Mental health and physical health are closely connected and critically important. More than 450,000 adults and young adults in N.C. have a serious mental illness, and rates of depression, anxiety and other disorders continue to rise, in part due to the COVID-19 pandemic.

Hospitals across the state are innovating to bring high quality mental healthcare to more North Carolinians, even as many areas face shortages in behavioral health specialists, like psychiatrists and inpatient mental health beds for those in crisis.

Six healthcare and community leaders recently came together in a virtual town hall to discuss these issues and other important topics related to improving mental healthcare access across the state.

The conversation was part of a series of virtual town halls hosted by the North Carolina Healthcare Association.

Panelists featured Paula Bird, RN, Vice President, Behavioral Health Services, Novant Health; Gary J. Salamido, President and CEO, NC Chamber; Robin Huffman, Executive Director, North Carolina Psychiatric Association; Archana Kumar, MD, Medical Director of Behavioral Health Services & Program, Director of Psychiatry Residency Program, Cone Health; Barbara-Ann Bybel, Director, Psychiatry Services and Vice Chair, Psychiatry Hospital Services & Integration, UNC Health; and Nisha Mehta, MD, a Charlotte-based physician, speaker and writer.

Here are some of the key takeaways from the conversation:

COVID-19’s impact on mental health 

The pandemic “really thrust people into an environment that none of us expected,” said Gary Salamido. “It introduced all kinds of stresses and stigmas. People are coming back differently than when they left.”

Salamido shared how Chamber members are working to support employees – “Their people are their priority when it comes to mental health, physical health, and financial health. It’s critically important to them that all of those are in balance.”

The panelists also discussed the impact of the pandemic on healthcare workers, and shared solutions such as employee wellness programs, resiliency trainings, and app-based intervention tools.

“We have an emotional health advocacy team,” Bird shared. “Our ICUs have turned into hospices [and] those nurses are not used to working in that environment. It’s really taking its toll.”

A fragmented, under-funded system

While COVID-19 exacerbated the mental health crisis, it didn’t create it. Robin Huffman shared the history of mental healthcare in North Carolina–efforts to close state mental hospitals and redirect funding toward community clinics inadvertently produced many of the issues we see today.

“It was a noble ambition,” she said, but the effort decentralized mental healthcare, making it more confusing for patients to navigate, and many funding streams did not materialize.

“State budgets haven’t adequately funded the mental health system, and the dollars that were promised to fund innovative services kept getting cut, and that’s how we got to the point we are at today,” she said.

Integrating mental and physical healthcare

One approach to making mental healthcare easier to access is integrating it into primary care. UNC Health, Cone Health, Novant Health and other systems across the state are working to embed psychiatrists and other behavioral health consultants directly into primary care practices, making it easier for people to get the help they need in a setting they already know and trust.

“Mind and body are not separate,” Kumar said. “We can change the concept of where people think about mental health and prevent them from having a crisis.”

Read more: Supporting Patients with Integrated Mental Healthcare

Improving access

Like many states, North Carolina has a shortage of mental health professionals. One of the factors behind shortages is a lack of mental health parity. Parity means insurance companies treat and cover mental health and physical health the same way. Federal laws require mental health parity, but Huffman shared that the regulations aren’t well enforced.

“We haven’t been able to ensure we actually have that parity in place,” she said.

But legislation signed into law former President Trump could improve the situation, she said. The COVID-19 stimulus bill passed in December 2020 included mental health parity compliance language, which requires all insurers to perform compliance analyses, and submit them to federal and state regulators on request.

Telepsychiatry is another solution for ensuring everyone in North Carolina can access mental healthcare. Through virtual visits, providers in urban areas can treat patients and counsel providers in rural areas.

Read more: Virtual Mental Health Programs Reach Patients Where They Are

Expanding Medicaid 

Several of the panelists advocated for North Carolina’s legislature to expand Medicaid. Many uninsured North Carolinians wind up in the emergency room if they experience a mental health crisis, because they aren’t able to access earlier interventions.

“We need to move the problem upstream by expanding Medicaid,” Bird said. “We’ve put them in that place because they have no other options. Medicaid is critical for our state.”

Similarly, Bybel advocated for expansion of medication-assisted treatment for those experiencing substance use disorder, which is not easily accessed, especially for those with Medicaid or without insurance.

“It’s evidence-based and it helps saves lives,” she said.

Expanding and investing in these programs, including Medicaid expansion, crisis services, telemedicine, and integrated care, will be critical to making sure every North Carolinian has the opportunity to access needed mental healthcare.

Read more: N.C. General Assembly: Close the Coverage Gap in 2021