NC expanding peer mental health support

NC expanding peer mental health support

By Taylor Knopf

North Carolinians in need of mental health support now have more places to call — and soon will have more places to go — for help. The state health department is investing more money in a greater array of mental health crisis services, including those run by peer support specialists. 

In addition to 988 — the rebranded nationwide suicide prevention help line — North Carolina recently added a statewide Peer Warmline

A Warmline is a noncrisis mental health support line staffed by peer support specialists — people living in recovery from mental health problems who may have also experienced substance use, psychiatric hospitalization, homelessness, incarceration or a combination of these. 

People with a history of mental illness sometimes prefer talking with people they feel they can relate to, who may have had similar experiences. And unlike 988, the North Carolina Warmline will not call for law enforcement or EMS unless the caller requests it. Though emergency responders are rarely dispatched after calls to 988, it occasionally happens — and the possibility does deter some people from calling.

Callers can reach the 24/7 Peer Warmline at 1-855-PEERS-NC (1-855-733-7762). The 988 call center also connects callers to the Warmline by request.

The state Department of Health and Human Services recently partnered with Promise Resource Network, a Charlotte-based peer-run mental health organization, to launch the statewide Peer Warmline. Promise Resource Network has been operating a Warmline for several years for Mecklenburg County residents, and it briefly scaled up to answer statewide calls during the early months of the pandemic. Then funding constraints led them to cut back to local calls.  

Historically, North Carolina has not always invited peers to crucial mental health service meetings or invested much in the types of peer-led services that some advocates have requested. Now, there seems to be a shift in this trend.

In addition to the Warmline, the state health department is investing $22 million in community crisis centers, including a new peer-run center that will open in Wake County. The facility will be in Raleigh, operated by Promise Resource Network and mirror the services at its peer respite center in Charlotte

A peer-run respite is designed to be a voluntary alternative to hospitalization for people in mental health distress, allowing them space and time to de-escalate their emotional crises without the hospital. Completely staffed by peer support specialists, respites are peaceful, home-like settings where people can stay and receive help from trained peers who are on their own recovery journeys. 

In response to the droves of people showing up at emergency rooms and psychiatric hospitals for help during their mental health crises, North Carolina is investing more in crisis alternatives such as the Warmline and peer respite, as well as new community crisis centers. DHHS recently announced financial support for five new centers for adults in Alamance, Forsyth, New Hanover, Pitt and Vance counties and three new centers for children in Gaston, Pitt and Vance counties. 

The funding for many of these new initiatives comes from state lawmakers’ $835 million investment in mental health services last year. The money comes as a result of a federal bonus that came to North Carolina when the state expanded the Medicaid program.

“We got money to invest in the crisis system,” said Kelly Crosbie, director of the NCDHHS Division of Mental Health, Developmental Disabilities, and Substance Use Services. ”We’re going to invest in some of the more traditional things that make up a good crisis continuum — everything from 988 to crisis teams to crisis receiving facilities, which are a much better and appropriate alternative to the emergency room for a lot of people that need that level of care instead.”

Peer support in demand

With the launch of the national crisis line 988, state-level data showed that 45 percent of more than 90,000 calls a month were from repeat callers, according to the 988 data dashboard.

“They are calling for someone to talk to, so we wanted to offer them an opportunity to talk to somebody with lived experience — someone who can share their experience of recovery and their experience of the system in North Carolina,” Crosbie said of the Warmline. “We just know it’s a valuable resource.”

Warmlines have been shown to reduce loneliness and participants’ use of mental health crisis services. Additionally, a review of several studies found that digital forms of peer support improve the lives of people with serious mental illness by “enhancing participants’ functioning, reducing symptoms and improving program utilization.”

Even before the Warmline expanded statewide, Cherene Caraco, chief executive officer of Promise Resource Network, said that the 988 call center was transferring people to her organization’s Warmline, especially during the pandemic when the Mecklenburg Warmline tried to scale up and answer statewide calls. She believes that when the 988 call center started referring callers to the Warmline, a nontraditional mental health resource, that gave it “a level of validation within the system that didn’t otherwise exist.”

“[The 988 call center] saw the value of it before we were funded statewide. Their endorsement is a big deal,” Caraco said. 

The statewide Warmline continues to gain traction. Noah Swabe, chief operations officer at Promise Resource Network, said the state’s financial support allowed the Warmline to double its number of full-time peers who answer the phones, which he said is necessary as call volume continues to increase. The Warmline recently received more than 4,000 calls in a one-month period, he said. 

In addition to the Warmline, Promise Resource Network’s peer respite has been in high demand. The Charlotte respite, which opened in 2021, is always full. Swabe said there is about a monthlong waitlist to get in. People with mental illness appreciate the nonjudgmental environment where they can stay in an unlocked facility for up to seven days while receiving support from peer support specialists. Promise Resource Network also has what the organization calls a “recovery hub” nearby, which has classes, groups and programs to support people.

Swabe said the plan for Wake County is to open a recovery hub and respite care to provide wrap-around services for those looking for alternative mental health support. Funding will come from DHHS, Wake County and Alliance Behavioral Health.

Buy-in from state and national leaders

During the Warmline ribbon-cutting ceremony, Crosbie visited the peer respite in Charlotte for the first time and said it was beautiful. 

“It is a peaceful setting. It offers dignity and offers a safe space. It offers harm reduction for folks who are using [drugs]. It’s very comprehensive,” she said. “We want to build more of those. Those are the kinds of places we need.”

In addition to the respite DHHS is helping to fund in Raleigh, Crosbie said she wants to see more peer-run spaces, like peer living rooms or day programs, and supportive places for those with mental health issues who are stepping down from hospitalizations, like the one operated by GreenTree in Winston-Salem. 

“We think peer services are wonderful evidence-based, great outcomes, resources for people. So we just know that, and so we’ve been looking at really refreshing our peer portfolio because it’s effective,” Crosbie said. “And we also are in the midst of a [health care] workforce crisis, and we’ve got lots of peers, and peer supports are effective treatment resources.”

Historically, peer-run organizations have struggled to scrape together funding to keep their programs going. The new outspoken support from Crosbie and the new waves of funding could be huge for the peer movement in North Carolina. 

Caraco, who has been a leader in the peer-led recovery movement for nearly two decades, said the support from the federal government and other national groups has also helped those in the more traditional mental health system recognize peer support as essential.

“The Biden administration has created a unity agenda and is naming peer support as a necessary component of a healthy array to prevent suicide, to support people, to create access, to [help with] workforce shortages,” she said. “They have been […] endorsing peer support for a variety of different reasons where our system is either struggling, has gaps or just not well equipped to do.”

“So we have not only more recognition at the federal and national level, but more push into states and to communities to make it a sustainable, healthy part of their community,” Caraco said.

Crosbie said she couldn’t speak to culture at the North Carolina division of mental health before she took the position, but said for her, peer services are “non-negotiable.” She has seen the power of peer support in her own family.

“For my father in particular, who had a serious mental illness, for so many reasons did not get traditional treatments,” she said. “But he was always helped significantly by peers. That was the only type of help really that made any difference to him, and therefore to me and my family.”

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