An undated map of downtown Chapel Hill and the majority of UNC

Addressing Basic Needs

This guest post by Macon Hollister and Sarah Holsapple originally appeared on Chapelboro.com

Recent news stories from Chapel Hill about an increase in crime, homelessness and behavioral health episodes on Franklin Street have highlighted to need for more comprehensive behavioral health services in Orange County. As Chapel Hill Mayor Pam Hemminger and law enforcement officials have said, “arresting people is not a long-term answer.” Others state that they “do not want to criminalize homelessness, but they argue that more needs to be done.” A joint statement from Pam Hemminger and Chief Chris Blue responds to these concerns and states “Looking ahead: more resources are needed to combat these complex and difficult situations. One part of the solution, which has been under discussion for several years, is the creation of an Orange County Crisis Facility, which would provide immediate access to resources for people experiencing mental health crises. This conversation needs to continue if we hope to develop meaningful and positive outcomes for those most in need.”

I agree with these statements in part, but want to provide further context to ensure we do not conflate criminal conduct, behavioral health issues and homelessness. As a Licensed Social Worker, I want to address the behavioral health component that can intersect for people experiencing homelessness and criminal justice involvement, but also can, of course, exist entirely separately. Mental Health and Substance Use disorders take millions of lives across our country every single day. Communities everywhere experience loss from the rise in overdose deaths. I know this because I see it firsthand every single day. I have witnessed the years of systemic failures that have continued to reject and push people away from the quality and humanistic treatment they need and deserve. While support for substance use disorder and behavioral health needs is available to some degree in our community, it fails to take into account basic needs of housing, food, and transportation. The Housing First model tells us that people need to meet these basic needs before they can make progress on other goals like treatment, education, and employment. Opioid Settlement and American Rescue Plan funds give us an opportunity to disrupt the current system and create new resources, including a one-stop transitional and holistic crisis-diversion treatment facility.

The lack of quality and evidence-based services that treat individuals with dignity and care while they try and navigate their trauma, substance use, and mental health is a crisis all across our country. Before moving to North Carolina where I currently work with individuals who have substance use and mental health diagnoses and frequently intersect with the legal system, I saw the same patterns and heard the same traumatic stories from the individuals I worked with on Rikers Island and in New York State Prisons. It can be defeating to go into work day after day and know that the services and referrals that you are going to try and piecemeal together for individuals will likely not work, because every service provider is understaffed, under resourced, and doesn’t have the capacity to deal with the “complex needs” of individuals who are struggling to make ends meet with these co-occurring symptoms.

However, most states and specifically North Carolina, finally have an opportunity to truly invest in quality, evidenced-based, person-focused treatment and services for those most vulnerable in our communities. With the allocation of 18 years of funding from the Opioid Settlement and shorter-term Rescue Plan funds, counties and towns all across the state are going to be given the opportunity to invest in making their communities, and the people who live in them, healthier.

However, we are already seeing what happens when there is limited funding and people who are not familiar with the needs of these individuals start making the decisions of where the money should be allocated. The systems and the service programs that have been in place for years and years don’t seem to be working, so instead of pouring money into broken systems and broken promises, local communities need to invest in something that could truly transform a community and the individuals who live within it.

If an individual’s basic needs are not being met, then complying with their mental health and substance use services treatment is going to be a constant challenge. If an individual doesn’t have housing, food, or a means to get to various treatment and court appointments across the county, their ability to participate in treatment services will be exhausting and impossible to navigate. If an individual doesn’t have a working phone in order to get in touch with their providers they are supposed to be meeting with, then you guessed it, their mental health and substance use treatment is going to be unsuccessful.

What if instead of this disparate web of services, we created a one-stop transitional crisis-diversion facility that addresses the multitude of needs these individuals have all in one place? People who are in crisis and unsheltered would have a safe bed to sleep in, people would be given warm meals, people would be given housing referrals and other support service referrals, provided peer support, have access to phones and computers, provided treatment for their diagnoses, and all while being treated with the respect and dignity that every human deserves. This place could exist, and it could be modeled after what Miami-Dade is doing in their own community. While this facility is a critical need, it would also require fully funded supportive services in the community.

I have seen how complex and intricate treatment and discharge service plans need to be for people who are trying to navigate substance use and mental health disorders in our community, and I have seen how overwhelming they can be for the individual to navigate on their own. Instead of continuing to invest in services and programs that do not and cannot meet the needs of these people, this is an opportunity to truly invest in something that could change their lives, and ultimately make the community more welcoming for everyone who lives there. We have a chance to disrupt the system and create an integrated system that works.

Everyone in the treatment and service provider world knows all the lingo and the research behind “best practice,” “trauma-informed care,” “person-centered services,” but until these attributes are applied to ALL parts of an individual’s life (their housing, their financial stressors, their ability to have access to food, and their basic human needs), it will not matter what state of the art treatment is being offered at the various programs. If an individual cannot get there or doesn’t have a safe place to stay at night, successful treatment will be hard.

The program I work for in Orange County (the Lantern Project in the Criminal Justice Resource Department) is a pre-arrest deflection, post-charge diversion and reentry program in the county for individuals with behavioral health issues, and we are working with over 150 people at any given time. We meet our clients in the jail, being released from prison, and on the streets to offer support to these individuals who are trying to navigate all of this on their own. We provide phones, case management, and peer support in order to try to connect individuals to programming and treatment services they need in the community. However, it is not enough.

The Orange County Behavioral Health Task Force and its Crisis Diversion Facility Subcommittee, has been working on the plans for a Crisis Diversion Facility with holistic and wrap-around services with the support of the County Manager and Board of County Commissioners in Orange County, NC. The other elected bodies, all our law enforcement chiefs and Sheriff, and community advocates and providers have shared their interest, guidance and support for this proposed facility. It is more than a conversation at this point and county funding has moved the planning to a new phase. However, significant additional funding will be needed in order to make this facility a reality for the people in our community who need it the most. We hope that more counties and local municipalities will follow in Miami and Orange County’s footsteps in making this type of crisis center a priority for the individuals in their own community. Until the basic needs of people with co-occurring behavioral health diagnoses are adequately addressed, the limited services that currently exist in most communities across the country will not be enough to support these individuals and their varying needs.

The proposed Orange County Crisis Diversion facility would offer Behavioral Health Urgent Care, facility-based crisis services, 24/7/365 walk in behavioral health services, detox services, medical urgent care, referrals to community treatment and facilitate that transition, referrals and information about other available social services, assistance with health insurance enrollment, transportation assistance, short term boarding for patients awaiting transfer to other services. The facility would be available to the general public, adults and children, people with special needs, and justice involved individuals. The goal is also to provide an alternative to the Emergency Department and the Detention Center for crisis responders.

It’s so difficult for individuals to get access to quality treatment and services every single day. Whether it is because there are no beds available, or the program doesn’t accept their insurance, or an ACT Team or other service provider are at capacity, or they just don’t have a ride, all of the obstacles feel insurmountable at times. An all-encompassing crisis center that provides individuals with those basic needs – a safe space to sleep and access to food, the lives of our community members would be drastically changed. We could give them the opportunity to truly engage in treatment and participate in vocational training, without those additional stressors.

The Opioid Settlement and ARPA funds are the key to making this work. A significant amount of money, dedication, and commitment will be needed. We want this Facility and programs to attract service providers who are passionate about this work, and compensate them respectively. We want to make sure there is enough staff so that clinicians and service providers can have reasonable caseloads that will allow them to actually help individuals, and not just manage various crises.

If we use these funds to fund existing programs that operate independently and do not address these basic needs of the people we serve, we risk creating exactly what we are seeing today with disparate siloed programs that all work on just their piece of the puzzle and miss the big picture of treating the whole person and all of their needs. We know the saying “don’t fix something that isn’t broken,” but I would argue the systems to serve these individuals have been broken for far too long, and it is about time for our communities to make it a priority to fix them.