According to the CDC, suicide has no single determining cause, but “occurs in response to multiple biological, psychological, interpersonal, environmental and societal influences that interact with one another, often over time” (Preventing Suicide, A Technical Package of Policy, Programs, and Practices). Adding to the complexity of addressing this issue is the ever-present stigma associated with seeking mental health care and the recognition that “mental health and access to treatment services are often overlooked in our health care system” (Healthy NC2030 Report). Barriers to mental health care also exist, particularly for those who are uninsured or underinsured and the emotional toll on families and friends is also significant.

The Need for Local Data

Current county-level behavioral health data are difficult to find. While a resident survey conducted in the 2016 Community Health Assessment (CHA) estimated self-reported prevalence of depression and anxiety in Guilford County at over 20%, this type of data collection is resource intensive. Medical records analysis is hampered by access restrictions. We lack current local data on issues that affect many in our community, including tobacco and alcohol use, perinatal anxiety or depression and trauma. We also do not have current local data on youth and issues like mental health, bullying and substance use.

From available data and the 2019 CHA “deeper dive” qualitative surveys and workshop discussions around mental health and opioid dependence and overdose, concerns regarding adequate access to care were frequently expressed. Following closely in importance was the recognition of the impact of the social determinants of health on mental health, community prevalence of substance use disorders, shortage of trained providers and treatment resources, knowledge of available mental health services, social stigma attached to mental health problems, lack of integration of mental health and primary care, lack of social support and toxic stress.  

2019 CHA key informant workshop participants were asked to share words or phrases that expressed their views of the current state of mental health in Guilford County and “chaotic,” “complex,” “broken” and “fragmented” were the most common one-word terms used (see image below). While these word clouds are not precise statements of fact, they may be interpreted as barometers of current values, perceptions, moods and priorities.

The 2019 CHA Key Informants struggled to identify services, infrastructure assets and policies that effectively address mental health in the county. They noted several important gaps or needs relating to mental health, including the need for greater integration of physical and mental health services, more trained and culturally representative providers, community supports for social determinants and more health insurance access (Medicaid expansion). Respondents also identified racial and ethnic minorities and children and adolescents as two population groups especially impacted by mental health issues. Racial minorities face inequity in access to mental healthcare and experience bias within that system.

Key Informants also considered promising approaches to improving Behavioral Health concerns. Suggestions and recommendations for addressing mental health issues addressed services offered, access related issues and service integration. Promising approaches included the promotion of community partnership such as faith-based integration, new enhanced crisis services and healthcare-community connections through joint facilities, transitions of care and integrated behavioral and primary care. When asked what makes them feel hopeful about the future of Behavioral Health, some key informants noted the importance of mental health “providers” and “collaboration” (see image below).  

Suicide

The suicide rate, one key mental health indicator, has risen over the years in NC and Guilford County. While the Guilford County five-year age-adjusted suicide death rate was 11.5 per 100,000 population (2014-2018) close to the Healthy 2030 target (11.0), this rate is not consistent across all subgroups.

As the charts below show, Guilford County men had a five-year age-adjusted suicide death rate that was three times higher than for women (18.8 as compared to 5.1 deaths per 100,000 population). Suicide death rates were more than four times higher among Whites (17.4 per 100,000) compared to African Americans (4.2 per 100,000).

Age is also a factor. In 2018, 45% of suicide deaths occurred among persons ages 20-39, with smaller percentages of deaths in other age groups (2020 Injuries Data Brief).

Because other challenges often contribute to suicide, such as those related to relationships, substance use, physical health, and job, money, legal, or housing stress, it will take the whole community to work together to address suicide and the mental health needs of our Guilford County community.

Below are three key partners who are working collaboratively to support a single point of entry, behavioral health urgent care that is linked to a crisis facility and use an integrated model of physical and psychological health:

Guilford County is the third largest county in North Carolina, includes the cities of Greensboro and High Point and is governed by a nine-member Board of Commissioners. The Commissioners are responsible for adopting the annual budget and establishment of the property tax rate. They adopt ordinances, or local laws, that govern issues such as development, noise and public health.

Sandhills Center is a Local Management Entity and a Medicaid-funded Managed Care Organization (LME-MCO) that acts as an agent of the NC Department of Health and Human Services. Sandhills Center provides access to publicly funded mental health, intellectual/developmental disabilities and substance abuse services for the citizens of Anson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph and Richmond counties. Sandhills Center connects people in need of services with providers and other community partners. Sandhills Center manages a network of providers to ensure quality services are available.

Cone Health is a not-for-profit health care network serving people in Alamance, Forsyth, Guilford, Randolph, Rockingham and surrounding counties. Cone Health has more than 100 locations, including five hospitals, three ambulatory care centers, three outpatient surgery centers, five urgent care centers, two retirement communities and more than 120 physician practices. These include primary and specialty care through Cone Health Medical Group and Triad HealthCare Network. Cone Health’s Behavioral Health Hospital offers pediatric and adult inpatient crisis stabilization at an 80-bed facility. Outpatient care includes numerous group therapy programs as well as individual counseling and day programs. The hospital also offers the community a 24-hour helpline that provides access to trained mental health professionals. Additional outpatient behavioral health centers are in Greensboro, Kernersville and Reidsville.

The Healthy NC 2030 Report identifies three levers for change to address suicide that coincide with developing efforts in Guilford County, including:

• Increasing state funding for mental health services provided through local mental health systems.
• Improving access to social services and other supports.
• Continuing to support the integration of physical and mental health (CDC, 2019) (HNC2030 Report).

In 2018, three large providers in mental health care, Guilford County, Cone Health and Sandhills Center, combined efforts to address mental health treatment in Guilford County through the formation of the Guilford County Behavioral Health Crisis Collaborative. As a result, there is an increased recognition that improved behavioral health would include: a single point of entry, behavioral health urgent care that is linked to a facility-based crisis facility and use an integrated model of physical and psychological health. Towards that end, steps are underway to support the formation of mental health urgent care center and two 16-bed facility-based crisis centers (one for adults and one for children and adolescents) with space for outpatient services for adults, adolescents and children by 2021, including securing state and other funding to support services provided through local health systems.