United States Senator Tillis travels to Raleigh on a mental health care program

By Taylor Knopf

North Carolina U.S. Senator Thom Tillis convened a small group of state health officials in Raleigh last week to discuss his mental health and substance use legislative agenda.

Tillis hosted the meeting during the week of the first anniversary of the passage of the Bipartisan Safer Communities Act, the first major gun violence prevention piece of legislation to pass Congress in 30 years. Tillis was one of the leading Republicans negotiating the bill in the wake of two mass shootings in Buffalo, New York, and Uvalde, Texas in May 2022.

In addition to some gun control efforts, the Bipartisan Safer Communities Act has authorized billions of dollars in new spending to expand and improve access to mental health services in communities and schools. Last week, Tillis said he doesn’t know of any state taking full advantage of all the new funding streams and he wants North Carolina to be the first to do so.

I am semi-obsessed with making sure North Carolina becomes the nation’s best practice on implementing all behavioral health provisions in BSCA, Tillis said.

He asked the two state lawmakers present if the General Assembly could create a study committee to analyze funding flows.

We are at our best when we are fully informed, Tillis said.

Senator Jim Burgin (R-Angier) explained the difficulty state legislators and legislative staffs have faced in trying to sort through all federal funding streams and their different needs. He suggested that Tillis make calls to House Speaker Tim Moore (R-Kings Mountain) and Senate Leader Phil Berger (R-Eden) to start a study committee.

North Carolina Department of Health and Human Services Secretary Kody Kinsley has suggested efforts to align some of the federal funding reporting requirements.

Every SAMHSA dollar, every CDC dollar, every CMS dollar has a completely different reporting scheme. . . has a completely different set of requirements, and for our cash-getting friends, there’s no worse gift than cash, Kinsley said with a laugh, referring to multiple federal agencies, including the Substance Abuse and Mental Health Services Administration, i Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services. You explained the lengthy bargaining process and regular reporting procedures that take place every time funds are distributed.

Kinsley said one part of the Bipartisan Safer Communities Act that North Carolina has really taken advantage of is the expansion of certified community behavioral health clinics. As a result of attempts to restructure the mental health system decades ago, community-based health care has declined, leading many patients to rely too heavily on emergency and crisis services. For years, health advocates and leaders have called for more community-based care rather than pushing people into hospitals and long-term facilities to receive mental health services.

Permanent telemedicine policies

I’d like to talk about things that help me focus on the next things we should do in Washington, Tillis said.

He said his goal is to make the telehealth benefits he gave during the pandemic permanent. These allowances have been progressively extended during the pandemic, creating a lot of uncertainty for providers.

A two-year extension means you’ll be using basically the same technology you’re using today, Tillis said. You won’t invest in bricks and mortar, you won’t expand access.

Tillis said she believes telemedicine has been stressed during the pandemic on a large scale, and that the bad things people feared might happen with remote medicine have not occurred. She said she wants to go back to Washington and lay the groundwork for not only permitting current practices but also paving the way for innovation and service expansion.

President Joe Biden’s administration recently announced a $40 billion grant program to improve broadband across the country that will likely help make more telehealth possible.

It’s something where I think effectiveness has been demonstrated. We need to establish that standard operating procedure, Tillis said, before turning the conversation around the group and asking what the next generation of telehealth would look like.

Robyn Jordan, a UNC psychiatrist who also represented the North Carolina Medical Society at the meeting, said telehealth has changed the way she and her team deliver addiction drugs.

We take people from all over the state now, whereas we couldn’t before, he said. And she can see them in their home environment, which gives an insight into how they live and if they maintain basic hygiene. He is also able to see people who are homeless or without transportation.

If that were reversed, I believe it would be devastating to the addiction space because so many people would lose care without telehealth, he said.

Stephen Lawler of the North Carolina Healthcare Association said telehealth is considered best practice in many cases now and is a huge boon for rural communities who can now connect with healthcare providers in other parts of the state.

When discussing innovations in healthcare, Lawler also mentioned insurance providers.

I think we need to have proper networks and proper payment to ensure no one is left behind because there is a barrier to entry because someone is off the network, he said.

Mental health providers have long stated that they need adequate reimbursement insurance to deliver and expand their services. There has been a lot of gray area regarding the insurance reimbursement of telehealth services. Meanwhile, federal equality laws have long been in place that require payers to cover mental health and substance use services at the same level as other health care services. Often this does not happen and equality laws are not enforced.

Tillis said she believes there should be parity in providing telehealth services like any other medical consultation. Insurance coverage of telehealth services is something he says should be considered moving forward.

Dealing with stigma

Another issue Tillis asked to hear the group’s feedback on was the ongoing stigma around mental health diagnoses and treatment.

The Senator shared a story about a mental health crisis he experienced during his first term as a state legislator in the General Assembly. He said he had a health problem that required him to take 90 milligrams of steroids a day for an extended period of time.

My otherwise quiet demeanor was a little escalated. But over the course of six months, I personally experienced drug-induced mania followed by severe depression, she said. I don’t think any of my colleagues knew what I was struggling with in the legislature.

Later, Tillis said she wanted to share her experience at a mental health conference, and her staff at the time balked, suggesting maybe she shouldn’t.

So I know we have a lot of work to do, because I can’t tell you how many times someone walks up while they’re doing all this mental health work and then whispers that they have a family member or friend going through all of this, Tillis said. So what else can we do? Or what else should we do about a political issue?

Ripple Sekhon, a doctor with the US Department of Veterans Affairs, said there remains a huge stigma issue in the military. He often hears from veterans who don’t want a mental health or substance use diagnosis recorded in their medical records for fear of backlash. From there, it’s hard to get them treated, he said.

Jordan, an addiction medicine psychiatrist, said that the stigma around addiction is even stronger than the mental health stigma, and sometimes, the mental health community stigmatizes addiction. He said one policy change that has greatly improved the stigma of addiction is the removal of a federal waiver that health care providers had to prescribe drugs for substance use disorders. Since that requirement was lifted, he said more providers have been interested in training to prescribe the drug and now view prescribing addiction drugs just like any other type of prescription.

He added that another recent policy change that has lessened the stigma around addiction was the U.S. Department of Justice’s updated guidance released last year saying it violates the Americans with Disabilities Act to discriminate against someone who takes drugs. for opioid use disorder. Prisons, health care facilities, and doctor’s offices cannot deny someone treatment or access to substance use disorder medication.

Jordan said he believes an organization will likely need to be sued in court for this new guidance to take full effect and take effect, but that it’s a step in the right direction to remove the stigma.

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