bring bipartisan leadership and dedicate the needed resources to move from Band-Aid approaches to true system reform,” the groups said.
“We request a meeting of state leaders and our organizations to immediately address this crisis.”
Basis for concerns
The groups cited as an example a 2021 State of Mental Health in America Report by Mental Health America that has ranked North Carolina 44th among states for access to mental health care.
The same report ranked North Carolina 45th in the country for youth mental health.
“The past piecemeal approach to building a behavioral health system is now grossly failing patients at a time when we are in a full-blown state of emergency with climbing suicide rates, emergency rooms filled with children in crisis, and diminishing behavioral health services close to home,” according to 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.”
The groups cited as an example that as of December, nearly 40% of all emergency department discharges for children were for behavioral health concerns. Reports also indicate a 91% increase in involuntary commitments in the last decade.
Another issue raised by the groups is what they are calling a health equity crisis.
The groups say there is 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.”
“Moreover, building more acute care beds isn’t going to solve the crisis.”
The groups expressed hope that their letter has been received with a sense of urgency “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 people who all of us serve deserve better,” the group said.
“We need the state as a convener and committed partner to help create and support the vision, policies and infrastructure for a truly comprehensive and integrated mental health system.”
No legislative action
The groups are facing an uphill climb in terms of stirring legislative action on behavioral health during the 2021 session.
A trio of bipartisan state House bills focused on behavioral health were introduced in late April to early May that had local advocates hopeful of a potential cultural change in how North Carolina responds to individuals in crisis.
Meanwhile, a fourth House bill that’s Democratic sponsored would create a statewide professional oversight board for certified peer support specialists.
None of the bills had been addressed in committee as of Monday.
Primary sponsors of all four bills are Rep. John Autry, D-Mecklenburg, and Cynthia Ball, D-Wake. Rep. Donny Lambeth, R-Forsyth, is a primary sponsor on three of the bills.
The bills reflect a grassroots effort involving mental health care that “is shifting from authoritative approaches to more responsive ones that engage individuals more effectively and with greater safety,” said Laurie Coker, a Forsyth County behavioral health advocate and staff member at Green Tree Peer Support of Winston-Salem.
Autry and Ball said in a joint statement in May that behavioral health advocates “have long been concerned about the overuse of involuntary commitment.”
“Its growing use since 2009 has caused concern about how the mentally ill are treated.”
Autry and Ball said that “research and best practices demonstrate less coercive responses are more beneficial.”
Part of the inspiration for the bills comes from a group of peer advocates mining the data from the N.C. Administrative Office of the Courts to learn how many involuntary commitments happened by county from 2009 to 2018.
“In some counties, the numbers of involuntary commitments more than doubled,” Coker said. “This jump in coerced treatment does not even address COVID or most of our opioid related crises.”
Coker called the “over-use of involuntary commitments a red flag regarding our public mental health system. Our state must address this unacceptable result.
“Our elected officials are aware of the financial costs, as well as the personal costs to individuals and families when systems overuse coercive measures in the name of treatment.”