With three different communities across North Carolina staggered by murders allegedly perpetuated by people suffering from mental illness, Gov. Josh Stein is seeking to use the power of state government to bolster services available to people who are in a mental health crisis.
The order focuses on using the state's criminal justice and health agencies to increase access to mental health services in prisons and during times of crisis; supports exploring how to increase insurance coverage for mental health services; and proclaims support for bolstering pay at understaffed prisons and state psychiatric hospitals.
"We're doing a lot of what works, but we're not doing it everywhere and we're not doing it enough. And so what we want to do is make sure that we are working in coordinated fashion at maximum efficiency so that we can have the greatest impact," Stein said.
He continued, "Because what we don't want are the crises, the horrific events that happened last year. We don't want them. Nobody wants them, and we can do better."
Stein was referencing the August slaying of Iryna Zarutska on a Charlotte light rail train by a man who had told law enforcement he was experiencing delusions; the September mass shooting at a Southport bar allegedly perpetuated by a U.S. Marine Corps veteran whose behavior had alarmed friends and family; and the Jan. 3 home invasion and killing of a Raleigh teacher by a man who had been diagnosed with schizophrenia and declared mentally incompetent to stand trial.
"This executive order is not intended to remedy all of our challenges. But we have a real problem staring us all in the face and the people of North Carolina deserve us to make progress. Everyone wants to live in a safe place. Families are looking for answers when their loved ones are in crisis," Stein said.
Finding ways to add employees
The N.C. Department of Health and Human Services and N.C. Department of Adult Correction are the state agencies most likely to come into contact with people suffering from mental illness.
They are also both chronically understaffed.
That's led to the shuttering of 12 out of 47 patient units, capable of serving nearly 300 people at full capacity, at DHHS' state psychiatric hospitals.
"We spent all the money on this facility. The units are there and they are empty, even though there is a long line of people waiting to get that kind of care," Stein said.
And 3,950 of the state's prison beds are unavailable.
When prison staffing shortages start, Stein said, the focus turns to securing the facility, rather than providing programs that could help people who are incarcerated there upon their release.
"More people working in the prisons will enhance security, but will also enhance the opportunity for people to gain skills to rehabilitate so that when they come out, they're ready to succeed," Stein said.
In both prisons and psychiatric hospitals, Stein linked the closures to low pay for state employees. In the psychiatric hospitals, that's low pay for nursing assistants who tend to patients. And in prisons, that's what Stein called the second-lowest pay for corrections officers in the country.
Stein has directed the state's Office of Human Resources to work with state agencies to find new ways to recruit and retain staff. Still, he acknowledged that finding and keeping staff likely comes down to pay, and that means working with Republican leaders at the General Assembly.
"When it comes to hiring enough nursing assistants to reopen all the units at our mental health hospitals, we need a budget. So we're going to do whatever we can without the money, but at the end of the day, we need a budget," Stein said.
Responding to a crisis
One place where North Carolina officials believe they are making progress is in services available to people suffering from a mental health crisis, whether it's the state's 9-8-8 phone line for someone undergoing a mental health crisis or standing up crisis response teams to respond to emergency calls.
"This executive order marks a milestone for North Carolina. It recognizes the important role of mental health in the health and safety of our communities," said Kelly Crosbie, the director of DHHS' Division of Mental Health, Developmental Disabilities and Substance Use Services.
Under the executive order, DHHS will work to expand mental health services available when people seek help by calling 911 while also making it easier for 911 operators to transfer to 988 responders.
Right now, 988 receives about 12,000 calls a day, Crosbie said.
"988 is able to de-escalate crises, link people to care, send out mobile crisis teams into the community to consult with 911, to consult with law enforcement. It helps people in that moment of crisis," Crosbie said.
The department will also explore ways to expand the use of co-responder models that see mental health providers go to behavioral health calls alongside law enforcement.
Jeff Smythe, the secretary of the N.C. Department of Public Safety and a former City of Burlington police chief, said about 40% of all law enforcement calls relate to someone experiencing a mental health crisis.
"Too often, the only tools available to the officers or the deputies in those moments are handcuffs and a jail cell. It's not fair to the individual in crisis, it's not fair to their families and it's not fair to our law enforcement officers, correctional officers or those who live and work in our communities," Smythe said.
Under Smythe's leadership, Burlington was one of three places where DHHS piloted a co-response program. When the program was underway, Smythe said, it was very uncommon for an arrest to be the result of a call where the co-response team was on hand.
That's key, Smythe said, to keeping people out of jail who may otherwise have been detained. He described a phenomenon called serving "a life sentence, one day at a time" where someone is arrested on a minor offense, often related to mental illness, and then commits another minor offense shortly after being released from detention.
"They're serving significant periods of time in jail, very unintentionally, and that's a draw on the system and it's bad for the individual," Smythe said.
By giving deputies and officers better tools to recognize and respond to mental illness, Smythe said, those people can be routed to care that offers more appropriate care than a jail cell.
Focusing on prisons
Stein also turned attention to the state's prisons, where 40% of the people who are admitted have mental health issues and 75% have substance abuse issues.
"These problems do not solve themselves just by time passing. They need to have interventions to address the underlying issues, and we kick these problems down the road at our own peril," Stein said.
Helping people while they are in custody will help prevent them from entering a cycle where they are arrested over and over again, keeping communities safe, Stein added.
In the executive order, Stein directed DHHS and the N.C. Department of Adult Correction to work together to standardize how Treatment Accountability for Safer Communities is used in prisons. That's a program that provides mental health services to people who are arrested or imprisoned.
Stein also directed DHHS to work with the Department of Public Safety to create a mental health crisis unit for the state's juvenile detention facilities. Of the kids admitted to juvenile detention facilities, Stein said, 98% have some kind of mental health diagnosis.
"It will help get these young folks the appropriate care they need," Stein said.
