'Could have been doing this all along': State budget invests in mental health resources

This article is part of the Mental Health Collaborative, a project completed by nine North Carolina college newsrooms to cover mental health issues in their communities. To read more stories about mental health, explore the interactive project developed specifically for this collaborative.

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The 2023-25 North Carolina state budget included a substantial investment in mental health funding, including a total of $835 million in behavioral health through the N.C. Department of Health and Human Services and Medicaid expansion. 

This investment, which the NCDHHS called unprecedented, includes an increase in Medicaid reimbursement rates for behavioral health services — $99 million to invest in the crisis response system and the expansion of re-entry and diversion programs for those involved in the justice system.

Gov. Roy Cooper and state legislators across party lines were advocates for mental health funding in this year’s budget, Kelly Crosbie, the director of the N.C. Division of Mental Health, Developmental Disabilities and Substance Use Services, said.

Crosbie said she and Carrie Brown, the NCDHHS' chief psychiatrist and deputy chief medical officer, met with state legislators to discuss budgeting for mental health. The data they presented matched what many legislators saw in their own districts, Crosbie said. 

“And none of [the state legislators] will tell you they’re mental health experts in any way, but what we saw were people who were very receptive to the facts that we are presenting," Crosbie said.

Alexandra Sirota, the executive director of the N.C. Budget & Tax Center, said that once the total amount in the state budget is decided, the process for choosing which issue areas to fund often does not allow for much public input. Most funding, she said, occurs because of the influence of lobbyists or a legislator’s interest — and she said only some of the most powerful state legislators have the power to set an agenda and allow proposals to move forward in the budget.

"It's unclear at this point how within that, the public has a way to document and identify needs that require funding from the General Assembly," she said.

Crosbie said the NCDHHS created four different advisory committees with the community about different parts of the budget to connect with North Carolinians about funding.

She said, in any given year, there is only so much money to go around in the state budget, and advocates with different areas of focus are all asking for funding, pulling legislators in different directions.

“I think we have had strong advocates from the General Assembly in years past, but obviously there’s been a lot of other pressing issues,” she said. “Sometimes it’s education that rests at the forefront, sometimes Medicaid and healthcare.”

Sirota said she believes state mental health funding increased this year because of the availability of federal funds as a result of Medicaid expansion. Without those funds, it's unclear if state legislators would remain committed to mental health funding, she said. 

Last March, the U.S. Department of Health and Human Services awarded 15 states, including North Carolina, with a one-year planning grant for Certified Community Behavioral Health Clinics. The clinics, which are federally funded, provide substance use disorder and mental health services to anyone, regarding of insurance status or diagnosis.

"It's novel, in that [the clinics] are changing the way that they're trying to pay for these services, like paying for the population more so than for individual services," Helen Newton, an assistant professor in the UNC Department of Family Medicine, said.

When state legislators speak about funding commitments they are not able to make, Sirota said, they often say they are constrained by the amount of money they are bringing in.But, Sirota said, Republican legislators cut income taxes for profitable corporations in the state, limiting the money that can be used to fund different interests.

“Unfortunately, what ends up happening is issues that all contribute to mental health and well-being get pitted against each other in really harmful ways that undermine the long term goal that we should all share: that everybody should get the care they need,” she said. 

Sirota said, rather than recognizing and planning for needs in advance, legislative leaders waited to make investments in services until the state was in a mental health crisis.

"I think the lesson should be — we could have been doing this all along if there was truly the will to center people's well-being in our decision making," she said.

@Lucymarques_

@DTHCityState | city@dailytarheel.com

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