By Rose Hoban
A high-level panel of experts forging recommendations to improve the mental health system met in Raleigh Tuesday to disclose their top suggestions to be shared with Gov. Pat McCrory later this year.
The full panel of the Governor’s Task Force on Mental Health and Substance Use convened at NC State University’s McKimmon Center to discuss their top proposals for strengthening the system of care for people struggling with addiction or mental illness.
But one of the problems they face is that the mental health system “is a broken system because it’s not a system,” said Department of Health and Human Services Sec. Rick Brajer, quoting one of the task force members.
In particular, the substance-use treatment system is underfunded and there are few treatment beds, leaving many people with drug and alcohol problems few choices. Many people with mental health and substance-use issues end up in prison or worse.
In 2014, 1,178 people in the state died of accidental overdose.
In the same year, there were almost 22,000 emergency department visits to treat overdose.
And former Lt. Gov. Jim Gardner, who leads the state Alcohol Beverage Control Commission, told the group that one young North Carolinian dies each week as a consequence of underaged drinking.
Approximately one in every five people is dealing with a mental health issue at any given point in time, according to John Santopietro, a psychiatrist who heads behavioral health for the Carolinas HealthCare System, based in Charlotte. And only 40 percent of those people get treated.
“And we know that the 40 percent that do get treated get bounced around a fairly disconnected and generally broken system in the country,” Santopietro told the group.
He noted that people with severe mental illness die, on average, 25 years younger than people without those issues and that the number of suicides in the U.S. is 40,000 people each year and growing.
“In North Carolina, where there has been, over the last 15 years, very significant and continuous change, the problem is palpable as well, with people ending up falling through the cracks and ending up in places … that they really don’t belong,” Santopietro said.
His subcommittee, tasked with making recommendations to help adults with mental health issues, had a dozen suggestions, but one rose to the top: housing.
“Housing is essential for stability in mental health and substance-use disorders,” he said. “How can somebody get stable on medications and in treatment if they don’t have a safe place to live?”
Santopietro said his subcommittee also felt that reinstating a system of case management for people with mental health and substance-use problems was essential, as well as diverting people with problems from the criminal justice system and into treatment whenever possible.
“Our work group felt passionately that North Carolina has the resources – both in terms of natural resources, professional resources, political resources, educational resources – to not just be in the middle of the pack nationally, but to be a leader nationally in solving this problem,” Santopietro said.
Destigmatizing mental health problems is one of the biggest priorities for reducing the burden borne by kids with mental health problems, according to William Lassiter, who leads programs for children at the Department of Public Safety. He is heading up a work group for the task force dedicated to youth issues.
He said destigmatization is key, “So that our folks will be willing to come forward so that when they have a problem they can come for help.”
He also emphasized the importance of mental health providers being “trauma informed,” an approach to looking at behavior that is gaining appreciation in the mental health-treatment world.
“We know that a lot of people enter our mental health system because they’ve had trauma in their life, and they use substances to try to escape from those problems,” Lassiter said, “We want to make sure that we’re trauma informed with law enforcement, with our school personnel and also with our EMS … and also our prisons and juvenile justice system.”
The concept behind trauma-informed care is that people engaging with someone who is having an immediate issue can recognize and address the reason behind the behavior as well as the behavior itself.
“There’s a reason why that kid is acting out,” Lassiter explained.
He presented on children’s issues along with Katherine Peppers, a pediatric nurse practitioner in Raleigh. One of the priorities their work group identified is the need to expand the pool of people working with kids who have mental health issues, which could entail broadening the scope of practice for professionals such as nurse practitioners and clinical social workers.
“Integration of mental health and primary care goes a long way in rural communities where they’re not going to see a psychiatrist,” Peppers said, noting that there are only 10 psychiatrists per 100,000 people in the U.S., and more than half of North Carolina counties are without a psychiatrist.
“There is national credentialing for pediatric mental health specialists so that nurse practitioners can then see those patients,” she said, noting that Duke University is interested in adding the certification material to its training program for nurses.
She also urged passage of bills at the General Assembly to modernize the state’s nursing practice legislation to give nurses the ability to work where there are no psychiatrists or psychologists.
Support from the top
Peppers got some backup support on expanding nursing practice from McCrory, who stopped into the meeting about halfway through.
“We have 345 nurses that are waiting for this certification,” he said, referring to a pediatric mental health specialist certification offered online by the Western Governor’s University. “They’ve already gone through it…. They’re ready to go but they can’t.”
McCrory said he would be willing to wade into a political fight around expanding nursing practice and certification.
“Get ready, there will be roadblocks, political roadblocks thrown in,” he said. “Any time you narrow or expand certification, there is an interest group that’s involved.”
McCrory told task force members that he supported their work, but he urged them to have rollout plans for their recommendations.
If they present only an announcement of their goals or recommendations, he said, “It’s not going to happen. I’ve learned an announcement doesn’t do it. If it requires legislative work, have a legislative plan in place.”
He also said there needs to be a communications plan and a strategy plan to get recommendations implemented, and a plan to get the public on board.
“To me, you can have the best ideas, but the rollout, if that fails, then it goes back on the shelf,” McCrory said.[box style=”1″]
Ideas cited by members of the Governor’s Task Force on Mental Health and Substance Use:
- The need for workforce development: For example, about 60 counties have no psychiatric provider. Ideas include expanding the “scope of practice” for nurses and education loan-repayment programs.
- Using “trauma-informed care”: A way of working with people with mental health issues that recognizes that many of them have experienced significant trauma
- Specialty courts: Increase the use of institutions such as mental health courts, drug courts and veterans courts to more comprehensively address people with specific problems.