Story by Madi Kirkman
Art and graphics by Bonnie Zhang
Only 36% of Hispanic or Latino adults and 39% of African American or Black adults received mental health services in 2021 compared with 52% of white adults, according to the National Institute of Mental Health.
In addition, “Black and Latinx youth are less likely than white youth to receive treatment for their depression,” according to a 2020 report from Mental Health America.
“Little progress has been made — and indeed a worsening of inequalities has occurred — when it comes to the mental health ‘treatment gap’ for racial/ethnic minority students,” stated a 2022 mental health survey conducted across hundreds of college campuses.
With Gov. Roy Cooper’s recent announcement of a $1 billion behavioral health investment plan, which aims to expand behavioral healthcare access statewide, the state has the opportunity to address these disparities for the millions of racial or ethnic minorities in the state.
“Paying attention to connecting with communities of color, communities of faith, is what we need to do to make sure that we’re building an inclusive system that is addressing everyone, and that we’re really highlighting and working on places we see disparities,” said Kelly Crosbie, director of the Division of Mental Health, Developmental Disabilities and Substance Abuse Services Division of the North Carolina Department of Health and Human Services.
Here’s more about the plan and how it will address these disparities.
Background on the plan
The plan is an effort to combat rising mental health and substance use disorder needs. In the last two years, rates of depression and anxiety have quadrupled and drug overdose deaths have increased 72%.
Youth suicides have also doubled in the last decade.
Funding for the plan — which is part of Cooper’s 2023-2025 budget recommendation under deliberation in the legislature —would come from the federal government signing bonus the state gets for Medicaid expansion Cooper recently signed into law.
The plan is divided into three key areas of investment: “Make behavioral health services more available when and where people need them ($550 million); build strong systems to support people in crisis and people with complex needs ($400 million); and enable better health access and outcomes with data and technology ($50 million).”
A high-level overview
The plan does not directly address communities of color.
However, it mentions “underserved areas” in reference to retaining and investing in more providers in these areas and hiring an “inclusive workforce.”
Crosbie said the plan is a high-level overview and is meant to address all people and communities that need services, including communities of color.
“I think we have that opportunity as we go forward to make expressly clear how we need to use these dollars to eliminate disparities, make sure we have access for communities of color,” she said.
Ceara Corry is part of UNC-Chapel Hill’s Counseling and Psychological Services Multicultural Health Program, which centers the needs of Black, Indigenous and students of color at UNC.
Corry said she isn’t surprised that communities of color haven’t been specifically mentioned in the plan yet, but she sees that as an opportunity to use the funds creatively.
“Sometimes I think that things are left vague on purpose so that the funds don’t feel too restricted and there can be some more flexibility there,” Corry said.
Heather Griffin-Dolciney, clinical director at Freedom House Recovery Center in Chapel Hill, said communities of color should be directly addressed in the plan. The community center provides support and treatment for adults with behavioral disorders or mental illnesses, according to its website.
“If not directly addressed in Gov. Cooper’s statements, certainly targeting the legal system, I think, is important because, as we know, there is a disparity in who’s represented in our jails,” she said.
How will the plan address the treatment gap?
Crosbie said the governor and the Department of Health and Human Services have been ensuring all operations in the state address communities of color, including engagement with faith-based communities, Spanish-speaking providers and the Latinx community.
A big part of the plan is to increase the recruitment and retention rates of providers, she said. The department will also work with providers of color to request more diversion and re-entry programs and crisis teams.
North Carolina has 30 mobile crisis teams, which offer an immediate response to individuals facing a mental health crisis, Crosbie said. Many communities of color and rural communities don’t have one.
“That’s a real problem because those are places, then, where people have to end up calling 911 or taking their loved one to an emergency department,” Crosbie said.
Crosbie said some members of communities of color may feel more comfortable engaging with a provider who looks like them.
Providers of color also start at a different place than others due to years of underfunding, meaning they haven’t received the same training or opportunities to get grants or technical assistance, she said.
To combat this, the plan includes certification training programs at no cost to help strengthen the workforce.
Behavioral health and the justice system
For the part of the plan that aims to make behavioral health services more available, $150 million of this investment addresses “the intersection of the behavioral health and justice systems.”
The state’s Task Force for Racial Equity in Criminal Justice reported that in 2018, Black people were arrested “more than 2.5 times as often as white people.”
“And so we want to make sure that those communities, in particular, are getting strong programs where we are diverting people into treatment rather than into prison and jails,” Crosbie said.
Griffin-Dolciney said the Community Justice Resource Department, which her center works with to provide individuals with jail diversion opportunities, serves as a model for the expansion of re-entry programs.
She said she hopes the state will provide funding for services for individuals who were diverted from jail or those who are coming out of jail and suffering from addiction.
“They really belong in treatment and not in the jail system,” she said.
‘A proactive approach to behavioral health’
Katie Kriener, senior vice president of medical group operations at Atrium Health in Charlotte, said the plan will provide funding to areas of care delivery that have previously been underfunded.
“The punchline would be it will provide us the ability to offer more access points and more programs to the patients that need them,” Kriener said.
She also said the Medicaid expansion law Cooper signed on March 27 will provide more coverage, affordable care and access to services.
“So this is obviously going to improve the access to services for underserved communities, many of which are communities of color,” she said.
There’s also a lot of opportunity for partnerships between local governments and health systems in the plan, she said.
For Atrium Health specifically, one example would be integrating behavioral health services virtually into primary care practices so that patient conditions can be identified and treated before they have time to escalate.
Kriener said Atrium Health also met with Health and Human Services Secretary Kody Kinsley to develop a plan that revolves around dignified, secure patient transportation from emergency departments.
“I think it’s going to show up different depending on the partnerships, the funding and the focus of the health system to really take these dollars and build something to serve the patients and the communities,” she said.
Reactions to the plan
Afshin Khosravi is the founder and CEO of Trilogy Integrated Resources, a company that offers comprehensive health resources for communities across the nation. The Durham County Network of Care provides critical behavioral health information for individuals and families in North Carolina.
In the past four decades or so, the population of those suffering from mental health disorders has gone from mental health institutions to prisons, which disproportionately house African Americans, Khosravi said.
“When you look at it that way, (Cooper’s) plan would be amazing,” Khosravi said. “And he’s not alone. This is the only issue that I know of in the country that has bipartisan support.”
Corry said she’s curious to see creative ways in which the funds from the plan will be used at universities in the state.
“It would be great to see more opportunities to hire maybe additional staff who could serve even more students,” she said. “We’re invested just like everyone else is to see how this plan helps us do our work better to create a more caring and wellness-minded campus for students.”
Kriener said there could always be more done with the state in a crisis characterized by a lack of funding and infrastructure, but that it’s a big step forward overall.
“It’s a huge win for North Carolina and the entire behavioral health system, so I feel positive about the focus and the energy of the plan, of the funding, of the focus that’s in place, and I would say that most in healthcare feel the same way,” she said.
Crosbie said the department has been collaborating with the General Assembly to try to explain its vision for the plan.
“We have been ensuring that we are ready,” Crosbie said. “So when the time comes, our team is ready. They’re really well read-in and everyone is aligned on the vision.”
