The Chatham Health Alliance deemed “access to comprehensive health services,” which included mental and physical health, as the No. 1 issue affecting Chatham County’s overall public health in the 2018 Chatham County Community Assessment.
“Many of the same barriers impede access to physical and mental health care, including services not being covered by insurance, lack of insurance, prohibitive costs, transportation, scheduling, and stigma,” the CCCA stated. “Healthcare, including access, cost, and quality, was listed as the number one issue affecting community health and seventh leading issue affecting quality of life for Chatham residents in the 2018 CCCS.”
Mental health professionals and advocates are worried about the impact the COVID-19 pandemic will have on society’s mental well-being, but both Chatham County and North Carolina lag behind their neighbors in access to those services.
In October 2018, the Kennedy-Hatcher Center for Mental Health Equity gave North Carolina an “F” grade on whether or not its state statutes treat mental health and physical health the same — this despite North Carolinian adults and youth having mental illnesses at higher rates than the national average: 1 in 5 for adults, 1 in 10 for youth compared to 1 in 6 and 1 in 12, respectively, in the United States.
The insurance quote firm QuoteWizard recently analyzed depression rates over a five-year period by state to measure access to mental health care and ranked North Carolina 43rd out of 50 states.
State Rep. Robert Reives II (D-Chatham) said that his conversations at the state level about mental health haven’t inspired much optimism.
“I wouldn’t even try to attribute what they say, but I’ll just say that they don’t realize that it’s an issue,” he said of his colleagues. “It’s not somebody simply not able to deal with something. It’s not a weakness on their part. It’s just a true life issue that just happens, and it happens to a lot of us, is the sad part.”
Derrick Jordan, the superintendent of Chatham County Schools, said the state has been helpful in supplying funds for school safety, but added that more needs to be done in mental health.
“Students are going home to parents who have mental health challenges or other family members who have mental health challenges,” Jordan said. “Figuring out how to balance that becomes a difficult proposition. I think we need more, more, more, more, more, certainly within the area of mental health, but not just within the school arena. We need mental health focus external to schools as well.”
Chatham County doesn’t fare too much better than the state in terms of access. The CCCA found just 1.34 psychologists per 10,000 residents in Chatham. The state average is 10. Additionally, the report says 39.5 percent of county residents knew where to find mental health services.
And utilization of services available, like the state-funded Cardinal Innovations Healthcare, is relatively low and decreasing. According to the 2019 Community Child Protection Team report, an average of 62 people per month came through Daymark Recovery Services — a mental health clinic supported by Cardinal Innovations — last year, a decrease of 70 from 2018 and 77 in 2017. Additionally, for fiscal year 2017-2018, Daymark provided 5,256 services, a 32 percent drop from the previous year.
The county government maintains a webpage — chathamnc.org/mentalhealth — that features several links to providers and information about finding help. The page stresses the importance of finding mental health treatment.
“Mental health needs to be understood at a new level,” the page states. “This includes a person’s emotional, psychological, and social state of being. The way that a person thinks, behaves, and experiences emotion is affected by their mental health. In turn, mental health is also affected by body chemistry, life experiences, and family history. The way that we perceive mental health should be no different than physical health.”
Most of the providers on the webpage’s list — mainly mental health counselors — accept Medicaid, and some take uninsured patients. But one of North Carolina’s barriers to mental health access referenced by studies and advocates is a lack of Medicaid expansion.
Medicaid provides health coverage to 27 million children under the age of 18 and covered 65.9 million people in 2018. The passage of the Affordable Care Act in 2010 gave states the option to expand Medicaid eligibility to uninsured adults and children whose incomes are at or below 138% of the federal poverty level. North Carolina has not taken up that expansion.
But that hasn’t stopped elected officials and health advocacy groups in North Carolina to keep pushing for expanding Medicaid. In the summer of 2019, a study conducted by George Washington University and funded by the North Carolina-based Cone Health Foundation and Kate B. Reynolds Charitable Trust estimated that expansion would insure an additional 3,673 more people in Chatham County. Chatham County’s Department of Social Services estimates that around 9,500 Chatham residents are currently on Medicaid, more than 13 percent of the county’s population.
And antidepressants ranked as the No. 1 drug group of prescriptions paid for by Medicaid in 2015, 2016 and 2017.
Both Reives and Jennie Kristiansen, the director of the Chatham County DSS, told the News + Record that there is a gap not being filled.
“The people who probably need the most help are falling in those health insurance gaps,” Reives said. “You have people who either can’t get it covered at home or they’ve got plenty of resources, they’ve got an overwhelming amount of resources, and I think that we’ve got to do better about filling in that gap, especially with this issue.”
Kristiansen added, “We do see families here at DSS who don’t or individuals too who aren’t eligible for Medicaid and their income is too low to qualify for coverage through the Affordable Care Act, and so they don’t have access to healthcare coverage. So I think that’s concerning too, and in thinking about access that certainly makes access more difficult.”
That lac of access to services has become an issue during the COVID-19 pandemic, when the normal avenues for treatment are taken up by coronavirus concerns. In response, Cardinal Innovations created a mental health crisis line at **ASK (or **275) for help specifically during this time. The agency’s board of directors includes Chatham County Public Health Director Layton Long, who said in a statement that **ASK is a “better alternative” to 9-1-1 for Chatham residents experiencing a mental health crisis.
“When they are able to speak to a licensed clinician in seconds, our community members can get quickly connected to the care and support they need,” Long said. “This also helps decrease traffic in crowded Emergency Departments as we continue to deal with the COVID-19 pandemic.”
Government agencies have also worked to provide funding for mental health services during this time. Among the moves:
• The Federal Emergency Management Agency began awarding federal money for mental health services to the state starting this month.
• The N.C. General Assembly passed and Gov. Roy Cooper signed a bill allocating $10 million to the state Dept. of Public Instruction for “contracted services... for school health support personnel to provide additional physical and mental health support services for students in response to COVID-19, including remote and in-person physical and mental health support services.” That would include school counselors, nurses, psychologists and social workers.”
• Senate Bill 704, which was also signed into law, directed for a study to be done looking at issues “that impact health care delivery and the health care workforce during a pandemic.” One of the issues the study should cover, the bill said, is the “sufficiency of support mechanisms for the health care workforce, including the availability of child care, transportation, mental health and resilience support services, and other support items.”
UNC-Chapel Hill professor Mitch Prinstein, who writes about and studies mental health among teenagers, said one of the most important steps society can take to address mental health, and with it access, is by eliminating the stigma around the topic — something both the CCCA and the county’s mental health webpage addressed.
“80 percent of humans experience some sort of significant mental health difficulty in their lifetime,” Prinstein said. “Eighty percent. This jig is up people. Everyone is going to basically have something going on at some point. I think it’s time we start talking about this as when and which difficulty rather than whether someone’s going to have a difficulty.”
Editor’s Note: Almost the entirety of the reporting for this piece was done as part of the News + Record/Our Chatham podcast series “The Chatcast,” which is available on Spotify, Apple Podcasts, Stitcher and wherever you get podcasts now. This content was covered specifically in Episode 8, “Stuck in the Gap.” You can also find more at chathamnewsrecord.com/chatcast.
Reporter Zachary Horner can be reached at zhorner@chathamnr.com or on Twitter at @ZachHornerCNR.