State officials tout ‘once-in-a-lifetime’ investment in mental health
Plus: Energy regulators seek to improve regulation of cold-weather power plants after blackouts; Catching up with Make-A-Wish; Public hearing for city's first social district
Today’s Charlotte Ledger is sponsored by T.R. Lawing Realty:
The latest state budget includes hundreds of millions of dollars to address growing mental health challenges; ‘There is such a pressing need’
By Taylor Knopf
North Carolina Health News
With record numbers of people in North Carolina experiencing mental health distress — especially children and adolescents — the new state budget includes hundreds of millions of dollars in new spending for mental health services.
Much of the money comes from Covid relief funds and a $1.4 billion federal sign-on bonus North Carolina received for expanding Medicaid.
“Everybody saw that to make big changes was going to take a lot of money,” said Sen. Jim Burgin (R-Angier), chair of the Senate health and health appropriations committees.
“And I think one of the attractions to Medicaid expansion for all of us was this once-in-a-generation or maybe even once-in-a-lifetime opportunity to say, ‘Mental health is a big deal.’”
Burgin, who embarked on a statewide listening tour to learn about mental health needs, said at every meeting he saw “a different face with the same heartbreaking stories about not being able to get services.”
In a week-long series last month, The Ledger and North Carolina Health News took an up-close look at teen mental health and explored potential solutions. The state spending attempts to address some of the problems highlighted in the series, from shortages of health care workers to children spending days in emergency rooms awaiting spots in more appropriate places for mental health treatment.
The new state budget includes significant rate increases, bonuses and education for different types of mental health workers. It also directs millions to expand preventive care and to fund alternatives to the emergency room for those in mental health distress.
For Charlotte specifically, the spending plan includes $200,000 for The Relatives, a youth crisis center, as well as $17.5 million to the Katie Blessing Foundation, the nonprofit arm of Starmount Healthcare, to open a new 70,000 s.f. youth behavioral health facility near the old Eastland Mall.
The behavioral health center, tentatively planned to open in late 2024, will include a behavioral health urgent care, inpatient psychiatric beds and an intensive outpatient program. Starmount president and founder Michael Estramonte said it’s rare to offer all of those services in one building, but he believes it will make it easier for families with a struggling child to know where to go. “Thanks to the General Assembly’s help, it’s allowing us to add all the necessary services under one roof at a meaningful scale, as really needs to be done to help the whole child,” he said in a text.
Mecklenburg County spokesman Alex Burnett didn’t know how much in other funding is coming to the county. But he said the county is “excited about the potential opportunities of additional state funding and is working with the state team to understand the implications for Mecklenburg County.”
Kate Weaver, vice president and programming director for the Charlotte chapter of the National Alliance on Mental Illness (NAMI), said the investment in mental health is desperately needed.
“There is such a pressing need for services, and the crisis with adolescents and young adults is particularly overwhelming,” she said. “I’m hopeful that we see the effects of that money quickly.”
Alternatives to the emergency room
In recent years, ERs across the state have been overwhelmed by mental health patients, who often end up waiting days or weeks for an available inpatient psychiatric facility bed.
Going to the ER during a mental health crisis can be a traumatic experience. The Ledger/N.C. Health News series outlined the problem and included firsthand accounts from children who spent days there waiting for beds.
Once a bed does open up, patients are often transported under an involuntary commitment court order. They may be handcuffed and driven by law enforcement officers in marked police vehicles to psychiatric facilities.
To help solve those problems, the budget includes:
More mobile crisis teams and respite facilities: Mobile crisis units are specialized teams of behavioral health providers that can meet someone where they are located. Respite facilities offer a supportive environment outside the hospital setting where someone having emotional issues can get support from behavioral health workers or peer support specialists. (Retreat@The Plaza is an example of a respite facility in Charlotte.) Both are alternatives to the emergency room, and the budget allocates $80 million over two years to those two types of programs.
A pilot program to get patients out of police cars: The budget directs $20 million over two years to pay for a non-law enforcement pilot program for transporting patients to psychiatric facilities. Putting distressed mental health patients in handcuffs in the back of a police vehicle is “not trauma-informed. That is not appropriate,” said Department of Health and Human Services Secretary Kody Kinsley.
Rep. Donny Lambeth (R-Winston-Salem) said he received three phone calls in one week last summer from families with a child in a mental health crisis asking him where to get help.
“Unfortunately, the only thing I could tell them is, ‘You need to go to the emergency room,’” he said. “We’ve got to get these individuals into a proper care site, not the emergency room.”
Supporting the role of primary care in mental health
The Ledger/N.C. Health News series highlighted a dramatic shortage of psychiatrists and child psychiatrists in North Carolina. The shortage means patients often have to wait weeks or months for an appointment.
Without access to psychiatrists, patients often turn to pediatricians and primary care providers to fill the gap. The budget includes money for two programs to support them in that role:
Phone Support: The budget includes $2 million per year for the Psychiatry Access Line (NC-PAL), a phone line that a primary care provider or pediatrician can call to get advice from a behavioral health expert.
Collaborative Care Model: Another $5 million will support this model of care that pairs an off-site psychiatric consultant with a primary care practice. The psychiatrist reviews patient charts and provides advice and support on mental health cases.
Higher pay for mental health providers
The budget includes hundreds of millions to increase reimbursement rates for health care positions, including skilled nursing facility workers ($71 million), personal care service providers ($50 million) and direct care workers for people on a state- and federally funded Medicaid program that serves people with intellectual and developmental disabilities ($55 million).
Reimbursement rates for mental health providers had not increased since 2012.
Meanwhile, workforce shortages meant some state psychiatric hospitals couldn’t admit patients even though they had empty beds and people were waiting in emergency departments for care.
“We can't do this if we don't have people to take care of the folks, and we’ve got hundreds of beds empty across the state because we don’t have workers,” Burgin said.
To attract workers to state mental health facilities, the budget includes one-time funding of $40 million over two years for sign-on and retention bonuses.
It also allocates $18 million over two years that will pay for a workforce center to provide free training to public sector behavioral health providers as well as grants to community colleges to enhance their behavioral health workforce training programs.
Improving access in rural communities
Rural communities have long lacked medical care, particularly mental health care.
The state budget includes $50 million toward a loan repayment program that will help recruit primary care and behavioral health providers to rural or underserved areas.
“We’re desperately short of people that are highly trained, especially psychiatrists and family practice doctors. So we put dollars aside to pay them up to $100,000 to work in tier-one or tier-two counties,” Burgin said.
The state spending plan also includes $20 million for grants over two years to rural health care providers for start-up equipment for telehealth, which will further improve access.
Mental health services for children, foster care system
North Carolina’s foster care system has been struggling for years with high-profile failures that include children living in emergency rooms and sleeping on the floors of social services offices. The children who are hardest to place often have serious mental health needs.
“[The foster care system] is a high priority to us,” Burgin said. “We think that has got to be completely renovated, rejuvenated and reconstituted into a well-run statewide plan, where we can keep up with these kids.”
The state budget includes the creation of a statewide specialty Medicaid plan for kids in foster care and their families that aims to streamline their physical and mental health care.
It also instructs the N.C. Department of Health and Human Services to develop a proposal for federal approval to provide more Medicaid-paid mental health services to adults with serious mental illness and to children with serious emotional issues. The goal is to reduce psychiatric hospitalizations and emergency room visits by providing more community-based services for those populations.
Finally, the budget provides $80 million over two years to support parents and other caregivers of children with significant behavioral health problems by “expanding intensive supports in the community and increasing structured options for meeting the needs of these children.” The money will also go to strengthening “specialized treatment options for children with complex behavioral health or other special needs.” —Michelle Crouch contributed to this article
➡️ Read The Charlotte Ledger/N.C. Health News September 2023 series “The Kids Are Not Alright: Inside N.C.’s teen mental health crisis”
◼️ This article is part of a partnership between The Ledger and North Carolina Health News to produce original health care reporting focused on the Charlotte area. We make these articles available free to all. For more information, or to support this effort with a tax-free gift, click here.
Today’s supporting sponsor is Landon A. Dunn, attorney-at-law in Matthews:
After last year’s rolling blackouts, regulators urge tighter oversight over cold-weather preparations of power plants
Federal energy regulators are calling for stepped-up oversight of gas-fired power plants to ensure they’re ready for cold weather, following the rolling blackouts instituted by Duke Energy last December.
In a presentation late last month to the Federal Energy Regulatory Commission, commission staff members made 11 recommendations to help prevent a repeat of the Dec. 24, 2022, power outages on the East Coast. That morning, as temperatures plunged into the single digits, Duke had to shut off power to an estimated 500,000 customers in the Carolinas as parts at some of its natural gas plants malfunctioned and no electricity was available to import from adjacent utilities.
At the time, Duke portrayed its failure to provide power as largely unavoidable, the result of lower-than-expected temperatures and higher-than-expected energy demand — and not from any identifiable missteps or lack of preparation on its part.
Regulators, though, suggested that the government needs to impose more rigorous standards for energy generation and transmission during cold weather, given that similar winter storms knocked out power four other times since 2011, and that 80% of problems with freezing equipment last December occurred at temperatures at which the parts were supposed to function.
“It’s abundantly clear that we must make major improvements to the cold-weather reliability of both the natural gas and electricity production and grid systems,” FERC Chairman Willie Phillips said in a news release. The N.C. Tribune and WFAE reported on the recommendations last week.
Regulators said action is needed by Congress and state legislatures to clarify rules for winter weather power generation and to increase requirements for utilities to document their preparations.
After a preliminary report this summer, a Duke spokesman said preparing the power grid for cold weather is an industry-wide issue and that Duke will continue to improve. —TM
Related Ledger articles:
“After blackouts, utilities are urged to prepare better for winter” (🔒, Aug. 2)
“Inside Duke Energy's Christmas Eve blackouts” (🔒, Jan. 4)
Taking Stock, sponsored by Topsail Wealth Management
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How local stocks of note fared last week (through Friday’s close), and year to date:
🎧 New podcast: A poignant look at how Make-A-Wish fulfills its mission
Make-A-Wish of Central and Western North Carolina is on track to have its busiest year of wish-granting ever.
It’s part of a national network of 60 chapters that grants wishes for children aged 2 to 18 with critical and life-threatening illnesses.
In a recent episode of The Charlotte Ledger Podcast, CEO Kathy Jetton talks with The Ledger’s Cristina Bolling about the types of wishes local Make-A-Wish “wish kids” are asking for, how their wishes are fulfilled and what it’s like to lead a non-profit that has such an emotional mission.
She shares several poignant stories about how working with children to fulfill some of their dreams can have a powerful effect on their health, while providing unforgettable memories for families.
The Charlotte Ledger Podcast features conversations on local topics including business, nonprofits, education and more. It’s available on major podcast platforms including Apple Podcasts and Spotify. Most conversations are under 30 minutes — perfect for listening in the car or while enjoying a fall walk. —CB
You might be interested in these Charlotte events
Events submitted by readers to The Ledger’s events board:
TUESDAY: “Hive at 35” Exhibit Opening, 11 a.m. to 4 p.m., Charlotte Museum of History. A new exhibit celebrating the Charlotte Hornets’ 35th anniversary opens today at the Charlotte Museum of History. The “Hive at 35” features Hornets artifacts and memorabilia, dating back to the team’s inaugural season as an expansion team in 1988-89. Exhibit included with museum admission.
OCTOBER 19: Things You Need to Know about Medicare “Advantage”, 7-8:30 p.m., Duke Energy Auditorium at Queens University of Charlotte. Medicare Open Enrollment begins Oct 15. Health Care Justice-NC is hosting a meeting to educate seniors on the pitfalls of Medicare “Advantage.” We’ll explain how the plans came to be, restrictions on providers, fraud charges against several of the major insurers and other aspects. Parking available in Lot A off Radcliffe Ave. Auditorium is in lower level of Rogers Building on corner of Selwyn & Radcliffe. Enter via west doors. Text RSVP to (704) 369-1318. Free.
◼️ Check out the full Ledger events board.
➡️ List your event on the Ledger events board.
In brief:
Plaza-Midwood social district: The Charlotte City Council is holding a public hearing tonight on a proposed social district in Plaza-Midwood, where walking with open containers of alcohol would be legal. The proposed social district would be in effect seven days a week from 10 a.m. to 10 p.m. along a one-mile stretch of Central Avenue and several side streets such as Thomas Avenue and Pecan Avenue. Dozens of other cities have established social districts but if approved, Plaza-Midwood would be Charlotte’s first.
South Charlotte deadly shooting: Police are looking for a suspect in connection with a shooting in the Park Crossing neighborhood off Park Road in south Charlotte that left a woman dead and a man in the hospital. Police said it appeared the two victims were in a car together when they were shot on Park Crossing Drive. (WBTV)
Police keeping closer eye on houses of worship: Charlotte-Mecklenburg Police said that in light of the conflict in Israel, it is increasing patrols at local synagogues and mosques. (CMPD)
Loves me some internet: Godzilla on the loose uptown
Ledger reader Nick shares an image he created using a new artificial intelligence tool that’s available for free. He asked Microsoft Bing’s Image Creator, which uses technology from OpenAI’s DALL-E 3, to create a “photorealistic Godzilla attacking Charlotte skyline”:
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