The auxiliary room in Chapel Hill’s Binkley Baptist Church quickly filled to capacity on Thursday night as impassioned members of Orange County’s Latinx community gathered for a mental health public assembly. Overwhelmingly, they were concerned about the ongoing and ever present mental health crisis in their community.

“We ask ourselves what keeps you awake at night?” Luis Royo, a deacon at St. Thomas More Catholic Church, said to open the event. “Latino leaders have sounded the alarm.”

According to the National Alliance on Mental Health, more than 18 percent of Hispanic or Latinx adults in the United States experienced mental illness in 2020, a percentage not too dissimilar to the reported 22.6 percent of non-Hispanic white adults who experienced mental illness that same year. However, the Hispanic community has been disproportionately under treated due largely to a lack of funding and bilingual care.

“[In the Latinx community], when our people build up the courage to speak, they often cannot find where to go. Unfortunately, it is a silent crisis,” Royo continued. “Churches are often the first place that a Hispanic person goes for help, and without institutions that offer help in their language, churches become the only place they can turn. Today can be the day this changes. We have lost too many lives from mental health crises.”

For many years, undocumented immigrants and those in the Latinx community supported by Medicaid who suffer from mental health illnesses, substance abuse, and developmental disabilities relied almost entirely on a single local nonprofit, El Futuro, one of the few organizations working in Orange County to provide mental health care service to the undocumented and Latinx community.

But due to ongoing issues with funding—which Cardinal Innovations Healthcare Solutions, the managed care organization (MCO) serving Orange County at the time cut in 2012, and El Futuro having to absorb the cost of treating undocumented immigrants ineligible for Medicaid—the nonprofit closed its Carrboro location in 2015, leaving the local Latinx community in the lurch and needing help.

“We are in a deep, deep hole, but that is why we are here,” Royo concluded. ”We want to come out as a community united.”

Leaders from the nonprofit groups Orange County Justice United and the North Carolina Congress of Latino Organizations organized last week’s assembly. Several Orange County commissioners and representatives from Alliance Health—the MCO now responsible for administering publicly funded behavioral health care services to Medicaid members and the uninsured in Orange and four other counties—joined the assembly to discuss a list of proposals set forth to better treat mental health within Orange County’s Latinx community.

Orange County’s mental health crisis isn’t new, however. It came to a head back in 2013 when the aforementioned Cardinal Innovations Healthcare Solutions, then the MCO responsible for dispensing state and federal Medicaid dollars in a 15-county region that included Orange and Chatham, made headlines for excessive CEO pay, luxurious board retreats, and apparent mismanagement of government funding, allegedly hoarding $70 million that was intended for patient services. Cardinal Innovations was accused of paying it CEOs over $1.2 million more than the state permits without attaining proper approvals. Cardinal’s CEO at the time, Richard Topping, was reportedly receiving more than $600,000 a year in 2016, well over the government statute’s mandated limit of just over $187,000.

At the end of last year, North Carolina’s health department shifted the responsibility of providing mental and behavioral health services for Medicaid patients away from Cardinal Innovations and over to Alliance Health. But members throughout Orange County’s Latinx community are worried about the transition.

“Tonight I am pleading for our state representatives and leadership from Alliance Health to take this very seriously, because it is a crisis,” said Diana Huerta, an Orange County resident who lost a family member eight years ago to suicide. “I can’t imagine all the suffering that he went through. A lot of people need help. We are crying for help.”

Huerta was one of three who gave personal testimonies at the assembly; two other attendees said they were angry and frustrated with the lack of initiative local leaders have shown toward the community’s mental wellness.

“This did not happen by accident,” Katherine Ward, a psychologist and cochair of the research team for mental health at Justice United, said at the event. “This happened from lack of interest.”

Ward said the community was no longer willing to settle for less than what it rightfully deserved.

“Alliance Health has the opportunity to correct the mistakes of the past,” Ward continued, “[but] in order to be recognized by Alliance, we need to be organized as a community and share a collective power. We need to have a concrete proposal, and that is why we are here today, with clear and precise proposals.”

Ward continued by reading the list of proposals from Orange County Justice United. First, the group demands the creation and maintenance of a guide to mental health services for the Latinx community. Second, it demands more resources for mental health group sessions (including workshops). Third, it demands investment in community health workers who are equipped to provide basic mental health services. And lastly, the group wants community leaders to ensure that Orange County’s future Crisis/Diversion Facility has bilingual, culturally responsive staff and that invests in bilingual therapist retention and recruitment.

Ward’s proposals were met with applause. Orange County commissioners and Alliance Health representatives took the stage shortly thereafter.

“During the COVID pandemic, mental health needs have grown exponentially for all of Orange County, the state, and the world,” said Orange County commissioner Amy Fowler. “We are all here tonight because we care, and we want to hear how to serve you, and all of Orange County residents.”

Fowler, a pediatrician, shared with the room her daily experiences with patients suffering from mental health issues and their fight to find treatment.

Following Fowler’s and other local leaders’ remarks, representatives from Alliance Health took the stage, including Alliance Health COO Sean Schreiber.

“Alliance formally believes that one of the best things we can do in every community is expand behavioral health care,” Schreiber said. “It’s a huge issue, not just in these communities, but nationwide.”

“As the local mental health authority and funder of services, we often get lots of proposals,” he continued. “What I found so encouraging about this proposal is that the first ask was for good partnership, and it’s really much easier to move forward with these kinds of initiatives when you have good partnership.”

Marcus McFaul, a reverend with Binkley Church, ended the assembly on a hopeful note.

“Today is a new day,” he said, arms spread in prayer. “The light has come out; the sun has come out.” 

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