Improving Mental Health

May is Mental Health Awareness Month. First, the terms “mental health” or “behavioral health” are misleading. “Brain disease” is more suitable. And they are complex brain diseases with widespread and often devastating effects on patients, families, and the community.

The Centers for Disease Control and Prevention (CDC) estimates that as many as 25% of all Americans experience some type of these brain diseases. National Alliance on Mental Illness (NAMI) reports 1 in 25 Americans live with a serious mental illness. Half of all chronic mental illness begins by age 14 with 75% starting by age 24.

Depression is the leading cause of disability worldwide.

You are far more likely to die by suicide or overdose than in an automobile accident. Americans wait an average of 10 years after onset of depression symptoms to seek treatment. Wake County suicide attempts are up 38% in the last two years. Drug overdoses are up more than 300%.

Involuntary-Commitments-WCIn Wake County, the number of involuntary commitments has increased substantially. According to the Wake County Magistrate, thousands of citizens received involuntary commitment in 2015—mandating they be treated in a psychiatric bed. The numbers rose from 5,241 in 2011 to 12,193 in 2015. That 132% increase marks a clear pattern.

North Carolina has cut 700 psychiatric beds from 2005 to 2011. That means many of these patients are stuck in emergency rooms or jails—not receiving appropriate treatment.

This makes Wake County jail the largest psychiatric facility in the state and of the 1,200 inmates 65-75% of them have mental health or substance abuse disorders.

This is not how we should treat brain disease.

Improving the System

The first step in improving mental health care is education. It’s vital to understand that these are diseases that need treatment. This starts the process of eliminating the stigma associated with mental illness.

Helping individuals, families, and our community cope with these challenges has been a focus of Caroline’s for the last four years. In addition to serving on the Board of Commissioners, Caroline serves on the Board of Alliance Behavioral Healthcare—Wake County’s local managed care organization. Alliance Behavioral Healthcare delivers mental health, substance abuse, and developmental disability services to our community.

The more she learned about the numbers, the more committed Caroline became to doing something about it. Wake had been simply performing crisis management. The costs of that are too much—the enormous financial burden to the public and health care systems. Even more importantly, the costs to patients and families are untenable.

Caroline reached out to communities that were doing a better job than Wake County. Every instance had one thing in common: A group committed to removing system barriers, improved communication, collaboration, and shared fiscal focus.

From this, the Wake Directors Group was born. Around the table sit the District Attorney, Chief District Judge, Chief Magistrate, Chief Public Defender, Chief of Police, Sheriff, head of EMS, Director of the UNC Department of Psychiatry, CEO of Alliance, president of Wake NAMI, School Superintendent, County Manager, City Manager, Director of Human Services and Director of Housing.

This group faces the challenges our mental health system needs to address: education, crisis services, and stabilization and recovery.


First, we need to know what these brain diseases look like and what to do when someone needs help. Mental Health First Aid is a great first step and the course can be taken by anyone: Caroline took the course at her church and found it to be very helpful.

The Directors Group determined that Wake County needed an online services directory that could be a resources for first responders, professionals in the criminal justice system, human services professionals, and regular citizens to know what services were available in our community. This directory will be up and running in late June— a link will be posted to the mental health resources page.


Wake County has a woefully inadequate supply of crisis services and psychiatric beds. The county and all of our partners are committed to working together to increase capacity. Hopefully, the state will also increase beds in state facilities.

Stabilization and Recover

Finally, stabilization and recovery are fundamental to improving mental health care. If patients cannot remain stable, they continue to cycle in and out of our hospitals and jails. The county is exploring increases in the supply of permanent—supportive—housing. Keeping folks housed, receiving their medications and counseling services helps them remain stable. When people are stable they participate in the community and lead happier lives.

Recovery from brain disease is possible. As a community, it’s vital to provide the psychological and counseling services that help citizens recover. Learn more about re-thinking mental health strategies with Alliance Behavioral’s It’s Time to Re-Think campaign.