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By Taylor Knopf

Some of the state’s top health organizations are asking North Carolina leaders for a meeting to address what they’re calling a “behavioral health emergency.”

The COVID-19 pandemic caused immeasurable stress and loss, resulting in more people needing mental health services. The demand increase has strained North Carolina’s already fractured mental health system. 

People who struggle to access mental health services when they first experience symptoms frequently end up in crisis and find themselves in jail or the emergency room. During the pandemic, North Carolinians flooded ERs looking for help, particularly for children, according to the North Carolina Healthcare Association

The rate of kids in the emergency room because of a behavioral health concern nearly doubled in 2020. By December, the rate of emergency room discharges for pediatric patients with a behavioral health condition had increased by 70 percent over the prior year, according to the NCHA’s patient data system.

“That’s alarming to us,” said NCHA lobbyist Nicholle Karim. “We know that the system was already strained prior to COVID-19, and now we’re seeing a growing need, particularly around children and youth coming into EDs or needing to access services for the first time.”

Warning flare fired

NCHA and 11 other leading health organizations outlined these concerns in a letter to state leaders last week, calling on both public and private entities to work together and look at ways to improve access to mental health services in the state, Karim said. 

Spokespeople for the governor and senate leader said they have received the letter. Gov. Roy Cooper’s office is working on a response and Sen. Phil Berger’s spokesperson said he is “open to meeting with the organizations to discuss the letter and their concerns.”

This graph compares the rate of pediatric patients discharged from emergency rooms across North Carolina between 2019 and 2020. These are children who were primarily at the hospital for a behavioral health concern. Data and graph courtesy of the NC Health Care Association

The letter points out that North Carolina ranks 44th nationally in access to mental health care, according to Mental Health America’s 2021 report. The same report ranked the state 45th overall for pediatric mental health care. 

Additionally, the letter references a 91 percent increase in involuntary commitments over the past decade, even before the pandemic hit. This trend was first reported by NC Health News after advocates dug up IVC data that was not publically available. 

“It was already a crisis, and now it feels like it’s reaching an emergency where we cannot ignore this anymore,” Karim said.

Hospital leaders across the state have reached out to the healthcare association to express their concerns, saying that the behavioral health care trends they see are not sustainable, Karim said.   

“From the hospital perspective, the over-utilization of emergency rooms is a canary in the coal mine, so to speak,” she explained. 

She said more people are using emergency rooms as a safety net, which “generally signals that something else is going on in the system that we all need to pay attention to.”

While lack of access to behavioral health services and mental health patients filling emergency rooms are problems that have existed for decades, they are heightened under the weight of the pandemic, Karim said.

Support from the business community 

Business leaders are also concerned about this trend because they know their employees have been through a lot over the past year and a half and may struggle to bounce back at work.

The NC Chamber, which advocates on behalf of the state’s business community, also signed on to the letter asking for a meeting with state leaders to discuss the behavioral health crisis. 

“Our most immediate concern is how do we address the needs, how do we identify them and how do we connect businesses of all sizes with the mental health system and with their local health care system to start the process,” said Gary Salamido, NC Chamber president and CEO, during a phone interview.

He added that business leaders are acutely aware that their employees have been impacted by loss, prolonged isolation, and caring for additional family members during the pandemic. 

“When people have support, we can make great strides in our state,” Salamido said. “Our physical health, our fiscal health, and our mental health is a key to North Carolina being a great place to live, grow, work and raise your family.”

This graph compares the rate of adult patients discharged from emergency rooms across North Carolina between 2019 and 2020. These are patients who were primarily at the hospital for a behavioral health concern. Data and graph courtesy of the NC Health Care Association

Including people with mental illness 

In order to truly address the many issues facing North Carolina’s mental health system, long-time advocate Laurie Coker said the state must bring people with lived mental health experience, herself included, into the conversation. 

“We have found that we have by and large been excluded from any of the discussions where the plans are being made for how to implement mental health services,” Coker said during a community discussion on the overuse of involuntary commitments hosted by NC Health News. 

“So we don’t have a very well-informed system, and therefore all the little things that look like on paper — that are supposed to be helping myself and my peers — they’re not working. And we have no way of giving feedback to help them get better.” 

Coker said that many people have struggled to access services or have not benefited from them, so they just drop out of the system altogether.

“What we’re seeing right now is things are really coming home to roost,” she said. “It’s not like the system was really working well before.

“We need to think about how to make services accessible and welcoming to people early on, before they go into crisis,” Coker concluded.

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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...

One reply on “‘Behavioral health emergency’: NC health organizations ask state leaders for help”

  1. Behavioral health emergency is really necessary topic! Now during the pandemic mental health has fallen in many people. As for me, I lost my sence of security and protection. I agree with the author of the article Taylor Knopf that the last two years have greatly influenced the behavioral health of children, regardless of the well-being of the family. Therefore it’s important to know as much information as possible, where to go if such problems arise.

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