Mental Health & Substance Misuse and our related result are aligned with the following Healthy NC 2030 Indicators:

• Reduce the suicide rate (per 100,000 population).
• Drug overdose/poisoning deaths

How would we experience this result in our community if we are successful?

• Access and ability for all people in Buncombe County to attain safe and affordable homes
• Social connection/cohesion across communities
• Free transportation 
• No ageism (especially with providers)
• No stigma
• Healthy intergenerational relationships
• Access to mental health care
• Equity exists - no discrimination - inclusive communities
• Accountability and commitment from systems and funders
• Dismantle hierarchical systems
• Less gatekeeping services
• Systems that empower
• Self-advocacy to meet needs
• Equitable opportunities
• Resiliency/strengths are honored and celebrated
• Acceptance of mental health as part of whole-person health
• Hope that things can change and improve
• No overdose deaths
• Readily accessible/available overdose reversal and drug testing kits

What information led to the selection of Mental Health & Substance Misuse and this related result?
Mental Health and Substance Misuse were one of 5 health conditions based on the size and severity of the issue in our community. Both primary and secondary data sources were compiled to support with size, severity, and feasibility. The Buncombe County CHIP Advisory Council, with representation from 40+ community organizations, were actively engaged in multiple monthly work sessions to identify which community health conditions to prioritize based on relevance, impact and feasibility.

Key findings related to Mental Health & Substance Misuse included:

• 27% of Buncombe County survey respondents identified having more than seven days of poor mental health in the last month (an 8% increase from the 2018 Buncombe CHA)
• 42% of Buncombe County survey respondents have experienced symptoms of Chronic Depression (compared to 33% from 2018 Buncombe CHA and 30% in the United States)
• 13% of Buncombe County survey respondents identified that they were dissatisfied or very dissatisfied with life (a 4% increase from the 2018 Buncombe CHA)

Access to Services/Care

• 25% of Buncombe County survey respondents identified they were unable to access needed mental health care or counseling in the past year, which is an 8% increase from the 2018 Buncombe CHA 

Mental Health-Related Emergency Department Visits (Anxiety, Depression, and Self-Harm

• 9% of White Buncombe County survey participants, 8% of Black/African American participants, and 16% of Hispanic/Latin/Latinx participants identified having suicidal thoughts in the last twelve months 

Alcohol Use & Dependency

•  61% of Buncombe County survey respondents identified as current drinkers which is a 9% increase from the 2018 Buncombe CHA 
• 23% of Buncombe County survey respondents identified themselves as heavy drinkers (compared to 18% for the WNC region and 15% for North Carolina)
• 24% of White Buncombe County survey participants, 17% of Black/African American participants, and 24% of Hispanic/Latin/Latinx participants identified themselves as binge or heavy drinkers

Substance Misuse

• 118 Buncombe County residents died due to drug overdose in 2021
• 108 Buncombe County residents died due to drug overdose in 2020

Mental Health and Substance Use/Misuse: trending increase of reported mental health symptoms (depression and suicidal ideation), continued increase in drug overdose deaths

Population health data continues to reflect that mental health and substance use are a growing public health crisis across the nation, and local data supports similar levels of urgency in Buncombe County. In applying a socio-economic perspective and life course framework to mental health and substance use, the underlying or root causes of these health inequities becomes clearer. When examining mental health through the lens of racial equity, research demonstrates that exposure to racism through structural and systemic oppression is as much of a significant health indicator as exposure to discrimination (Williams, 2019). More specifically, the experience of racism is a root cause for health disparities, not an individual’s racial or ethnic identity. Given the root causes for diseases of despair, there is also a clear connection between an individual’s exposure to Adverse Childhood Experiences and Adverse Community Environments (the pair of ACEs) and systemic racism and oppression on health outcomes.
Decades of research on Adverse Childhood Experiences has demonstrated that an individual’s exposure to traumatic events increases the risk of substance use/abuse, which has since supported a shift towards trauma-informed treatment and services (Philippa, et al, 2011). This shift in treatment focus highlights the importance of trauma-informed and resiliency-based interventions – meaning the focus is now shifting to understanding the events, circumstances, and systems and environments (social determinants of health) that have caused harm to an individual, rather than placing unreasonable responsibility on an individual for circumstances which are heavily influenced by social and environmental determinants of health and often outside of their control.

At a population level, this looks like dismantling oppression and racism in all policies and systems, and on a community or local level this involves rebuilding mental health and substance use services and interventions that are culturally sensitive and trauma informed. This shift to providing evidence-based harm reduction interventions that center around meeting an individual “where they are” and creating opportunities for authentic connection and resiliency continue to show promising outcomes.

Philippa L. Farrugia, Katherine L. Mills, Emma Barrett, Sudie E. Back, Maree Teesson, Amanda Baker, Claudia Sannibale, Sally Hopwood, Sabine Merz, Julia Rosenfeld & Kathleen T. Brady. (2011). Childhood trauma among individuals with co-morbid substance use and post-traumatic stress disorder. Mental Health and Substance Use, 4(4), 314-326, DOI: 10.1080/17523281.2011.598462

Williams D. R. (2018). Stress and the mental health of populations of color: Advancing our understanding of race-related stressors. Journal of Health and Social Behavior, 59(4), 466–485. https://doi.org/10.1177/0022146518814251