Data is gathered from NC DETECT. This table provides emergency room (ER) visits related to suicidal ideation/thoughts/plans/intent. The data points include suicide ideation ER visits from Buncombe County residents, as well as ER visits for the entire state of North Carolina. 

**NOTE: At this time, NC DETECT data reports only include overall numbers for Emergency Room visits for suicidal ideation; goal is to obtain and include disaggregated data by race/ethnicity and gender.

Story Behind the Indicator data was gathered from: community partners/providers, those impacted the most/those with lived experience, and Buncombe County residents.

What’s Helping? - Mental Health

• “Buncombe is resource rich comparatively”
• “There are a lot of mental health professionals working in this area”
• “Outreach to vulnerable, at-risk groups”
• “Prevalence of telehealth and support group options [during COVID-19 pandemic]
• “Community health workers are bridging a lot of gaps, especially when everything was shut down”
• Peer supports - those with lived mental health experience
• Existing community programs that address mental health
• Crisis Intervention Training (CIT) for law enforcement and first responders
• Community Health workers
• Increase mental health screenings within primary care provider offices
• New national 988# for crisis support
• 211
• NCCARE 360

What’s Hurting? - Mental Health

• “Stigma”
• “Waitlists [for services] are sometimes longer than 3 months”
• “Medicaid access barriers and insurance costs”
• “Systemic racism within healthcare systems – we need more culturally aware service providers”
• “High cost of living and poverty creates housing instability which negatively influences mental health”
• "3+ month waitlists for services" 
• "Medicaid barriers and insurance costs"
• "Licensed providers who bill through insurance are often controlled by larger entities" 
• "Current practice requires an individual to have a 'clinical home' established in order to access services"
• "Not enough mental health resources available to meet the needs of the community"
• "Systemic racism and reasonable distrust in systems of oppression"
• "High cost of living"
• "Impact of social determinants of health"
• "There are a few big, corporate mental health agencies vs. the need for more culturally aware inclusive services"
• "Waitlist times, especially for adolescents needing appointments for psychiatric support"
• "Crisis burnout and secondary traumatic stress exposure for health care/social service workers has been amplified by the COVID-19 pandemic"

Partners in our Community Health Improvement Process:  

• Buncombe County CHIP Advisory Council members/agencies
• VAYA 
• North Carolina Center for Health and Wellness
• WNC Healthy Impact

Partners with a Role in Helping Our Community Do Better on This Issue: 

• CHIP Advisory Council members and organizations
• MAHEC
• Local hospital networks *to be further defined
• Community-based crisis programs *to be further defined
• Buncombe County EMS – Community Paramedicine/Post-Overdose Response Team
• Harm Reduction Providers – community reversals *to be further defined
• *Community-based peer support specialists – to be further defined
• Sunrise Community for Recovery & Wellness
• Umoja Health, Wellness, and Justice Collaborative
• Appalachian Mountain Community Health Services
• Institute for Preventive Healthcare & Advocacy

Strategies Considered input was gathered from: community partners/providers, those impacted the most/those with lived experience, and Buncombe County residents.

What Works to Do Better?

• Talking about it (formally and informally) supports with reducing isolation and stigma
• Provide more specific education that normalizes personal experiences
• Language Justice - more Spanish speaking peer supports, counselors, healthcare providers; widely available materials that are in Spanish; services delivered in Spanish without being put on a waitlist for interpretation services
• Formal Children’s Collaborative group to address micro and macro-level advocacy
• Home Visitors services to support with healthy attachment and parenting skills
• Growth around brining attachment-focused parenting
• Organizations becoming more trauma-aware
• Dismantling white supremacy culture within healthcare and social services institutions
• Creating systems and services that are equity-driven 

Process data was gathered from a variety of community-driven sources, including those with lived experience, those most impacted by the focus health condition, those providing services/support in the community, professionals/organizations with a role to play, and the 40+ agencies that represent the Buncombe County CHIP Advisory.