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Behavioral health crisis among youth: NC plan seeks to provide public schools with more resources

The state has a new plan to get more resources for young people who experience a mental or behavioral health issue.

Posted Updated

Monica Casey
, WRAL Durham reporter

The North Carolina Department of Health and Human Services (NCDHHS) released a plan Tuesday to provide more resources to schools to support the mental health of young people.

The 11-page “North Carolina School Behavioral Health Action Plan” cites a 2021 survey conducted by the U.S. Centers for Disease Control and Prevention showing one in five North Carolina children seriously considered attempting suicide and one in 10 made the attempt.

“Many young people who are having a behavioral health need don’t receive the care that they need,” said NCDHHS senior advisor for children and families Hanaleah Hoberman.

The plan also cited various studies that found:

  • One in four young people nationwide experience a mental or behavorial health issue while in grade school
  • In North Carolina, about 50% of youth with mental health disorders do not receive necessary care.
  • Youth are six times more likely to complete evidence-based treatment when it is offered in schools versus other community settings.

“The public believes that guidance counselors can meet the needs,” said Wake County school teacher Lynn Guilliams as part of the study. “My school has 2,200 students and four guidance counselors.

“They don’t have time to do restorative circle groups or therapy. But the public has the perception that we have these kinds of services. The perception is that the schools can handle this, but we can’t.”

Hoberman helped put together the state’s plan, which shows gaps in the public-school workforce. It focuses on closing the gap between the need and the resources available to young people in crisis.

“North Carolina public schools fall significantly short of meeting nationally recommended student-to-staff ratios for specialized instructional support personnel, including school psychologists, nurses, counselors, and social workers,” the plan states.

The plan includes a call for funding for School Health Advisory Councils, support for Mental Health First Aid, and expanded telehealth programs.

“(For) many people, whether it’s young people or their parents, transportation is a big barrier to care,” Hoberman said.

The plan also calls for $100 million to establish more school nurse and social worker positions.

“What we know is that we're experiencing a behavioral health crisis in our children and youth,” Hoberman said. “We were seeing concerning numbers before the pandemic, and what we know is that the pandemic has just accelerated those concerns, whether it's depression or attempts of suicide.”

Dr. Jeylan Close is a pediatrician and child psychiatrist for Duke Health. She also worked on the plan.

“I think that having more therapists available would make a big difference, especially for kids, therapy can be very meaningful,” Close said.

Close said there has been an increase in the number of kids coming to the emergency room after a suicide attempt.

"Knowing that there are limited resources to help can be really hard,” Close said. “I think both myself and many of my colleagues struggle with knowing there are often too few resources to meet the needs of kids."

“Expanding and strengthening the workforce in schools to support student behavioral health is foundational to the strategies described in this action plan,” the plan states.

American Academy of Child and Adolescent Psychiatry map showing a shortage of child and adolescent psychiatrists. Image from AACAP.org illustrating shortage of child and adolescent psychiatrists (CAPs) by county across North Carolina.

How NC public schools are staffed to address mental and behavioral health

The plan includes a county map illustrating the shortage of child and adolescent psychiatrists (CAPs). Here’s how the map produced by the American Academy of Child and Adolescent Psychiatry is categorized:
  • Mostly sufficient supply: at least 47 CAPs per 100,000 children
  • High shortage: 18-46 CAPs per 100,000 children
  • Severe shortage: 1-17 CAPs per 100,000 children
  • No CAPs

Here’s how public schools in Wake County fare:

  • Category: Severe shortage
  • Total CAPs: 43
  • Number of children younger than 18 years old: 258,475
  • Number of CAPs/per 100,000 children: 17
  • Average CAP age: 52

Sixty-one of North Carolina’s public school districts, including Franklin, Johnston, Person and Sampson counties did not have any CAPs.

Here’s how public schools in Chatham, Cumberland, Durham, and Orange counties fared:

Chatham County
  • Category: Mostly sufficient supply
  • Total CAPs: 10
  • Number of children younger than 18 years old: 14,589
  • Number of CAPs/per 100,000 children: 69
  • Average CAP age: 45
Cumberland County
  • Category: Severe shortage
  • Total CAPs: Four
  • Number of children younger than 18 years old: 82,308
  • Number of CAPs/per 100,000 children: Five
  • Average CAP age: 58
Durham County
  • Category: Mostly sufficient supply
  • Total CAPs: 58
  • Number of children younger than 18 years old: 65,821
  • Number of CAPs/per 100,000 children: 88
  • Average CAP age: 46
Orange County
  • Category: Mostly sufficient supply
  • Total CAPs: 55
  • Number of children younger than 18 years old: 28,517
  • Number of CAPs/per 100,000 children: 193
  • Average CAP age: 49

Gov. Cooper releases plan to address NC’s mental health and substance abuse crisis

Gov. Roy Cooper released a comprehensive plan this month – “Investing in Behavior Health and Resilience” – to invest $1 billion in addressing North Carolina’s mental health and substance use crisis.

“Our mental health system is under significant stress and in need of major investments to make sure every family, student and North Carolinian can get critical care,” Cooper said in a news release. “This plan tackles the ongoing mental health crisis in a direct and meaningful way by investing in the whole-person health of North Carolinians. It will empower workplaces, schools, and local governments in search of more ways to help their communities and most importantly, it will save lives.”

“When a person has a mental health or substance use condition, it can limit their ability to work, to parent, and to engage in their community,” the plan states. “More than two million North Carolinians have a mental illness, and more than one million have a substance use disorder.”

The plan listed several key stats about how more people than ever have mental health and substance use disorder needs. It includes:

  • Rates of depression and anxiety have nearly quadrupled. The study states from 2019 and 2021, the percentage of Americans reporting symptoms of anxiety or depression rose from 11% to 41%.
  • Drug overdose deaths jumped 72% in two years. The study states that 4,041 North Carolinians died in 2021 due to drug overdoses. It’s about 11 overdoses per day. It broke the record set in 2020.
  • Youth suicides doubled in the last decade. Suicide is the second-leading cause of death for youth ages 10-18 in North Carolina.
  • More than 50 children sleep in emergency departments and DSS offices each week. North Carolina children with complex behavioral health needs require placements with strong supporting services. Until those spots and treatments are available, they have nowhere else to go.

The governor’s plan suggests three steps to strengthen the state’s behavioral health system:

1. Make behavioral health services more available when and where people need them:
  • Raise Medicaid reimbursement rates for behavioral health services ($225 million for three years)
  • Improve access to routine, integrated care in communities and schools ($175 million)
  • Address the intersection of the behavioral health and justice systems ($150 million)
2. Build strong systems to support people in crisis and people with complex needs
  • Build a strong statewide behavioral health crisis system ($200 million)
  • Transform child welfare and family well-being ($100 million)
  • Create sustainable hospitalization and step-down options ($100 million)
3. Enable better health access and outcomes with data and technology ($50 million)

“Investing in behavioral health is a smart investment in lowering overall healthcare costs and keeping a strong workforce,” the plan states. “For example, untreated depression can lead to decreased self-care, such as not taking prescribed medication for diabetes, which can result in expensive hospitalizations for diabetic crises.”

If you're having suicidal thoughts or a mental health crisis, call or text 988. Veterans can press “1” after dialing 988 to connect directly to the Veterans Crisis Lifeline, which serves our nation’s veterans, service members, National Guard and Reserve members and those who support them. For texts, veterans should continue to text the Veterans Crisis Lifeline short code: 838255.


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