HAMLET — During a roundtable discussion on Medicaid expansion at the Hamlet Depot on Wednesday, Gov. Roy Cooper turned the conversation toward mental health and substance abuse.
The governor, addressing Hamlet Police Chief Dennis Brown, said he’s heard about the challenges faced by law enforcement by those with mental health and addiction issues.
According to Brown, the two seemingly go hand-in-hand.
“What we’re finding (is) our folks that are going through a mental health crisis are self-medicating,” Brown said. “They know they need help. The hospital has become a negative place for them. They don’t want to go to the hospital anymore, so they’re treating themselves with illegal narcotics, substances they find on the street.”
The chief said the mental health and addiction situation has extended beyond the tipping point, and Richmond County, as a Tier 1 county, is more affected due to the lack of resources.
Dr. Tammie Gainey, CEO of Sandhills Best Care in Rockingham, said her office is dealing with mental health and addiction daily.
“Rural communities in North Carolina have been Ground Zero for the opioid epidemic,” said Kody Kinsley, secretary of the N.C. Department of Health and Human Services.
Gainey referenced a recent report from the Office of the State Medical Examiner noting that Richmond County had the highest rate of fentanyl-involved deaths among the state’s 100 counties.
Click here to read about the county’s opioid crisis.
While her office does provide addiction services, Gainey said more local resources are needed.
“Now what you find is it’s escalating,” Brown said. “They’ll go to the hospital for an evaluation, (Medicaid) will only cover a certain percentage of the treatment. If there’s not a facility available that will take them because they don’t have health insurance, they’re released back on the street — no follow-up, no assistance.”
With nowhere to go, the chief said those who need help are moving into vacant homes with no power or running water.
“When you have someone living in an abandoned house with defecation, and urine, and wildlife, it’s a horrible lifestyle,” Brown said, adding that his officers dealt with that situation the day before.
Brown added that some of those who were not previously violent are “going out and robbing folks for money so they can buy narcotics to offset some of the issues they’re going through,” and are becoming “more combative and resistant toward law enforcement.”
The chief said some of his officers have been assaulted on the rising number of mental health calls.
Cooper asked Brown about the percentage of time officers spend on calls where the individuals need “healthcare not handcuffs.”
“I think the better question is, ‘What time do we not spend on those type of issues?’” Brown replied.
There have been at least two apparent mental health-related standoffs this month in Richmond County.
On Aug. 3, a man was taken in for an evaluation following an incident where he reportedly claimed in a 911 call that someone was shooting at his house, then allegedly shot at deputies who responded. A week later, a veteran was reportedly taken into custody following a brief standoff after his family filed to have him involuntarily committed.
“We’ve had to place folks who do not need to be incarcerated in jail because they’ve turned violent,” Brown said, adding that the department has reached out for help from Adult Protective Services and adult care providers — to no avail.
“This extension, from my understanding, would expand these services and allow more treatment, more follow-up, more assistance,” Brown said.
However, treatment — as Kinsley pointed out — is expensive.
“That money that is going to be coming into counties to try to help make up for the opioid burden that you have felt … is a drop in the bucket compared to the cost of treatment, which can easily be $10,000 a month per person,” Kinsley said.
Richmond County is slated to receive $4.8 million over an 18-year period from the initial opioid settlement.
Earlier this month, the Richmond County Board of Commissioners approved three grants totalling $150,000 from the settlement funds, including $49,500 to Samaritan Colony for its treatment facility.
Click here to read that story.
Samaritan Colony is in the process of constructing a women’s treatment center.
Cooper said the federal government is prepared to offer the state a $1.6 billion “signing bonus,” with mental health in rural North Carolina being a priority for that funding.
“If you can get someone on Medicaid expansion, pay for that treatment, then all of a sudden those resources that you’re getting from the settlement dollars … then you’re paying for recovery supports, for housing …employment supports to help support people that have a history of addiction to get into a job and get stable to get their own self-sufficiency — which is what we want,” Kinsley said. “We want Medicaid to be a program that’s more about spring back into where you need to be.”
The secretary added that the lack of Medicaid expansion has been “an unfunded mandate” on local governments, “and we have got to turn the tide here.”
“Studies show it reduces crime rates … improves food and housing insecurities, it definitely will help,” Gainey said about expansion.
However, one of the concerns with mental health, according to Gainey, is that local management entities are closed networks: “…which make it challenging for us to bring providers here into the area.
“Sure we can offer telehealth, but can they get credentialed to provide the services?” Gainey queried.
“One other thing,” Gainey continued, “is if a patient calls and needs to be same-day, they end up in the (emergency room) because we have to wait on prior authorization to be approved, that can take several weeks to occur through the LME.”
Another challenge Gainey mentioned is the length of time to change patients from one Medicaid plan to another, “…so there is this huge delay in services that is affecting our county.”
Gainey suggested partnering with FirstHealth to use the former Sandhills Hospital in Hamlet for services including addiction treatment center and a place for children’s and veterans’ mental health.
“These are all things that are needed,” Gainey said.
Kinsely said last week there were around 350 people across the state — mostly uninsured — waiting in emergency departments for psychiatric care.
“What’s tragic is about the same time we had about 100 empty beds … that were not accepting patients often because … of their inability to pay,” Kinsely said. “There wasn’t insurance coverage for those folks to be admitted, so we end up getting folks stuck in the wrong place.”
Kinsley said there is a large portion of people who are uninsured who also have mental health and substance abuse issues, “and the provisioning of these services gets messed up.”
In March, the governor released a plan to invest $1 billion in behavioral health services.
According to Kinsely, a keystone in Cooper’s plan is to raise Medicaid rates for behavioral health — last set in 2012.
“We can’t buy eggs based on 2012 prices, and so we surely can’t buy behavioral health services based on 2012 prices,” Kinsely said. “We need to get those rates up to be more competitive with the market.”
Cooper said expansion was supported by both the N.C. Association of Police Chiefs and N.C. Sheriffs’ Association.
The latter organization, in a June 2022 letter to legislative leaders, said a “significant percentage” of those in jails across the state “are suffering from substance abuse issues, mental health issues, and physical health issues that should be treated by medical professionals in a medical facility rather than in a county jail.”
“Many of these inmates can not afford health insurance yet they do not qualify for Medicaid,” the letter continued.
Brown said those with mental health and addiction issues “don’t need law enforcement, they need health insurance.”
“Until we get to a point where those folks can get that treatment,” Brown said, “that crime is going to spread.”
