Publications

Transforming North Carolina's Mental Health and Substance Use Systems: A Report from the NCIOM Task Force on Mental Health and Substance Use (2016)

Abstract

Mental health and substance use disorders are among the top conditions for disability and burden of disease, as well as cost to families, employers, and publicly funded health systems in the United States and worldwide. In the spring of 2016, North Carolina Governor Pat McCrory issued an executive order declaring, “mental illness and substance use disorders are among the biggest health care challenges that our state will face over the next decade." The North Carolina Institute of Medicine (NCIOM) Task Force on Mental Health and Substance Use was funded by the Kate B. Reynolds Charitable Trust, with the goal of developing recommendations to increase and improve community-based and evidence-informed prevention, treatment, and recovery services and supports for individuals with mental health and substance use disorders. The Task Force focused on recommendations to support a full continuum of community-based mental health and substance use prevention, treatment, and recovery services for all North Carolinians, as these services are essential to keeping people healthy in their home communities and assisting people who are transitioning back into the community after a crisis or in-patient treatment.

Full Description

Mental health and substance use disorders are among the top conditions for disability and burden of disease, as well as cost to families, employers, and publicly funded health systems in the United States and worldwide. In 2014, approximately one in five adults in North Carolina had a diagnosable mental, behavioral, or emotional disorder during the past year and one in twelve adults was dependent on or abusing alcohol or illegal drugs. While many people report mental health concerns or low levels of substance use, mental health and substance use disorders are uniquely characterized by ongoing signs and symptoms that impair an individual’s ability to relate to others and function in their daily lives.

Mental health and substance use disorders are chronic or recurrent conditions that, like other chronic illnesses, require ongoing care and treatment for individuals to regain health and maintain recovery from mental health and substance use disorders.  As with any chronic disease, prevention, identification, treatment, and recovery services and supports are essential to ensuring positive health outcomes. These services, when managed and implemented effectively, can minimize costs to individuals, families, businesses, and governments in the long-run.

Effective treatments for mental health and substance use disorders exist and can help individuals with mental health and substance use disorders live, work, learn, and participate fully in their communities. Unaddressed mental health and substance use disorders can have a variety of negative influences on homelessness, poverty, employment, safety, and the economy. In North Carolina, access to services and supports for individuals with mental health and substance use disorders varies based on a number of factors, including insurance coverage, specific type of mental health or substance use disorder, and geographic location.

The prevention, diagnosis, and treatment of mental health and substance abuse disorders are difficult for several reasons. One reason for such difficulty is that there is no “system” for mental health and substance use services. The “system” includes a variety of fragmented providers and services and the various agencies that provide funding and oversight. The fragmentation of the mental health and substance use service systems contributes to unnecessary disability, school failure, homelessness, and incarceration.5 Fragmentation and disarray are primarily driven by payment policies that create huge disparities in access to high-quality, effective prevention, treatment, and recovery services as well as the lack of integration between mental health and substance use services and physical health services, and the nearly constant changes over the past 15 years to North Carolina’s public mental health and substance use system. This fragmentation creates significant systemic barriers to delivering the prevention, treatment, and recovery services that are needed.

Mental health and substance use are at the forefront of health policy issues today, both at the national and state levels, due to rising visibility of the costs of not addressing mental health and substance use treatment needs. In 2015, with funding from the Kate B. Reynolds Charitable Trust, the North Carolina Institute of Medicine (NCIOM) convened the Task Force on Mental Health and Substance Use, with the goal of developing recommendations to increase and improve community-based and evidence-informed prevention, treatment, and recovery services and supports for individuals with mental health and substance use disorders. The Task Force had three workgroups; cross-cutting, which considered how to support the development of a full continuum of community-based mental health and substance use prevention, treatment, and recovery services for all North Carolinians, and adolescent and older adult workgroups, which looked specifically at the unique needs of these populations.

The Task Force was co-chaired by Angela Bryant, Senator, North Carolina General Assembly; Courtney Cantrell, PhD, former Director, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, North Carolina Department of Health and Human Services; Josh Dobson, Representative, North Carolina General Assembly; and John Santopietro, MD, FAPA, Chief Clinical Officer of Behavioral Health, Carolinas Health System. They were joined by 67 other task force and steering committee members including legislators, state and local agency representatives, service providers, advocates, and community representatives. The Task Force met five times and each workgroup met four times between June 2015 and July 2016.