North Carolina Panel Takes Up Care for Inmates With Mental Illness

A new 15-member North Carolina committee charged with improving mental health care for people leaving state prisons held its first meeting on Oct. 27, according to North Carolina Health News. The panel was created in response to Gov. Josh Stein's Executive Order No. 33, which directs the state's behavioral health and criminal justice agencies to coordinate more closely and asks where the gap in care between the two systems actually sits.

The committee is a subgroup of the state's Joint Reentry Council, which brings together representatives of every cabinet agency as part of an effort to improve reentry outcomes by 2030. Its members plan to meet monthly and to deliver initial recommendations to the Governor's Office and the legislature by mid-January, said Steven Mange, deputy secretary for external affairs at the Department of Adult Correction and a committee member.

Three further meetings are scheduled and will be livestreamed: Nov. 16 on the department's Specialty Mental Health Supervision Initiative, Dec. 3 on its High-Priority Reentry Program, and Jan. 11, when interim recommendations are to be discussed.

A caseload that has more than doubled since 2014

The numbers behind the panel's assignment are in the department's own caseload data. As of Oct. 20, mental health staff were serving 9,031 people across 54 prisons, out of a state prison population of more than 33,000. Just over one-quarter of the population — 26.9 percent — carries a mental health diagnosis requiring treatment, up from 12 percent in 2014. More than 2,720 people have been added to the caseload since 2020 alone.

Lewis Peiper, the department's chief of behavioral health, told NC Health News that demand is not leveling off. "More and more individuals are coming into prison and entering the mental health caseload for ongoing services," he said.

The intake figures show the same trend at the front door. Over the past five years, between 35 percent and 47 percent of men entering prison were referred to mental health services at intake based on their screening responses. Among women entering prison, the share ranged from 64 percent to 73 percent.

Roughly 4,700 people leave each year

About 4,700 people with mental health diagnoses are released from North Carolina state prisons annually. They leave with the same housing, employment and health care problems that confront anyone returning from incarceration, compounded by a condition that makes discontinuity of care especially costly.

The state's own accounting of the alternative is blunt. Incarcerating one person in a North Carolina prison costs more than $54,000 a year, and the article describes a pattern in which people without a direct connection to care cycle back into jail, prison or a hospital.

For readers who follow addiction treatment, the overlap is familiar: reentry programs that link people to outpatient care at release have been the subject of parallel policy fights over medication continuity for opioid use disorder, including the Texas prison system's decision to ask lawmakers only to maintain treatment funding, reported last month in our coverage of the TDCJ budget.

Where the care is actually delivered

Most psychiatric care inside the system is outpatient. As of Oct. 20, 8,792 people were receiving outpatient care while 239 were in residential or inpatient beds. Inpatient psychiatric treatment is concentrated at two sites: the Central Prison Healthcare Complex in Raleigh, which has 398 total hospital beds, 216 of them for inpatient mental health care, and the healthcare complex at the North Carolina Correctional Institution for Women. The department also operates specialized therapeutic treatment units and peer support programs.

More than 30 prisons use telepsychiatry to deliver mental health care, Peiper said, which extends access in the system's more rural facilities. Services are provided at no cost to incarcerated people, and referrals can come from the person in need, from prison staff or from a family member who raises a concern.

The article attributes part of the difficulty to staffing. Limited staffing and other operational barriers make it hard for the department to coordinate treatment and support as people transition out, which is the specific problem the committee has been asked to solve.

What the committee can and cannot change

The panel's mandate is advisory. Its product is a set of recommendations, due in January, for the governor's office and for legislators who would have to fund anything that follows. Medicaid, which finances behavioral health care for low-income adults, is administered by the Department of Health and Human Services rather than by the corrections department.

What the committee does have is a deadline and a public calendar. The livestreamed sessions on Nov. 16, Dec. 3 and Jan. 11 will show whether the recommendations reach the operational questions the data raises: how a release date gets matched to an appointment, who carries a prescription across the boundary between custody and the community, and what happens in the counties where the nearest prescriber is hours away.