Can Charlotte region fix ‘fragmented’ mental health system? Failing could be dire
READ MORE
Charlotte’s ‘fragmented’ mental health system
As mental health inequities persist in Charlotte’s communities, can the region fix its problems with access to resources? This Charlotte Observer special report takes a closer look at North Carolina’s mental health crisis, and how local young people and adults have been impacted since COVID-19.
Expand All
Luther Kissam V got help.
He remembers struggling with his mental health as early as elementary school, breaking down in tears on a youth soccer field after a pass went out of bounds.
“I was so upset that I hadn’t done it perfect … I ran to my coach crying, wrapped my arms around him and said, ‘I just want to die,’” he told The Charlotte Observer.
Kissam was later diagnosed with bipolar disorder, which can cause periods of mania and depression. His teens and early 20s included periods of psychosis, suicide attempts, hospitalizations and treatment programs.
Now, the 25-year-old Kissam is living with a balance of medications, therapy and healthy habits that works for him after years of work and support from family, friends and mentors. He’s a graduate of UNC Charlotte and a published poet, releasing “have I told you about my superpowers: a book of resilient verse” in 2022. He works for a nonprofit, will soon start a master’s degree program and is writing a novel.
“I have a life that’s worth living,” he said.
But he worries about those without the support system and access to resources he had.
“I think there is a critical lack of quality care that is available and affordable to most Americans,” he said.
Other advocates and experts agree: Work is underway to improve the Charlotte area’s mental health care system. But inequities in access to care and stigmas about getting help persist, especially in historically marginalized communities. And data show many in the community are still struggling with their mental health in the wake of the COVID-19 pandemic.
Failing to change things could have dire, widespread consequences.
“If we don’t do something — not just anything, but the right things — then what we’re going to see is continuing escalation,” said Cotrane Penn, a division director in Mecklenburg County’s Child, Family, and Adult Services department.
Worry about trends post-COVID pandemic
The region is seeing increased suicidal behavior among young people, as well as more adults in need of treatment for anxiety and depression, Penn said.
By 2022, 1 in 5 adults in Mecklenburg reported being diagnosed with depression, and 1 in 5 high school students reported seriously considering suicide in the past year, according to county data. North Carolina’s rate of adults reporting symptoms of anxiety and/or depression reached 24.9% in 2023, the most recent data available from health policy research group KFF.
It goes beyond diagnosed conditions: Mecklenburg’s 2024 county health report said the rate of adults reporting eight or more days per month of “not good” mental health increased to 20.1% of residents, from about 15% in 2018.
Mecklenburg County health director Dr. Raynard Washington calls it “a general level of mental distress in the community.”
UNC Charlotte professor Roger Suclupe said the COVID-19 pandemic triggered an increase in many mental health conditions.
“COVID-19 brought a lot of issues regarding anxiety, depression, isolation. We even saw an increase in substance use,” said Suclupe, a licensed clinical social worker whose research focuses on traditionally marginalized communities.
Some may be experiencing delayed reactions to the impacts of the pandemic on their mental health, said, Dr. Kevin Marra, a psychiatrist and director of medical services for nonprofit provider HopeWay.
“A lot of people were in survival mode ... but when things start to settle down, that’s when you start to see a lot of the delayed effects come out of that,” he said.
Stigma, barriers to access and lack of knowledge
COVID-19 was part of what led Kate Weaver, now the executive director of the National Alliance on Mental Illness’s Charlotte chapter, to her organization.
She closed her photography studio during the pandemic and, driven by her experience trying to find mental health care for her teenagers, sought out volunteer opportunities related to mental health.
“I didn’t want other families to go through what we had gone through, which was a very lonely, exhausting, difficult time finding appropriate resources for them,” she said.
Under her leadership, NAMI Charlotte set out to provide more services tailored to the local community’s needs. The group “identified access to care as the number one reason people do not seek help or find help” in Mecklenburg, where insurance issues can make care unaffordable and many aren’t unaware of the resources that are available.
“The statistic, which to me is horrifying, is that the average time between someone starting to experience mental health symptoms and finally getting treatment is 11 years,” she said.
Penn, whose county team includes clinicians, nurses and community partnerships on mental health, said that “access to care is a major challenge” because many treatment options are unaffordable.
Not all mental health providers accept private health insurance, Medicare or Medicaid, she noted. Those who are uninsured or underinsured often can’t afford to pay out of pocket, and people with insurance still often have to fight their insurance company for coverage of mental health services.
“Do we have enough clinicians who serve the community at-large, or do we have a lot of clinicians who are serving more affluent members of our community only?” Penn asked.
North Carolina’s Medicaid expansion helped improve access, Penn said. But that program could be in jeopardy amid federal funding cuts and policy changes.
In Cabarrus County, Anjie Vickers worries about stigma — beliefs and stereotypes individuals and communities may hold about mental health and mental health care.
A longtime nurse, she’s now a family support group facilitator with NAMI Cabarrus. The work is personal for her: Her youngest child was diagnosed with a mental health condition at 18, and her middle child died by suicide four years ago.
“That shame and stigma that we have is often the barrier to getting the help that they need,” she said. “It’s the barrier to getting early treatments, help, even knowing what resources are available.”
Inequities persist in communities of color, low income and rural areas
Access problems are particularly acute in lower-income communities, rural areas and communities of color, advocates, providers and experts say.
The United Way of Greater Charlotte tries to partner with groups already working in communities that have trust and relationships with residents.
“White people, because of both socioeconomic and cultural background, tend to access care more readily, people in communities of color less readily,” President Kathryn Firmin-Sellers said. “That’s both culture and economics.”
Much of Suclupe’s research at UNC Charlotte focuses on the Latino community, where language barriers can prevent people from accessing accurate, vital information about mental health. Something as simple as a poorly translated form can prevent someone from getting the help they need, he said, by inadvertently providing inaccurate information or playing into stigma.
Ivonne Erion, vice president of NAMI Cabarrus, is working with other groups in her county to incorporate more bilingual services into mental health care to keep up with a growing Spanish-speaking population.
“Mental health conditions aren’t discriminating,” she said.
At Charlotte Black Therapy, a practice that primarily serves Black and LGBTQ+ people, founder Markia Hearst says “trauma is at the underbelly of most issues that we see.” People are seeking mental health care, she said, to get help processing life experiences that are impacting their health and emotional well-being.
Stigma also often comes into play, the licensed clinical social worker said, when younger patients want an older family member to participate in their therapy.
“It’s a lot of pushing stuff under the rug, and we’ll just kind of keep operating as we have and trying to survive,” she said.
Challenges can look different in more rural communities, too.
Dr. Jamie Stevens, chief behavioral officer for Cabarrus Rowan Community Health Centers, said reaching people in more rural areas of the organization’s footprint requires more outreach.
“We’ll have to do flyers or go to outreach events or even do canvassing,” he said.
Piecing together a ‘fragmented’ system
Work is underway to try to address challenges within the region’s mental health care system, including under Mecklenburg County’s new Behavioral Health Strategic Plan.
“Access,” Penn said, is “the overarching goal” of the strategy, published last year.
The plan calls for a greater variety of mental health services, more focus on preventing or catching mental health issues early and more collaboration between health care providers. It also emphasizes a renewed focus on how a person’s mental health affects other parts of their life and their community, from jobs and education to public safety.
County Manager Dena Diorio’s proposed budget for the new fiscal year beginning in July includes $250,000 for a vendor to help start implementing the plan. The county will start looking for that partner later this year.
Elsewhere, NAMI Charlotte is stepping up to launch new online, phone and in-person services to help people find treatment that fits their needs and financial situation. The United Way of Greater Charlotte is investing in that project, which hopes to pull together information on a variety of resources into one, easy-to-use system.
New facilities such as the Katie Blessing Center and the Smith Family Behavioral Health Urgent Care aim to provide more places for people in need of care to go. Katie Blessing, set to open next year, will provide emergency, inpatient and outpatient mental health care for kids and teens under one roof in east Charlotte.
The Smith Family BHUC, also located in east Charlotte, provides an alternative to traditional emergency rooms for people in a mental health crisis and helps set people up with longer term treatment options. No one is turned away for being uninsured or underinsured.
And HopeWay provides financial aid and scholarships to some patients so they can access care or continue getting treatment after insurance stops paying.
The United Way of Greater Charlotte is also investing in a Cabarrus County collaborative to address the county’s mental health needs. The project brings together groups ranging from NAMI Cabarrus and other mental health-focused organizations to the local Boys & Girls Club and Girl Scouts.
They’ll work together to help educate families about mental health and resources available in the community to combat stigmas and ensure people know where to go when they or a loved one are in need.
Novant Health is incorporating mental health into other aspects of medical care to try to improve rates of early intervention, including asking questions about mental health during check-ups and increasing mental health staffing at doctor’s offices throughout the region.
“Having therapists available in one convenient location makes it easier for these patients to get the help they need,” Dr. Uma Suryadevara, clinical physician executive for Novant Health’s psychiatry institute in Charlotte, said.
Marra, of HopeWay, is hopeful having more resources in the community will lead to more people getting help earlier.
“There are a lot of things that can be done done much, much earlier in the progression of a mental health episode that these facilities will be able to capture, so that we don’t see people who are in the throes of a severe episode because they were unable to get treatment for something that’s very treatable,” he said.
Firmin-Sellers believes tailoring the approach to mental health to specific communities can help unite the region’s “incredibly fragmented” mental health care system and improve quality of life overall.
“I think we can’t underestimate the importance of mental health as a driver of economic mobility,” she said.
‘Consequences will ripple far beyond individual suffering’
The consequences of failing to address the region’s mental health needs “will ripple far beyond individual suffering,” Suryadevara said, because untreated mental health issues can make it harder for people to hold down a job or get an education and can lead to more substance abuse and crime.
“This in turn puts an enormous strain on public services and will worsen poverty and despair. Schools and workplaces will be affected negatively as students and employees struggle to perform at their highest level. Stigma will worsen, and families will bear the weight of unspoken pain,” she said. “If we neglect mental health, communities will no longer be resilient or cohesive.”
Sitting in a coffee shop reflecting on the healthy place he’s reached, Kissam remembers “so many people I’ve met who are working just as hard as I am, who because they don’t have the resources that I’ve been privileged enough to have … were not given these second chances and the quality of care I was given.”
He hopes the community can rally behind making the system work better for everyone.
“I want to live in a United States, in a state of North Carolina, in a city of Charlotte, where we give people the opportunities to get access to high quality treatment when they need it, at an affordable price,” he said. “And I think that’s achievable if people prioritize it.”
Editor’s note: If you or someone you know needs help, the national Suicide & Crisis Lifeline is available 24/7 by calling or texting 988.
This story was originally published May 21, 2025 at 5:00 AM.
