RALEIGH, N.C. — Access to mental-health care in rural communities continues to shrink, but a team of nurse practitioners aims to change that.
The University of North Carolina-Chapel Hill has received $6 million in federal funding to recruit, train and financially support 70 primary-care nurse practitioners specializing in mental health who will work exclusively in rural areas. Dr. Victoria Soltis-Jarrett, Carol Morde Ross distinguished professor of psychiatric-mental health nursing at the university, is leading the effort and said mental-health needs in the state are outpacing the number of health-care providers.
"The mental-health system in North Carolina is overwhelmed,” Soltis-Jarrett said. “So it's not that it's broken so much as it's just overwhelmed and inundated with referrals because primary care doesn't know necessarily how to manage these individuals."
Suicide is now the second-leading cause of death among the state's young people, and in 2016 more than 1,000 North Carolinians ended their own lives, according to the state Department for Health and Human Services.
Soltis-Jarrett added in the southeastern part of the state, natural disasters have compounded stress from the opioid crisis.
"One in particular is in the southeast of North Carolina where they've had a lot of tragedy with the two hurricanes, flooding, there's a lot of poverty,” she said.
She said allowing nurse practitioners to provide health care without oversight from physicians could allow nurses to expand their services even more.
"I've actually even had physicians say, 'Is there any way we can get rid of this restriction or requirement?' I think is how they put it,” she said.
The SAVE Act, introduced earlier this year by Rep. Josh Dobson and Sen. Ralph Hise from Spruce Pine, both Republicans, would lift state restrictions that now require nurse practitioners to be supervised by a physician.
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Boulder and Broomfield County residents can now access mental health services the same way they can access urgent medical care.
Dr. Nadia Haddad, medical director of mental health services with Mental Health Partners, said all too often, people can't get help unless they are already connected with an outpatient provider, and many have months-long waiting lists. She said if people have to wait for care, their situation can get worse, and what might have been a manageable issue can turn into a crisis.
"They are going to the emergency room or going to a psychiatric hospital. And so what we're trying to do is fill that gap so that people can get connected with services when they need it, on a walk-in basis," she said.
Mental Health Partners, a community mental health center serving Boulder and Broomfield counties for 60 years, recently launched UrgentPsych Mental Health and Substance Use Urgent Care. The walk-in program provides immediate, in-person support for urgent mental health and substance use needs for anyone, regardless of their ability to pay, whether or not they are an existing client, or speak English. For more information about the 24-hour facility in northeast Boulder, call 303-443-8500.
Mental Health Partners' new Intensive Family Services program provides in-home therapy for K through 12 youth with disruptive behaviors who are at risk of being placed in foster care or the juvenile justice system. The urgent care facility is also available to people of all ages.
"That's another really challenging part of seeking out services. Care for children and adolescents is often even more challenging to find. There are fewer child psychiatrists out there," she said.
Both new programs were created in part to get people the services they need to avoid hospitalization. But Haddad said when people do reach a point where they need 24/7 monitoring and daily visits from a medical provider, it is essential that people can access hospital-level care.
"The vast majority of people who are dealing with mental health-related issues do not require hospitalization. If we can change people's trajectories earlier, we can prevent mental suffering, and they may not have to go through the hospital," she explained.
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This is National Library Week, honoring the many roles that libraries play in their communities.
In central Texas, a pilot program is using the public library system to expand mental health services in rural areas.
Residents in four counties can get assistance at their local public library through the Libraries for Health program.
Trained mental health peer specialists evaluate clients and refer them to clinics for additional help if it's needed.
The program is funded through the St. David's Foundation, working to advance health equity in Central Texas.
The foundation's Senior Program Officer Abena Asante said the initiative works in tandem with the mental health community.
"It's in no way taking the place of clinical-directed psychologists," said Asante. "It's just one community response in addressing the lack of mental wellness resources in rural communities."
Asante said libraries are trusted and accessible gathering places for people living in rural areas. The libraries tailor programs to meet specific local needs based on feedback from the residents.
Data collected during the 3.5-year pilot program will be used to evaluate its success. The nonprofit Via Hope trains the peer specialists who work in the libraries.
Dr. Sandra Smith, vice president of Via Hope, said the staffers use their own life experiences to help them relate to the clients.
"They have to have had a mental health challenge at some point in their life," said Smith. "We don't ask them any specifics about that, we don't ask diagnoses - it's a self-disclosure."
The Libraries for Health program operates in eight libraries in Bastrop, Caldwell, Hays and Williamson counties. If successful, it could be implemented in other parts of the state.
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A Connecticut bill under consideration in the Legislature would establish peer-run respite centers to help people with mental illness.
Senate Bill 370 would establish eight centers, with three specific facilities for transgender, Spanish, and BIPOC communities. Unlike inpatient hospitalization, the programs are voluntary and allow a person to come and go.
Jordan Fairchild, executive director of the group Keep the Promise CT, said hospitalization can disrupt a person's life.
"If someone calls 988 and said the wrong thing or if they say the wrong thing to a provider, they can end up having the police show up at their door, be taken to the hospital against their will, be thrown in a locked ward, possibly forced on medication," Fairchild outlined.
She has heard of transgender people who've been hospitalized had hormone replacement therapy taken away, were called by their dead names and had to sit in groups with people who harassed them.
The bill garnered universal support during a public hearing last month but opponents questioned how the state will pay for the program. For now, the bill has been referred to the Office of Legislative Research and the Office of Fiscal Analysis.
Mindy Wallen, a certified recovery support specialist, came to Connecticut from Texas after her child, who has been hospitalized more than 20 times, came out as nonbinary. Wallen said even though hospitalizations helped develop a tool kit for her son to work on his mental health, there are lingering issues peer-respite centers can better address.
"You still have times when you might be dealing with like a recurrence of treatment-resistant depression, or, you know, like that sort of thing where there needs to be a kind of a more supportive environment, and a place to go just to kind of regroup and reset," Wallen explained.
Currently, 15 states operate peer-run respite centers, which have proven beneficial for more than just patients. A report from Washington State's Health Care Authority finds the centers can decrease the need for inpatient psychiatric care. It also noted the centers have lower costs than other facilities and have reduced Medicaid expenses.
While support for the bill is high, funding remains a challenge. Building and staffing these costs a little more than $8 million, less than 1% of the state's budget.
Matthew Blinstrubas, executive director of Equality Connecticut, said it is contradictory for such programs to hinge on money.
"This is a, for all intents and purposes, a cost-reducing measure," Blinstrubas pointed out. "It does require resources to get up and running. And so, that's where the conversation is now and we will know in the coming weeks where we stand in terms of what resourcing peer-respites will look like."
The centers are shown to cost less than more coercive options. The median cost of an inpatient psychiatric stay in Connecticut is more than $40,000, while a stay at a peer-run respite center in nearby Massachusetts costs around $3,200.
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