‘We are sinking’: More anxiety, more violence, and a shortage of NC healthcare workers

“Folks, we have a huge problem with mental health,” state Senator Jim Burgin (R-Harnett) told a room full of people at a town hall in Kannapolis last week.

Sharing the stage with North Carolina Health and Human Services Secretary Kody Kinsley and three other Republican legislators, Sen. Burgin said lawmakers wanted to hear directly from the public about mental health and substance abuse challenges in advance of the upcoming legislative session.

The percentage of American adults with symptoms of anxiety or depression nearly quadrupled during the pandemic.

“Usually in a given week, one in nine people would say ‘I feel lonely, low or I feel a bit anxious.’ During that period of time, that number went to one in three, disproportionately among younger individuals,” Kinsley told the audience.

The 2022 Mental Health America report ranked the state 21st in adult mental health, but 42nd in youth mental health and 38th in access to care.

Over half (51.6%) of North Carolina adults with a mental illness receive no treatment.

Trauma as a common denominator

Gwen Bartley, executive director of Amazing Grace Advocacy, said the county’s mental health task force has recently been focused on the threat of mass-shootings.

“We recognize that trauma has been a common denominator in many of the national tragedies. So, we’re wondering is North Carolina conducting any research or providing any information for communities to do preventative work in regard to mass shootings that focuses on the trauma and behavioral health aspects?”

Sec. Kinsley agreed gun violence has been more frequent. Five North Carolinians per day die from a firearm-related death, more than 1,700 in 2020.

He recounted the October 13th mass shooting in Raleigh’s Hedingham neighborhood that left five people dead. The Chief Medical Examiner’s Office worked through the weekend performing autopsies on the victims.

“And then two days later, a two-year-old crawled into the back seat of their Dad’s truck and shot a gun and killed himself, and we had to take that body as well.”

Kinsley said in addition to discussing the trauma, the state must focus on safe gun storage.

“Everyone wants to protect their families, if you need quicker access to a firearm, then there’s a firearm safe. 4-H staff, they are talking about safe shooting training — it is just as much about how to respect a firearm as it is about leadership and civic duty.”

Kinsley believes a layered, public health approach can improve community safety.

“Thinking [of it] akin to how we think about traffic accidents. There isn’t a one answer solution for trying to reduce injuries from traffic accidents. Over 30 years we were able to really reduce the number of people who got in accidents and people who were injured from it because we had a layered approach. We didn’t say one size fits all, we met people where they were, and we tried to change behavior over time. There were seat belts and speed limit signs and air bags for folks that don’t wear seat belts, an array of different things. And I believe we can do the same thing around violence.”

NCDHHS just released a ten-page white paper on approaches for reducing gun misuse and mitigating violence. It’s estimated 32% of youth firearm suicides and unintentional firearm deaths could be prevented through safe storage.

“Who’s coming to work for us and do this kind of work?”

Up next, a veteran health care provider from Winston-Salem raised concerns that residential facilities that care for those with behavioral needs are increasingly closing because of low wages and burdensome requirements.

“We talk about the kids and how we want to provide for them, but the state is not helping residential level three providers to keep kids and stay open.”

Pam Phillips explained how a little-known statute passed by lawmakers in 2015 required her facility to hire workers with at least a year of experience, even for the most entry-level tasks.

“People that have experience, they are not coming to work for us for what we can pay. They are not,” Phillips said firmly.

“I got into this because I got tired of seeing these kids that were misdiagnosed sent to the county jail, so this is real to me.”

The 65-year-old Phillips said she has been trying to find out where that statute came from for four years in hopes of getting it changed. Until that happens, she’s unable to take in more patients at the Triad home that provides care for young men.

“We need help. We are sinking. We are at the bottom of this mental health structure, and we can’t hire anybody.”

Phillips said when Arby’s can offer a starting wage between $17 and $22 per hour, her behavioral health facility can’t compete.

“Who’s coming to work for us and do this kind of work?” Phillips asked. “I’ve been spat on and everything else. But I just keep praying and keep moving.”

Opioids take their toll

Dr. Russell Suda, an obstetrician in Kannapolis, told lawmakers the state must do more to help pregnant women who are also substance users.

The opioid epidemic started in 1990s mainly as a male problem.

“But by 2010 we’ve got more women showing up for overdoses at ERs. More women are showing up in rehab,” Suda explained. “Men are still outdistancing women in being successful at committing suicide, but women are doing it more often.”

“What I’m pleading for here is to bring care to pregnant women as a priority.”

Too often, Suda said, doctors don’t want to treat pregnant patients with an addiction, worried about possible malpractice claims against them.

Programs like the SUN Project at the Cabarrus Health Alliance (CHA) provide prenatal care and clinical services to women suffering from substance use disorders.

Suda said trying to keep mothers and babies together may be one of the best strategies for breaking the cycle of addiction and keeping families together.

“Every dollar you spend, gives seven dollars in savings from criminal justice work, more health care work, from social service work, from all these other allied services that are costly,” Suda reminded the panel.

Do it right, not quick

Addiction was also on the mind of Mary Beth Poplin, the nurse manager over behavioral health services at Atrium Health Cabarrus.

“I have a front row seat to the emergency department, and I can tell you I have ten kids there currently.”

With almost forty years in the medical field, Poplin said she has learned what does and doesn’t work.

“You’re not gonna fix anything in five days. I can’t get somebody sober in five days. If you want to get somebody off drugs and alcohol, I need a 30-day in-patient treatment center where they get through steps one, two and three and they get a temporary sponsor, and then they don’t come back to my ER,” explained Poplin.

She told lawmakers that when it comes to programming, you can’t put a band-aid over a hemorrhage.

Patients need time to recover from mental health challenges and substance abuse, not to be turned out after a handful of days expecting that will result in a better outcome.

“Take some time to do it right, not quick.”

The elephant in the room

Keshia Sandidge, a clinical social worker and member of the Cabarrus County Board of Education, asked the question that was on the minds of many in the room.

“When are we going to expand Medicaid here in North Carolina?”

The North Carolina Senate passed a bill to expand Medicaid in June, only to have the legislation bottled up in the state House. On this night, Sen. Paul Newton (R -Cabarrus) seemed content to let the House members take the heat.

“We recognized the financial benefits to the state. We recognized this is a window for those financial benefits that might close. We also recognized the population we’re talking about these are not ne’er-do-wells, these are people who are working, but just making too much money to qualify for Medicaid.

“Long story short, we decided it was in the best interest of North Carolinians to expand. Our colleagues in the House had a different notion on that. I’ll let them answer,” said Newton with a smile.

Rep. Kristin Baker, M.D. (R-Cabarrus) said Medicaid transformation has finally put the state in a position to consider Medicaid expansion, but it must be a clean bill.

“If it’s not just Medicaid expansion, we need to look at everything else in that bill, and we need to do a risk benefits trade-off,” said Baker, a practicing psychiatrist. “It is complicated, we have to do the right thing by our citizens health-wise and fiscally. We need to make sure it’s a good bill the whole way through.”

Sandidge stood her ground.

“I appreciate that we do have a lot of problems. I totally agree with that,” Sandidge responded. “But you guys are the ones we have assigned to address them. So, we expect for you guys to do that.”

Lawmakers will get their chance to tackle Medicaid expansion again in January. Each month that passes without expansion, the state is missing out on $521 million in federal funding according to Kinsley.