This story first published online at North Carolina Health News.

Throughout the pandemic, more people have sought mental health crisis services or have gone to hospital emergency rooms in distress. Hospitals leaders say the COVID-19 pandemic has created a behavioral health emergency.

Pandemic-related stressors caused more demand for mental health services and an increase in substance use and overdoses, advocates and the data say. 

The state budget released Monday, which the governor signed into law, provides some funding to relieve some of the pressure the surge of mental health patients have put on hospitals.

The budget includes a $10 million grant program hospitals can apply for to expand telepsychiatry services to outpatient settings—such as primary care offices—and $1.5 million to East Carolina University’s NC-STeP program to provide more psychiatric consultations to patients showing up in emergency rooms across the state in mental health distress. 

Nicholle Karim, policy director for the North Carolina Health Care Association, said her organization which represents the state’s hospitals is very appreciative of this investment in telehealth services for people with mental health diagnosis.

The budget also includes a provision that will require LME-MCOs, the state’s behavioral health management companies, to reimburse hospitals for services provided to Medicaid patients in the emergency department for behavioral health services after 30 hours. Karim said the Health Care Association asked for this policy change because so many behavioral health patients wait for long periods — sometimes days or weeks — to be discharged or transferred to a more appropriate setting for care. 

Before this change, the hospitals were not being reimbursed for more than 30 hours of services provided to behavioral health patients during these long waits. 

“It’s a larger system change to make sure that when the emergency department is being utilized for these patients, who need these services for their behavioral health diagnosis, that the LME- MCOs will develop an adequate and accessible network of providers,” Karim said. 

As wait times for psychiatric beds have increased during the pandemic, the budget includes funds from the sale of the Dorothea Dix hospital property fund to open more inpatient beds to treat people with mental illness. Johnston Health Enterprises, Good Hope Hospital in Harnett County and Harnett Health System, Inc. would each receive $1.4 million from the fund.

Psychiatric hospitalization alternatives

Additionally, the budget gives a one-time amount of $25 million to Forsyth and Mecklenburg Counties to “aid in assisting individuals who are experiencing a behavioral health crisis by diverting the individuals from the local hospitals, which are under pressure from the COVID-19 pandemic, to more appropriate settings to address those individuals’ needs.”

“Now we can consider what our community truly needs to reduce overuse of high-cost crisis services while improving outcomes,” said Laurie Coker, founder of Green Tree, a nonclinical mental health service in Winston-Salem staffed by people with their own stories of mental health struggles and recovery.

“Hospitalization is not the best option for many, and indeed the rate of suicidality is actually highest shortly after discharge from psychiatric hospitalization according to recent research. We need an array of options in our community.”

Coker is hopeful that peer-run organizations such as hers can be part of the solution in Forsyth County. Green Tree already provides 24-hour support to the local hospital to support mental health patients who show up in distress but don’t rise to the level of needing psychiatric hospitalization. 

“Expanding our array of crisis response components will increase access to alternatives that might be more welcoming and appropriate to individuals earlier in their distress,” she said. “Further, these models would also greatly reduce the costly and troubling overuse in our county of involuntary commitment orders which are often sought in desperation because we do not have responsive upstream crisis components.”

Missing from the budget were funds to expand mental health peer support centers, similar to Green Tree, which are operated by people who have experienced mental illness, homelessness, incarceration, substance use or some combination of these. NC Health News reported on the 91 percent increase in petitions to involuntarily commit mental health patients over the last decade, and the trauma many live with after being handcuffed and transported by law enforcement in the process. In response, a bipartisan group of House lawmakers sought to create community-based alternatives, but those measures didn’t make the budget. 

The budget does include about $1 million to establish STAR (Support Team Assisted Response) pilot programs in Charlotte, Greensboro and Greenville, which are non-police mental health response teams that go out to “low-level incidents” and connect people to resources and services. The budget also gives $1.5 million to Recovery Innovations, Inc., a nonprofit managing the Dix Crisis Intervention Center in Onslow County for a behavioral health urgent care pilot program.

Additionally, there’s a $50 million allocation to establish electronic patient records at all state-operated health care facilities, including the psychiatric hospitals, and to train staff on how to use them.

Recovery courts and 1,000 Innovations Waiver slots

It’s not uncommon for people with a substance use disorder or other mental health issues to find themselves in front of a judge. The budget includes about $3 million to establish recovery court pilot programs in courtrooms in Cumberland, Harnett, Haywood, Onslow, Pitt, Robeson and Wayne counties. 

These are special court programs, aimed at being more therapeutic and less punitive, for people who have committed a crime and are struggling with mental health or substance use issues. 

For those with disabilities, there will be 1,000 new slots—which is higher than in recent budget cycles—for people with disabilities to receive enhanced community services under the state’s Innovations Waiver, which has a current 10-year waiting list of about 15,000 people. Budget writers also included a modest increase in funds—$4 million, up from about $2.4 million in past budget cycles—to aid North Carolinians with traumatic brain injuries.

The budget includes one-time funds of $12.6 million to care facilities for people with intellectual and developmental disabilities (IDD) to help with extra costs during the pandemic. Workers at these facilities will also receive a pay increase to $15 per hour. 

“Disability Rights NC is pleased with budget provisions that will improve the lives of people with disabilities in NC. The budget fills three gap areas by extending Medicaid eligibility to parents of children in the foster system; women for one year after giving birth; and people with age-related or other disabilities who receive Special Assistance and opt to stay in their homes,” DRNC Policy Attorney Tara Muller said in an emailed statement. 

“Thanks to this budget, thousands of people who otherwise would have been forced to enter institutions like Adult Care Homes to access healthcare, now will be eligible for Medicaid and all its supports while living at home,” she said.

Some smaller allocations for nonprofits that serve people with disabilities include $200,000 to Aces for Autism in Pitt County, $500,000 to GiGi’s Playhouse to help people with Down syndrome in Raleigh and Charlotte and $100,000 to Reality Ministries, a nonprofit in Durham.

Addiction treatment funding

About $16.5 million from the opioid settlement fund is included in the budget to address opioid addictions issues throughout the state. The budget gives $75,000 to the NC Harm Reduction Coalition and $25,000 to law enforcement agencies for the purchase of naloxone, an overdose reversal drug. 

Budget writers gave several small allocations to organizations that provide services, support and treatment to people with addiction issues, including the following:

  • $500,000 to Partners for Behavioral Health Management for addiction treatment in Surry County
  • $10 million to Hope Alive in Robeson County 
  • $250,000 Hope Restorations in Kinston 
  • $50,000 to The Anchor Holds in Nash County 
  • $500,000 to Wilkes Recovery Revolution in Wilkes County 
  • $100,000 to Fellowship Hall in Greensboro 
  • $112,000 to Group 40 Ministries in Union County 
  • $200,000 to Dew4Him Ministries in Wake County to support women with SUD
  • $21,000 to Living Free Ministries in Alamance 

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