The Cost of COVID-19 in North Carolina: State Funding for Mental Health Services

Written by Rachel Haake, M.A.
Edited by Sarah Banducci, Ph.D. and Ryan Bell, Ph.D.

Since March of 2020, COVID-19 has ravaged the United States, both exposing and exacerbating pre-existing crises like the “Deaths of Despair” epidemic—the increasing rates of death by suicide and drug overdose among US adults. Sustained recovery from the pandemic will require scientifically informed policies. Among these should be expansion of funded programs addressing the far-reaching consequences of COVID-19 on mental health and substance use.

Nationwide, reports of mental health concerns were on the rise in 2020. In a recent CDC web-based survey of 5,412 adults (>18 years), 41% of respondents experienced at least one adverse mental health condition during the month of June 2020. These conditions included symptoms of depression, anxiety, trauma- or stress-related disorders, and initiation or increase in substance use. More than 10% of respondents reported seriously considering suicide in the 30 days prior to completing the survey. Notably, the prevalence of these mental health conditions over a 30-day period in June 2020 were 2-4x higher than those reported from April to June of 2019. Researchers believe that social isolation, decreased recreational activities, absence of school structure, job loss, financial worries, grief and loss of loved ones, and various forms of violence (such as intimate partner violence) may be driving these adverse mental health experiences.

In North Carolina, the total number of COVID-19 cases has surpassed 800,000 (as of 02/16/2021). Similar to the rest of the country, the pandemic’s consequences on mental health and substance use are alarming. According to NCDETECT, a North Carolina statewide public health surveillance system, the number of people visiting an emergency room for an opioid overdose in July 2020 was 40% higher compared to the same period in 2019. While the state’s overdose rates have risen, substance use treatment centers have been forced to reduce services and cut staff. Prior to the pandemic, suicide was the second leading cause of death for people aged 15-34 in North Carolina. The state has seen an increase in calls to suicide hotlines related to COVID-19, indicating more incidences of severe distress and crisis likely attributable to increased isolation, economic uncertainty, and grief.

At both state and national levels, the devastating impact of the pandemic on mental health is clear. To respond to COVID-19-related mental health consequences, experts recommend expanding the use of telehealth services, investing in community-level intervention and prevention efforts, expanding access to comprehensive mental health and substance use treatment options, and offering harm reduction services (like syringe exchange programs).

While some of the work to address the mental health and substance use related consequences of COVID-19 occurs at the federal level, state governments are at the forefront, regulating and funding mental health services. has generated a list of bills introduced in the North Carolina General Assembly that aim to address the mental health and substance use challenges facing the people of North Carolina due to COVID-19. Over the following months, our work will focus on tracking and evaluating these and related pieces of legislation and their impact on the health and wellbeing of North Carolinians. Our goal is to keep our readers informed on how elected decision-makers are responding to the mental health consequences of COVID-19.

We hope you’ll join us.

To preview the legislation we’ll be following, analyzing and evaluating, check out our list below.

  1. COVID-19 Recovery Act (SB 704): A wide-spanning Act to provide aid to North Carolinians in response to the COVID-19 crisis.
  2. Student Mental Health Well-Being/COVID-19 (SB 844): Appropriates funds to establish a system of mental health support for students.
  3. CARES Act Funds for TROSA (HB 1210): Appropriates CARES Act funds to Triangle Residential Options for Substance Abusers (TROSA).
  4. Funds for Statewide Telepsychiatry Program (HB 1204): Appropriates funds for the state-wide telepsychiatry program, NC-STeP.
  5. School-Based Mental Health (SB 476): Requires the state board of education to adopt a school-based mental health policy; requires K-12 schools to implement a school-based mental health plan including mental health training programs and suicide risk referral protocols.
  6. Medicaid Funding Act (SB 808): Appropriates COVID relief funds for the operation of the North Carolina Medicaid Program, as well as for behavioral health and crisis services, early childhood initiatives, and COVID-19 testing and contact tracing.
  7. Coronavirus Relief Act 3.0 (HB 1105): Provides additional and revised uses for federal COVID relief funds for disaster recovery.
  8. Pilot Project to Treat Opioid Overdose (HB 17): Directs the continued development and implementation of a pilot project to address the needs of opiate and heroin overdose victims who are not getting follow-up treatment in Wilmington, NC.

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