Mental Health

Mental health and substance use disorders affect people from all walks of life and all age groups. These illnesses are common, recurrent, and often serious, but they are treatable and many people do recover. Mental disorders involve changes in thinking, mood, and/or behavior. These disorders can affect how we relate to others and make choices. Reaching a level that can be formally diagnosed often depends on a reduction in a person’s ability to function as a result of the disorder. (SAMHSA Website). Nearly 1 in 5 American adults will have a diagnosable mental health condition in any given year. Approximately 46% of Americans will meet the criteria for a diagnosable mental health condition sometime in their life, and half of those people will develop conditions by the age of 14. Youth mental health is worsening. From 2012 to 2017, the prevalence of past-year Major Depressive Episode (MDE) increased from 8.66 percent to 13.01 percent of youth ages 12-17. Now over two million youth have MDE with severe impairment. Mental and behavioral disorders are among the leading causes of disability in the U.S., accounting for 13.6% of all years of life lost to disability and premature death.

Depression (major depressive disorder or clinical depression) is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors.  Depression, especially in midlife or older adults, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. These conditions are often worse when depression is present. 

Anxiety disorders are another very common form of mental disorder affecting our residents. Anxiety disorders are illnesses that cause people to feel frightened, distressed and uneasy for no apparent reason.  For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, school work, and relationships. Anxiety is a growing concern across the State and in Union County, especially among teens.  WRAL News in Raleigh recently talked with teens regarding anxiety, and they mentioned social media, technology and school shootings as reasons for the increased stress levels.

Suicide is rising as a leading cause of death for children and adolescents. According to the North Carolina State Center for Health Statistics, the rate of youth suicide in North Carolina has nearly doubled over the previous decade.

• 16% of high school students in 2017 reported seriously considering suicide.
• 12% of heterosexual students, and a staggering 43% of gay, lesbian, or bisexual students.

Despite this worrying trend, significant barriers remain for many who need access to mental health services. Thoughts of suicide and suicide attempts are more common among children who experience mental health issues like anxiety and depression.

Over the first few months of 2020, the world was thrown into a global pandemic. As the number of cases of COVID-19 increased, so did the associated experiences of anxiety, depression, and suicidal ideation. The mental health effects of COVID-19 are as important to address as are the physical health effects – but not everyone has equal access to care.

Positive Factors

Teletherapy Options Available 

As per the CDC, changes in the way that health care is delivered during this pandemic were needed to reduce staff exposure to ill persons, preserve personal protective equipment (PPE), and minimize the impact of patient surges on facilities. Telehealth – the use of communication and information technologies to access health care services remotely– has provided a great benefit to many patients. Not only does telehealth bring healthcare services to you at any moment, but also it addresses the scarcity of providers in remote areas, the lack of proximity to health care facilities, the restricting schedule, and the unreasonable cost. Recent policy changes during the COVID-19 pandemic have reduced barriers to telehealth access and have promoted the use of telehealth as a way to deliver acute, chronic, primary and specialty care. Many mental health professionals in Union County utilize teletherapy. 

Behavioral Health Collaborative

The Union County Human Services Agency’s Behavioral Health Collaborative program was started in fiscal year 2019 to build a partnership and help support the social and emotional needs of students at Union County Public Schools (UCPS).  The program began with initial staffing in November 2018, and, although it is still only partially staffed, has:

• Served 90 students during its first month of operation (December 2018)
• Served over 3,000 students in FY19
• Served 2,771 students during the first 6 months of FY20

Employee Assistance Programs (EAP)

An employer-sponsored employee assistance plan (EAP) is a work-based intervention program designed to identify and assist employees in resolving personal problems that may be adversely affecting their performance at work, such as marital, financial or emotional problems; family issues; or substance or alcohol abuse. EAPs may also offer a wide array of services covering basic legal assistance and referrals, adoption assistance, help finding elder care services, wellness programs, and more. Employers usually pay for EAPs, and their services are often available not only to employees but also to employees' immediate family members or to anyone living in employees' homes. EAPs can help employers reduce absenteeism, workers' compensation claims, health care costs, accidents and grievances. In addition, they can address safety and security issues, improve employee productivity and engagement, and reduce costs related to employee turnover. Many employers provide EAP programs to their employees. 

Mental Health First Aid (MHFA)

Mental Health First Aid is a public education program that can help individuals across the community understand mental illnesses, support timely intervention and save lives. Mental Health First Aid teaches how to identify, understand and respond to signs of mental illnesses and substance use disorders. The course introduces participants to risk factors and warning signs of mental health concerns, builds understanding of their impact and provides an overview of common treatments. Through role-playing and simulations, it demonstrates how to assess a mental health crisis; select interventions; provide initial help; and connect people to professional, peer and social supports as well as self-help resources. Mental Health First Aid encourages early detection and intervention by teaching participants about the signs and symptoms of specific illnesses like anxiety, depression, schizophrenia, bipolar disorder, eating disorders and addictions. The program offers concrete tools and answers key questions like “What can I do?” and “Where can someone find help?” Participants are introduced to local mental health resources, national organizations, support groups and online tools for mental health and addiction treatment and support. The course is taught by certified trainers and it usually free to community members. 

Restricting/Negative Factors

Stigma

False beliefs about mental illness can cause significant problems. Stigma is when someone views you in a negative way because you have a distinguishing characteristic or personal trait that's thought to be, or actually is, a disadvantage (a negative stereotype). Stigma usually arises from lack of awareness, lack of education, lack of perception, and the nature and complications of the mental illness. People who have mental illness experience two types of stigma - public stigma and self-stigma.  Public stigma is the reaction that the general population has to people with mental illness. Self-stigma is the prejudice which people with mental illness turn against themselves. As a result of both, people with mental illness are robbed of the opportunities that define a quality life: good jobs, safe housing, satisfactory health care, and affiliation with a diverse group of people.  It may also deter people with mental illness from seeking help.

Lack of Insurance

The rate of children with private insurance that does not cover mental or emotional problems continues to increase, and private insurance companies continue to place subtle restrictions on coverage for mental health treatments. In NC, 11.9% of Children had private insurance that did not cover mental or emotional problems. The proportion of youth with private insurance that did not cover mental or emotional difficulties nearly doubled, from 4.6 percent in 2012 to 8.1 percent in 2017. In NC, 10.8% of adults with mental illness are not insured. (2017 National Survey on Drug Use and Health: Detailed Tables https://www.mhanational.org/mentalhealthfacts). According to 2019 Community Health Assessment (CHA) surveys completed by Union County teen, adult, and senior adults respondents: 10% of teens, 15.5% of adults, 31% of senior adults cited lack of insurance as a reason to not see a mental health professional. 

High Costs

The Mental Health Parity and Addiction Equity law (MHPAE) was enacted a decade ago and promised the equal coverage of mental health and substance use services. However, the rate of children with private insurance that does not cover mental or emotional problems continues to increase, and private insurance companies continue to place subtle restrictions on coverage for mental health and substance use disorder treatments. The rate of children with private insurance that does not cover mental or emotional problems continues to increase, and private insurance companies continue to place subtle restrictions on coverage for mental health treatments. According to 2019 Community Health Assessment (CHA) surveys completed by Union County teen, adult, and senior adults respondents: 17% of teens, 38% of adults, 43% of senior adults cited lack of money as a reason to not see a mental health professional. 

Lack Mental Health and Substance Use Disorder Providers

The number of mental health providers in Union County per resident is lower than the State average. The state ratio is 439:1; Union County is 835:1. The gaps are largely felt in the rural areas of the county. Union County does not have its own emergency psychiatric hospital and those who require treatment must go out of the county to seek help. In addition, there is a lack of providers on the substance used disorder continuum in Union County. 

Transportation

Transportation is a key component of ensuring “access to care.” 90.4% of Union County residents own a vehicle while 1.8% of the population has no means of transportation. While this percent is low, there are areas within the County where this is as high as 8%. In addition, there is no public transportation in Union County. The Human Service Agency's Transportation Division (UCT) is Union County's only source of public transit, and our transportation services are available to all County residents.  According to 2019 Community Health Assessment (CHA) surveys completed by Union County teen, adult, and senior adults respondents: 12% of teens and 6% of adults cite lack of transporation as a reason to not see a mental health professional when needed. 

Program Awareness

Community members are often unaware of the resources which are available to them, multiple ways to disseminate this information needs to be developed. According to 2019 Community Health Assessment (CHA) surveys completed by Union County teen, adult, and senior adults respondents, 23% of teens and 38% of senior adults cited that they did not know where to go for mental health services.  

Workforce Recruitment and Retention

One of the best strategies for providing community mental health services is recruiting a quality workforce and retaining this workforce into the future. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the mental health workforce is one of the fastest growing in the country. Despite this growth, there is a shortage of mental health workers, especially in rural communities. Generally, the mental health workforce is made up of psychiatrists, psychologists, social workers, and counselors. The main factors that impact recruitment and retention as:

• National and local competition for mental health employment positions
• Medicaid requirements related to billing and reimbursement
• Lack of funding to support competitive pay
• Licensing requirements
• Whether or not an individual gets reimbursed for supervising a new employee
• Education and training
• Workload and resources for complex cases
• Geographic isolation
• Employment opportunity for spouses
• Cultural differences

Behavioral Health Providers

• LME/MCO
• Daymark
• Center for Emotional Health
• NAMI
• Thompson 
• Atrium Union
• Bridge to Recovery
• McLeod Addictive Disease Center
• Behavioral Health Collaboartive
• Outpatient Therapists
• Employee Assistance Programs (EAP)

Healthcare Providers

• Primary Care Physicians 
• Community Care of North Carolina
• Community Health Clinic (free clinic)
• HealthQuest 
• Matthews Free Medical Clinic
• Atrium Union 
• Novant Health
• Union County Health Department Clinics
• Union County Human Services Dental Clinic

Non-Profit Organizations

• Turning Point

Schools and Universities

• Wingate University
• South Piedmont Community College (SPCC)
• Union County Public Schools
• Union Academy (Charter School)

Union County Government 

• Human Services Agency -Department of Social Services, Health, Transportation, Veterans Services, Community Support and Outreach
• Union County Communications Department
• Union County Library
• Board Of County Commissioners
• Municipal County Leaders
• Parks and Recreation

Existing Coalitions and Community Committees

• System of Care (SOC)

Business Community

• Chamber
• Rotary Club
• Transportation Agencies

Other

• Faith-based Organizations
• Activists/Community Volunteers
• Support Groups

Steering Committee Recommendations

• Behavioral Health Therapy
• Medication for some mental health conditions
• Change legal age from 18 to 21 years to purchase cigarettes
• Support groups (NA, AA, Depression, Anxiety)
• Peer to peer programs
• School-based mental health services
• Stop the Stigma Campaign
• More green space
• More Mobile health and mental services
• Education about cognitive development (for parents; teachers) to help with intervention
• Mental Health First Aid
• EAP programs
• Physical Exercise
• Awareness Campaigns
• Tobacco Ordinance

Evidenced-based Practices

Mental Health and SUD

Mental Health First Aid Training

One in five Americans has a mental illness or substance use disorder, yet many are reluctant to seek help or simply don’t know where to turn for care. Recognizing mental health and substance use challenges can be difficult, which is why it’s so important for everyone to understand the warning signs and risk factors. Even when friends and family of someone who may be developing a mental illness recognize that something is amiss, they may not know how to intervene or direct the person to proper treatment. All too often, those in need of mental health services do not get them until it is too late. Learning MHFS has been shown to increase knowledge, confidence and helping behaviors, and reduce stigma.  Mental Health First Aid has been taught to a variety of audiences, including health, human services and social workers; employers and business leaders; first responders; faith community leaders; college and university staff and faculty; law enforcement and public safety officials; military members, veterans and family members; people with mental illness and addiction and their families; and other caring citizens. Certified Instructors teach the program in communities

Youth Mental Health First Aid is designed to teach neighbors, teachers, parents, peers, and caring citizens how to help a youth or teen who is experiencing a mental health or substance use challenge or is in crisis. The course discusses mental health challenges for youth, reviews typical adolescent development, and provides guidance through the ALGEE action plan for both crisis and non-crisis situations. Topics covered in the manual include anxiety, depression, substance use, disorders in which psychosis may occur, disruptive behavior disorders (including AD/HD), and eating disorders.

Prevention and Education

Mental health conditions and serious mental illness are impacted by a variety of factors. Prevention measures in community settings can help to support individuals at risk of or living with mental health conditions. Community members should be educated about the importance of treatment and prevention. Community education can help to reduce stigma surrounding mental health conditions and promote a positive mental health environment. Training sessions can be formal classes regarding constructive mental health promotion or informal conversations between community members. Change in the perception of mental health often starts with individuals; moves to families, the workplace, and schools; and ends with community leaders who are then equipped to maintain formal and informal community education efforts surrounding mental health.

Employee Assistance Programs (EAP)

An employer-sponsored employee assistance plan (EAP) is a work-based intervention program designed to identify and assist employees in resolving personal problems that may be adversely affecting their performance at work, such as marital,    financial or emotional problems; family issues; or substance or alcohol abuse. EAPs may also offer a wide array of services covering basic legal assistance and referrals, adoption assistance, help finding elder care services, wellness programs, and         more. Employers usually pay for EAPs, and their services are often available not only to employees but also to employees' immediate family members or to anyone living in employees' homes. EAPs can help employers reduce absenteeism, workers' compensation claims, health care costs, accidents and grievances. In addition, they can address safety and security issues, improve employee productivity and engagement, and reduce costs related to employee turnover. Many employers provide EAP programs to their employees. 

Telehealth/Teletherapy

 As per the CDC, changes in the way that health care is delivered during this pandemic were needed to reduce staff exposure to ill persons, preserve personal protective equipment (PPE), and minimize the impact of patient surges on facilities. Telehealth – the use of communication and information technologies to access health care services remotely– has provided a great benefit to many patients. Not only does telehealth bring healthcare services to you at any moment, but also it addresses the scarcity of providers in remote areas, the lack of proximity to health care facilities, the restricting schedule, and the unreasonable cost. Recent policy changes during the COVID-19 pandemic have reduced barriers to telehealth access and have promoted the use of telehealth as a way to deliver acute, chronic, primary and specialty care.

School-based Health Centers Services

School-based health centers (SBHCs) are the ideal location for primary care and mental health staff to collaboratively address students’ physical and mental health needs—leading to greater success in school and in life. Their proximity to students and ability to provide mental health care in a safe, private, and confidential environment allows for the development of ongoing relationships between practitioner, patient, and family to support positive behavioral change.To have the greatest positive impact, school-based mental health services should be fully integrated into the everyday functioning of the school by following these best practices:

Mental health services build from and complement a positive school climate.

Mental health services, especially prevention and early intervention services, are available to all students.

Mental health providers work with school staff in teams.

Mental health providers serve as a resource to teachers and other school staff.

School districts partner with county and community agencies to provide mental health services.

Mental health services are organized into a three tier system: universal, targeted, and intensive.

Other

Work Force Recruitment

Recruitment focuses on attracting current health professionals and students to open positions or to future positions. Retention focuses on keeping healthcare professionals employed in their healthcare facilities and communities. Successful recruitment and retention practices can minimize the number and duration of staff vacancies, which can, in turn, save money, improve quality of care, and ensure that services are provided in the community.