We see a house that has floodwaters up to the threshold of the front door. the photo is taken from on a boat, we can see the bow of the boat and a man in bib waders with his back to the camera. Took place during Hurricane Florence. standing on the bow holding a rope.
Local fishermen in Carteret Conty used their boats to rescue neighbors from flooded houses. People in southern Carteret County said the waters that inundated the area were higher even than during Hurricane Hazel in 1954. For many people, the experience was terrifying. Photo courtesy: Glenn Skinner

By Taylor Knopf

The North Carolina Governor’s Office announced preliminary estimates this week that Hurricane Florence created about $13 billion in damages to the state.

On Wednesday, Gov. Roy Cooper recommended a $1.5 billion relief package, which includes a significant amount of mental health funding. The General Assembly will take it up next week when it meets during a second special session aimed at Florence relief efforts.

The relief money will generally come from three places: the federal government, private insurance and the state. The legislature will put together a state-funded relief package that the governor will need to sign.

Table courtesy of the NC Department of Health and Human Services and the Governor’s Office.

The state also manages the federal relief money. N.C. leaders have been criticized for the speed at which they dole this out, as many have continued to wait for Hurricane Matthew funds.

Cooper’s budget proposal was released before Hurricane Michael pounded the central and western portions of the state on Thursday.

Health and Human Services

Officials at the Department of Health and Human Services estimate the total health care impact of Florence will be $232.5 million. DHHS expects that $149.3 million will be covered by federal and private funding. That leaves an unmet need of about $83.2 million.

The health care section of Cooper’s Hurricane Florence proposed budget package includes $50 million for mental health services, including $3 million specifically earmarked for substance use treatment programs.

“This impact estimate reflects the anticipated cost of services that will be needed in impacted areas,” DHHS staff wrote. “It does not attempt to quantify the effects of trauma experienced by individuals and families impacted by the storm.”

Table courtesy of the NC Department of Health and Human Services and the Governor’s Office.

These mental health services include “responding to trauma; community outreach, screening and training; school screenings and training; and patient transportation for appointments with mental health providers in the three catchment areas with impacted counties.”

Based on past experience with natural disasters, staff estimate that mental health services for Medicaid participants will surge in about two months. They predict that surge will continue for up to eight months.

The budget proposal cites Trillium Health as an example. The mental and behavioral health management organization calculated it needed $10.2 million in additional costs after Hurricane Matthew in 2016.

DHHS staff expects that between 3,200 to 3,750 “uninsured adults will need outpatient therapy, medication management, intensive in-home services, community support team services, assertive community treatment team services, and/or substance abuse intensive outpatient services.”

Experts say it is normal for increased levels of stress, anxiety and depression after a traumatic event such as a hurricane. Many lose everything: home, car and other possessions. Some even lose their livelihoods, such as farmworkers and fishermen.

“We know disasters are stressful,” said DHHS Sec. Mandy Cohen, announcing a state-sponsored hotline in the days following Florence.

You can reach North Carolina’s “Disaster Distress” hotline at 1-800-985-5990.

Mental health and disability

Debra Kindervatter, president of the Wilmington chapter of the North Carolina National Alliance for Mental Illness, said she was disappointed there wasn’t more funding for substance use treatment.

“A lot of people with mental illness self-medicate, especially when they are stressed,” she said.

Kindervatter said she hopes some additional mental health funding will be used to alleviate the wait times for psychiatric beds to deal with the increased amount of suicide ideation that can occur after a storm.

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Julia Adams, an N.C. lobbyist who represents an array of disability organizations, said this is the first time she’s seen this much detail in the HHS portion of a disaster relief budget, particularly around mental health and intellectual or developmental disability.

She said that North Carolina continues to learn from every hurricane. And with Florence in particular, Adams said she saw “more synergy” throughout the governor’s entire cabinet.

DHHS was particularly active before, during and after Florence, she said. The department had a standing afternoon call with providers and mental health advocates before and during the storm. She said the call is still taking place twice a week.

“They were reacting and adjusting in real time,” Adams said. “I’ve noticed an enhanced focus around Medicaid and health needs during this emergency.”

She added that there have been many meetings since Hurricane Matthew about emergency preparedness at which the disability community has been very vocal.

Adams was pleased to see the attention on mental health and disability in Cooper’s proposed relief budget, particularly for things that often get overlooked.

“Medical equipment such as ramps and wheelchairs don’t always survive hurricanes,” she said. “And some of our group homes are gone.”

Will the state lawmakers’ budget include all the governor’s request? That remains to be seen, Adams said. But they will likely differ on some things.

Adams said that she and others will be at the capitol Monday morning when legislators arrive to advocate for these issues.

She’s optimistic, noting that there are a number of strong health care leaders in the General Assembly who have already started thinking about health more holistically since the conversation about Medicaid transformation.

Housing

Housing is one of the determining factors when it comes to whether a person has a positive health outcome, according to a growing body of research. When a hurricane hits, it destroys homes and displaces thousands.

The Governor’s office estimates that Florence impacted 1 million households — 26 percent of N.C. residents — resulting in $3.4 billion in damages.

In addition to money from Federal Emergency Management Agency (FEMA) and private insurance, Cooper recommends the state contribute $243 million to the rebuilding effort.

Samuel Gunter, director of policy and advocacy for the NC Housing Coalition, said he’s been on the phone with the state’s Republican leaders all week discussing post-Florence housing needs.

He said he doesn’t anticipate that they will pass everything exactly how the Governor laid it out in his storm relief proposal but anticipates there will be a strong legislative response.

“We are going to see some difficulty getting the money out the door,” he said. “In addition to the dollar figure, we are looking at the policy for how it will be distributed.”

Rural housing is going to be one of the toughest issues to address, he said, noting there is already a huge lack of affordable housing in those areas.

Table courtesy of the NC Governor’s Office.

He said one reason it’s taking so long to hand out the Matthew relief money is that the state’s disaster recovery strategy shifted over the last several years.

There used to be a system where direct appropriations were given to community development organizations throughout the state. Now, most of those organizations went under or pivoted in significant ways to stay afloat, Gunter said.

“Now we are learning that this long-term capacity to do community development is important,” he said.

“For context, those were the boots-on-the-ground for Floyd recovery,” Gunter said. “Storm recovery is long-term community development. Gutting houses and pulling people off roofs is over quickly. Most of the work is done over a decade or more and that takes long-term commitment and financing.”

He expects the Florence recovery will be a little quicker than Matthew since the state has spent time over the last couple of years setting up a program to manage disaster relief funds.

Gunter said his organization is also concerned with equitable recovery. He noted that disasters such as Matthew and Florence disproportionately impact poorer communities of color. While damage to expensive beachfront homes frequently gets the media attention after a storm, hurricanes end up really hurting poorer residents who frequently live on cheaper land that is more likely to flood.

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Taylor Knopf

Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...