By Rose Hoban

Hundreds of people concerned about North Carolina’s mental health system convened in Chapel Hill on Saturday morning for an annual event that’s become a prime forum for laying out the priorities and concerns of the mental health community.

About 400 service providers, advocates and consumers of mental health services were joined by some two dozen county and state lawmakers for the 42nd annual Mental Health Legislative Breakfast, at UNC Chapel Hill’s Friday Center for a morning of talk, tales of life in the mental health system and opportunities to make the case to lawmakers for improved services.

This year’s event saw a significant presence of leadership from the Department of Health and Human Services, with Sec. Mandy Cohen, behavioral health chief Kody Kinsley and Debra Farrington, who helps lead the state’s Medicaid program, on which many behavioral health patients rely, in attendance.

woman stands at a podium talking about mental health issues while people sit at tables listening.
Health and Human Services Sec. Mandy Cohen spoke of her frustration that North Carolina had not yet expanded Medicaid during her remarks to the annual Mental Health Legislative Breakfast. Photo credit: Rose Hoban

“We are continuing to have conversations about what’s going on in the community and what’s happening in people’s local areas,” said organizer Jenny Gadd, a social worker with group home housing provider Alberta Professional Services. “We’ve gotten bigger in that we’re now very much statewide and attracting a statewide audience.”

Despite the strong turnout and the force of the message, some attending questioned the impact of this year’s event – or any advocacy activities – in light of the political battle lines that have hardened in Raleigh.

“I think fundamentally, there’s just still such a deep divide… an even deeper divide than there used to be” said Vicki Smith, head of the Alliance of Disability Advocates and the former head of Disability Rights NC. “It’s hard for people to hear one another.”

Medicaid expansion elusive

About 150,000 adults with mental health issues are uninsured in North Carolina, Cohen told the crowd. She said that many of them could receive health coverage if the state were to expand Medicaid, a policy made possible under the Affordable Care Act, passed in 2010. Since 2012, it’s been possible for states to extend coverage to low-income adults who otherwise don’t qualify for the program because they earn too much annually, even as they don’t earn enough to afford coverage.

“You can hear in my voice, I’m getting frustrated, guys,” said Cohen, who was attending the event for the fourth time since arriving in the state in 2017. “Thirty-seven other states have said yes to Medicaid expansion and yet North Carolina continues not to be able to find a way to yes.

“That’s just not acceptable to me,” she said to strong applause.

Medicaid expansion has been a perennial issue at the annual breakfast, but the voices of advocates in the mental health space haven’t seemed to move the needle in what’s become a dividing line between the Republican-led legislature and Gov. Roy Cooper. A standoff between the General Assembly and the governor over Medicaid expansion, along with a handful of other hot-button issues, has resulted in North Carolina not having a full state budget, which was due last July.

Cohen cited results in Ohio, which expanded Medicaid under Republican Gov. John Kasich and which has seen faster drops in the rate of opioid overdose deaths over the past several years than in North Carolina.

“I want to be mobilizing every resource, but right now we’re diverting all or our federal dollars to treatment because we haven’t taken advantage of Medicaid,” she argued.

But according to the lawmakers present, there seems to be little chance of Medicaid being passed during the legislative short session that begins in late April. They also expressed pessimism the state budget impasse would be resolved. 

“I do think that most people are hungry for a politics that sets ideology aside on the far left and the far right and says how can we come together and solve problems,” said Rep. Josh Dobson (R-Nebo) as he accepted an award for being a legislative champion on mental health issues.

Shows an African American woman at a podium telling a moving story about her son with severe, persistent mental illness
Speakers at this year’s breakfast also helped make the point that mental health issues cut cross race, class and wealth lines, with lawmakers themselves talking about their own encounters with the mental health system. Rep. Graig Meyer (D-Hillsborough) talked of the difficulties getting help for his adopted daughter, who struggled with childhood trauma, Hillsborough Commissioner Matt Hughes talked of seeking treatment for anxiety, depression and ADHD. Rep. Carla Cunningham (D-Charlotte) drew the room to a standstill with a wrenching portrayal of her years of struggle to find help for her 38-year-old son, who has an intellectual disability in addition to being diagnosed with schizophrenia and bipolar disorder. Photo credit: Rose Hoban

That was one thing that he and his Democratic colleagues were able to agree on. 

Dobson also pointed out that the budget stalemate in Raleigh means that one-time cuts to the state’s mental health managed care agencies won’t be enacted without the full budget going into effect.

“They’ll actually get more funding,” he said. “So that is one positive.”

‘Contributing factor’

The lack of movement on issues frustrated social worker Bebe Smith. She questioned how much good the event does if the priorities highlighted by advocates don’t translate into legislative action.

“Medicaid expansion is an example of that,” she said. “For a number of years, that’s been the thing we sort of keep zeroing in on, but it’s still stalled.”

But Gadd, the organizer, disagreed that the annual breakfasts don’t have an effect. 

“We often see follow-up in how things are funded,” she said. “I think things tend to have a line item in the budget that maybe they didn’t have one before.”

She noted how since the breakfast highlighted funding problems in group homes for people with intellectual and developmental disabilities, the legislature has since included line items to cover shortfalls. And another year, the breakfast focused on adverse childhood experiences and the science showing how childhood trauma has ripple effects for years. She said it gave lawmakers insight into the need for early childhood supports, which translated into legislative attention.

“That can’t all be because of the breakfast, obviously,” Gadd said. “But I think that we were definitely contributing factor for that.”

Outgoing Durham Sen. Floyd McKissick (D) agreed that events such as the breakfast actually move the needle, but not always in ways that advocates might see.

“Legislators are now more likely and predisposed to become active for mental health issues that otherwise may not have always been on the radar screen,” he said.

Note: NC Health News editor Rose Hoban moderated the Q&A panel with lawmakers at this event.

a bearded man talks with two animated women
Pamela Swan and Jeanne Manley buttonhole Kody Kinsley, Deputy Secretary for Behavioral Health & Intellectual and Developmental Disabilities at DHHS after his presentation on his department’s initiatives. Photo credit: Rose Hoban

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...