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From hurricanes to coronavirus: NC plans to shift mental health hotline to latest crisis

News & Observer - 3/27/2020

Mar. 27--RALEIGH -- The rapidly unfolding coronavirus crisis is disrupting nearly every part of modern life, from long-term school cancellations or loved ones who have fallen ill to unemployment numbers at unheard-of levels.

Stress caused by those byproducts of the pandemic are pushing mental health providers, who typically have appointments with patients in person, to provide the much-needed care virtually or on the phone.

"Disasters of any nature are traumatic, and this is one that is radically changing the way people live their lives on a day-to-day basis, and there's a lot of uncertainty," said Kody Kinsley, the N.C. Department of Health and Human Services' deputy secretary for behavioral health and intellectual and developmental disabilities.

That uncertainty can lead to new mental health conditions or exacerbate existing ones, according to Kinsley and other experts. To help those are suffering, North Carolina officials have loosened rules around telehealth and are exploring widening a crisis hotline that has been active in the eastern part of the state since Hurricane Florence in 2018

In a March 22 letter requesting a disaster declaration from President Donald Trump, Gov. Roy Cooper described an increasing need for mental health services. Hotlines like the N.C. Suicide Prevention Lifeline, Hope 4 NC, the Substance Abuse and Mental Health Services Administration Disaster Distress Helpline all saw increases in call volume, Cooper said. And across the state, managed care organizations saw a 63 percent increase in call volume from March 13 to March 22 when compared to the month's first nine days.

An event like the coronavirus pandemic will cause worry that leads to anxiety, Kinsley said. For others, he said, the isolation that is part of staying at home to avoid contracting the coronavirus can lead to depression.

"Every person is going to be touched by this with regard to their social and emotional wellness," Kinsley said.

Expanding Hope 4 NC

Part of North Carolina's plan for mental health as the coronavirus pandemic unfolds is expanding the Hope 4 NC program that has enrolled hundreds of thousands of North Carolinians in Eastern North Carolina since Hurricane Florence.

"Our team is working on figuring out how to bridge Hope 4 NC into a statewide strategy, and I expect we will figure that out very soon," Kinsley said.

Since starting operations in September 2018, the program has given free crisis counseling to more than 275,000 residents

"We want it to be that big a program again, but statewide," Kinsley said.

Typically, the Hope 4 NC counselors have gone door-to-door in impacted communities. With so many people isolating themselves from outside human contact, though, door-to-door counseling would not be a part of the statewide program.

Figuring out how a statewide Hope 4 NC program could provide services remotely is among the challenges DHHS faces, a process Kinsley likens to "building the plane as we fly it."

Hope 4 NC was scheduled to stop providing services on March 30, 2020.

Kinsley's DHHS team is also trying to obtain bridge funding to maintain the infrastructure while it seeks a more permanent funding stream. Key to a more permanent funding stream would be the individual assistance Gov. Roy Cooper requested from President Donald Trump as part of North Carolina's disaster declaration.

Waiting for FEMA

Trump granted North Carolina's disaster declaration Wednesday, but only signed off on part of the requested assistance. North Carolina municipalities are eligible for a 75% reimbursement for actions taken to prepare for or respond to the coronavirus crisis, according to FEMA.

But Cooper also asked for crisis counseling, disaster unemployment assistance and disaster case management, among other pieces. Per FEMA's daily briefing on Thursday, the state's request for that assistance remains "under review."

A release from Cooper's office said the state is "still waiting" for the additional aid.

Other governors, such as New York'sAndrew Cuomo and Washington'sJay Inslee, have asked FEMA for similar individual assistance programs to those Cooper did. While those states haven't received the full packages they requested, most declarations have included individual assistance for crisis counseling.

As of Friday, North Carolina was joined by Iowa, Maryland and Missouri as states whose individual assistance requests remained under review.

In a prepared statement Thursday, Cooper said, "We will continue working with FEMA as they review our request for more benefits for people affected by this pandemic."

FEMA did not respond to an emailed list of questions from The News & Observer, including queries about why North Carolina hadn't received a decision on individual assistance and when it could expect such a decision.

Should North Carolina receive approval for crisis counseling, the state would need to submit to FEMA an application describing how the program would work and how funds would be used.

DHHS in action

Even as FEMA deliberates over North Carolina's request for crisis counseling funding, the state is pursuing other actions to make mental health services available.

To help make it easier for mental health professionals to offer care, the state DHHS rewrote Medicaid and state policies about billing for telehealth and parameters of service on the fly.

"I believe we've moved our telehealth policy 10 years forward in 10 days' time," Kinsley said.

Another important development, Kinsley added, was the federal DHHS' notification to providers that it will not be investigating potential HIPPA violations while the pandemic is ongoing, allowing them to provide telehealth services over whatever technology is available. Many providers will have HIPPA-compliant platforms available, Kinsley added, but it is important that those who do not remain able to provide service.

Kristin Krippa, a psychologist with offices in Cary and Pittsboro, said her patients have been experiencing increased anxiety; while parents, in particular, are struggling with the pressures of working from home and also providing classwork for kids whose schools have closed during the pandemic.

"We quickly moved almost everyone to video sessions, and I personally am even doing video sessions with young kids," Krippa said, "so that they can continue to get the support they need and feel that continuity of care because everything is disrupted."

Caring for mental health is important on its own, Kinsley said, but also provides a safeguard against the coronavirus.

When the behavior health system fails, Kinsley said, "More people show up in our emergency departments, more people show up in our jail and more people show up experiencing homelessness. ... (Now,) we need our health care system at hospitals focused on COVID-19, and we don't need to flood our jails with folks."

'Invisible wounds of the pandemic'

DHHS officials and providers both expect the state's mental health needs to mount as the disaster unfolds, and potentially to continue climbing even long after it comes to an end.

The lingering psychological impacts of a disaster are indicative in the Hope 4 NC statistics after Hurricane Florence. Initially, the program expected to serve about 49,000 people in Eastern NC between July 1, 2019, and March 30, 2020. In reality, it served more than 102,900 people.

Dr. Mehul Mankad, the chief medical officer of Alliance Health, said it is normal for mental health impacts to present themselves well after a traumatic event or time.

"It sometimes takes weeks or months for the impact of that physical trauma to sink in psychologically," Mankad said. "I believe as a member of the mental health community that we will be dealing with the invisible wounds of the pandemic for years to come.

"There will be people that are shaken by this, and it will affect them in ways that they are not aware of until somebody else points it out to them or they need to go talk to somebody."

Kinsley, of DHHS, also expects more people to seek help as the disaster continues.

"I suspect we'll see a more demonstrable increase in demands weeks into this," Kinsley said. "It's kind of human nature: People kind of hunker down and try to manage this before they reach out for help."

This reporting is financially supported by Report for America/GroundTruth Project and The North Carolina Local News Lab Fund, a component fund of the North Carolina Community Foundation. The News & Observer maintains full editorial control of the work. To support the future of this reporting, subscribe or donate.


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