Matthew Whittle

For the fourth and final installment in our series on public health, we’re taking a look at the mental health system.

Mental health in North Carolina is a vast and complex field – one that intertwines public and private agencies and providers. The complicated network is a result of the reforms begun in 2001 and continued and adjusted through today.

Those reforms began with the divestiture of services by the state government, meaning that no longer would the state be responsible for both the management and the delivery of mental health services. Since then, the system has seen a continuation of changes, and in some ways the state has again become more involved, particularly in managing and overseeing the care provided to indigent and some Medicaid clients in certain regions.

However, it is still a complex system, one that often sees people falling through the cracks and caught in a web of confusion. But there are dedicated state employees who work diligently every day to ensure that those people requiring mental health services are able to receive the care and attention they need.

One of those people is Ashley McKenna, a rehabilitation counselor for the N.C. Department of Health and Human Services Division of Vocational Rehabilitation in Alamance County since 2012.

She explained that her role in the mental health system is to help clients, who range in age from high school on up, access the services they need in order to gain competitive employment.

McKenna also explained that the people who fall under the scope of mental health, and whom she helps, can range from those who can live and function largely on their own and just need a small amount of assistance, to those who must have full-time care. Diagnoses, she said, can range from ADHD, to anxiety or depression, to autism, to bipolar disorder or schizophrenia.

“We have people with graduate and doctorate level degrees, and we have we have people who will never be able to drive or cook a meal by themselves, but could perhaps do a very structured, repetitive task for a few hours,” McKenna said.

The challenge, she said, is that often when clients come to her agency, they either have never been officially diagnosed with a disorder, they have been misdiagnosed, or they have not had proper, steady treatment. Such clients are usually referred by schools, some component of the criminal justice system, or people seeking help on their own or through family members.

“They are no longer stable and come to us as a resource,” she said. “Our goal is to get them successfully employed.”

And so not only are the counselors working to coordinate services for their clients in order to get into the workplace – services that often are only available on a limited basis – they also help find services outside that scope, as well as other agencies and groups that can then help their clients pay for those services not covered by Medicaid or other insurance.

“When the public mental health system changed, we lost case managers, and we have kind of stepped into that role,” McKenna said.

But with a caseload that ranges from 100 to 150 clients, some of whom have been active clients for six, seven, even eight years, finding them the proper care within the proper timeframe can be hard. Multiply that difficulty out over eight other counselors over three counties – Alamance, Caswell and Rockingham – with caseloads that can match or surpass McKenna’s, and the challenge becomes even greater.

“It’s not a unified system,” she said. “And that’s frustrating. The thing I feel the most when I have a client come to me with a missed diagnosis or who has been untreated for a long time is frustration.”

Unfortunately, she added, there’s no easy solution to that problem. While a more centralized system may help, she acknowledged that with everything currently so spread apart, expecting a return to a state-run system is likely unrealistic.

However, she said, at least in Alamance County and the rest of her region, the community has recognized the challenge presented by mental health concerns and the state agencies, the private providers, the schools, non-profits and even law enforcement are working together to make sure people are receiving the care they need in a timely fashion.

“I can only speak about Alamance County, but our community has really seen and understood what the needs are,” McKenna said.