By Kaitlin Ugolik Phillips

During the 38th annual NCIOM health policy meeting on October 20, plenary speaker Wizdom Powell, PhD, reminded attendees of the words of author Chimamanda Ngozi Adichie:

“The single story creates stereotypes, and the problem with stereotypes is not that they are untrue, but that they are incomplete. They make one story become the only story.”

Dr. Powell went on to speak about the dangerous single story our culture tells us about the behavioral health of boys and men. As the meeting went on, it became clear that this warning against a single story was key to every talk and panel about the challenges and policy opportunities for behavioral health in North Carolina. There is no single story about behavioral health, no one way to experience trauma, no solitary impact of trauma throughout the life course, and no lone narrative about the effect of COVID-19 on all of the above.

The meeting, titled “Community, Resilience, and Hope: Achieving Healthy NC 2030 Behavioral Health Goals,” brought together (virtually) more than 400 people to discuss indicators of behavioral health and potential policy solutions for improving North Carolinians’ mental well-being. The event included a unique mix of speakers, including Dr. Powell, a population health scientist with a focus on the behavioral health of Black men and boys, and LaToya Powell, deputy general counsel at the North Carolina Department of Public Safety, who spoke about the North Carolina Chief Justice’s Task Force on ACEs-Informed Courts.

An overarching theme of the meeting was that this time of COVID-19 recovery provides a unique opportunity to change things for the better, and we don’t have to start from scratch. HNC 2030 offers a road map, based on real data, to get us there. The report identifies policies to achieve change that will positively impact health care, business, education, and many other areas of life in our state. It also brings together partners willing to do the work to get there, an effort augmented by the 2021 NCIOM annual meeting.

Addressing The Burden of Behavioral Health on Black Men and Boys

After a welcome from NCIOM President and CEO Kathy Colville; comments from Board Chair David Sousa and incoming Board Chair Carrie Rosario; and an introduction to HNC 2030 from State Health Director Betsey Tilson, NCDHHS Chief Health Equity Officer Victor Armstrong introduced Dr. Powell’s plenary session.

Dr. Powell’s work focuses on the intersection of race, masculinity, health beliefs, and behavior, and she shared insight about the burden of behavioral health that men and boys carry. “I think we’ve been telling a fairly dangerous story about boys and men that positions [them] to be problems to be solved rather than as potential wonders to behold,” she said. “We have created structural blind spots that really diminish our capacity to respond to the unmet behavioral health needs of this population.”

Much research on behavioral health has compared White men to Black men, “assuming what we learned would be meaningful,” according to Dr. Powell. She urged attendees to “embrace the socio-exposome” — a term for the totality of individual, familial, community, environmental, and sociopolitical exposures over each person’s life course — when addressing behavioral health. This idea complements the growing focus on social drivers of health, including adverse childhood experiences (ACEs).

Connecting Trauma, Poverty, and Justice Involvement with Behavioral Health

The final plenary session began with a brief video from North Carolina Chief Justice Paul Newby, District Attorney Ben David, and Judge Andrew Heath describing the Task Force on ACEs-Informed Courts. The goal of the task force is to train judges and court administrators on the effects of ACEs, equip juvenile court officials to recognize young offenders and victims affected by ACEs, identify existing and design new programs to intervene and put youth on a pathway to a successful adult life, and provide a platform for court officials to offer feedback on this experience.

LaToya Powell, deputy general counsel at the North Carolina Department of Public Safety, then gave a live talk in which she shared her experience as a prosecutor seeing kids as young as 11 in court for drug offenses. Many of them had gotten involved with drugs to help pay bills for their families. “That’s what ACEs looks like in reality,” Powell said, adding that research shows 90% of youth involved in the justice system have experienced one traumatic event and 3% have experienced multiple types of trauma.

“My vision for a trauma-informed court system is one where we no longer have to talk about the school-to-prison pipeline,” Powell said. Black youth, she noted, are three times more likely to be referred to court for the same behavior as their White peers, and four times more likely to be suspended or expelled from school. “We need to make sure courts are trained to identify these needs and respond with support, not punishment.”

Policy Panels: Reaching HNC 2030 Behavioral Health Goals for Specific Health Indicators

After a brief introduction to the State Health Improvement Plan and results-based accountability from Kathy Dail, director of the Community Health Assessment Program at NCDHHS, participants broke into five breakout rooms to attend panels on: preventing overdose deaths, building access to behavioral health services through community, reducing tobacco use, reducing alcohol-related harms, and preventing suicide and self-harm. Read key takeaways from each panel below.

The Resources to Keep Going: Improving Mental Health Access and Treatment to Prevent Suicide and Self-Harm

Moderator: Victor Armstrong

Panelists: Lisa DeCiantis, Ames Simmons, Jason Nieuwsma

Panelists shared data on suicide deaths and suicide attempts in North Carolina, and discussed risk factors for suicide. Ames Simmons identified a real need for data development initiatives to understand the disparate impact of suicide across different populations – especially LGBTQ individuals. Lisa DeCiantis discussed North Carolina’s intensive stakeholder-driven process to implement 9-8-8, a statewide suicide prevention hotline that will provide people with a centralized resource to get the help they need. Jason Nieuwsma discussed various primary prevention strategies to address suicide risk among military veterans and other groups at high risk, including community strategies to improve relationships, social connectivity, and individuals’ sense of purpose.

Preventing Overdose Deaths: What’s Working and What Needs to Change

Moderator: Carrie Rosario

Panelists: Nabarun Dasgupta, Marcus Plescia, Jamie Carter

Drs. Rosario, Plescia, Dasgupta, and Carter shared key information on the status of the addiction and overdose crisis facing North Carolina, including data on the rise in fatal and non-fatal overdoses during the COVID-19 pandemic, policy solutions to increase access to evidence-based treatment, and guidance on the use of forthcoming opioid settlement funds to support communities. Several panelists emphasized the inclusion of people who use drugs in decision-making processes, increasing funding for federally qualified health centers (FQHCs) serving uninsured North Carolinians, and using state opioid funds to support the provision of low-barrier, evidence-based, patient-centered care. Evidence-based treatment with buprenorphine and methadone has been shown to reduce the risk of overdose and mortality related to other causes, improve retention in care, and reduce injection drug use and other behaviors associated with infectious disease transmission.

Behavioral Health Services: Building Access Through Community

Moderator: April Bragg

Panelists: Gabby Stein, Deepa Avula, Cherene Caraco

The COVID-19 pandemic has exacerbated existing mental health conditions and created new ones. There is a need for increased diversity in the mental health workforce, with a goal of ensuring people from all backgrounds have access to support from practitioners who can understand their lived experiences. Speakers also identified additional strategies for improving behavioral health services, including the use of peer support services and applying trauma-informed approaches to behavioral health care.

We Know What Works: Reducing Tobacco Use in All Forms

Moderator: Sally Herndon

Panelists: Kurt Ribisl, James Davis, Michael Scott

It is a myth that all it takes to quit smoking is making up your mind to do it. According to James Davis of the Duke Center for Smoking Cessation, 14.1% of the US population smokes and 68% of smokers would like to quit. The success rate for quitting is less than 5%. Involvement of a medical provider or counselor doubles that success rate. North Carolina has one of the lowest cigarette tax rates in the country, and Kurt Ribisl of the Department of Health Behavior at the UNC Gillings School of Global Public Health says raising that tax to $1.45 per pack would prevent 23,600 kids from starting smoking and prevent 17,600 premature deaths. Michael Scott of the Center for Black Health and Equity explained the need for targeted cessation measures to “fight fire with fire,” acknowledging that tobacco products are advertised more in Black and Brown communities. Scott noted that 72.8% of Black smokers say they want to quit compared to 67.5% of Whites, but Black smokers are less successful in their attempts. He called for policies that take into account the fact that not all populations are equally protected by laws and policies, and for culturally centered cessation programs that address menthol smokers specifically and recommend services that are broadly available. NC Quitline and the Duke-UNC Tobacco Treatment Specialist Training Program are two examples.

Reducing Alcohol-related Harm to Individuals, Families, and Communities

Moderator: Mike Yow

Panelists: Elinor Landess, Mina Cook, Kurtis Taylor

Panelists addressed innovative prevention and intervention models for reducing alcohol-related harm to individuals, families, and communities throughout the state. The panelists placed particular importance on how families and communities can prevent underage drinking, which is associated with the development of alcohol use disorder later in life. Policy recommendations included consistent accountability for retailers who sell to underage buyers, changing physical environments to reduce youth access to alcohol in homes, and talking to youth about the risks of underage drinking.

For the full 2021 Annual Health Policy Meeting program, click here.

For more information on Healthy North Carolina 2030, click here.