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The mental health care system in North Carolina has been failing for years. Perhaps nowhere is that more evident than those who get caught up in the criminal justice system, out of sight, therefore out of mind for the general public and policymakers. But their plight — and the brokenness of the mental health system — affects everyone in the state.

How NC's mental health system is 'Fractured'

Fractured series logo

WFAE’s investigative series "Fractured" has shown how North Carolina’s mental health system is in crisis.

For example, defendants who are too sick to stand trial often wait more than a year to get a bed in a state psychiatric hospital. Others with severe mental illness often cycle in and out of jails dozens of times. People who go to hospital emergency rooms in a mental health crisis wait an average of 16 days for a state hospital bed.

Morning Edition host Marshall Terry spoke to reporter Dana Miller Ervin about the series, issues her reporting has addressed so far and stories that remain. Highlights from their conversation:

How NC’s mental health system got this way

“The bottom line is just chronic underfunding of the mental health system,” Miller Ervin said. So, in what was a national wave of deinstitutionalization to get people out of hospitals who'd been living there, North Carolina cut the number of state psychiatric hospital beds by about half 20 years ago, but it never fully funded outpatient care.

"We made mental health into a Medicaid-funded system, but we didn't expand Medicaid. So hundreds of thousands of low-income people don't have coverage. Then we underfunded the Medicaid system we do have. We haven't raised Medicaid reimbursement rates for behavioral health care in a decade.

What happens as a result is that people who can't get paid enough leave the mental health system. So we have a huge workforce shortage in mental health care. And we don't have enough capacity in the community because they don't have enough people to work.”

How North Carolina compares to other states

“We rank 39th to 40th in the country in terms of the number of state psychiatric hospital beds per person because of those staffing shortages I talked about, one-third of our beds aren't operating. So today we have only about 600 state hospital beds for more than 10 million people," Miller Ervin said.

"Like most non-expansion states, we don't do well in terms of access to mental health care at all. Mental Health America says we rank 39th in the country for that, too. Now, in addition to all that, the private insurers here pay less for mental health care than insurers in other states.

"So now we've got this combined massive underfunding, which means we don't have the capacity. So here's one last data point: 44% of North Carolina kids who need to be in a psychiatric residential treatment facility, are shipped out of state, away from their families because we don't have the capacity here to help them."

Implementation of Medicaid expansion

"The General Assembly (passed) a bill expanding Medicaid," said Miller Ervin, "but it won't go into effect until we pass a budget. As of last week, the House and Senate were still pretty far apart on a number of things.

"The expectation is they will eventually pass a budget, and we'll get expansion. But we don't know a lot of details on how that will affect the mental health system.

"One of the reasons why is that North Carolina is going to get a lot of money just for expanding. That includes a $1.8 billion signing bonus from the federal government. That's a payment just to induce non-expansion states like North Carolina to finally expand. So we're getting $1.8 billion with basically no strings attached. And the question is, how are they going to use that? The House and the governor want to put $1 billion of that into mental health to build out some of that capacity that we're sorely lacking that I've talked about."

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Dana Miller Ervin is a reporter at WFAE, examining the U.S. health care system.
Marshall came to WFAE after graduating from Appalachian State University, where he worked at the campus radio station and earned a degree in communication. Outside of radio, he loves listening to music and going to see bands - preferably in small, dingy clubs.