News

Pills, lack of behavorial health treatment are biggest threats

By Bill Moss, Published: April 8, 2016

Prescription drug abuse and poor access to mental health services are the biggest threats to the health of Henderson County residents, a new countywide health assessment says.

Conducted every four years, the Community Health Assessment was based on input from health care providers, mental health agencies, social workers, school officials and nonprofit agencies that serve the poor.
“When compared with peer counties and the state, Henderson County is a relatively healthy county,” the report said. “According to the Robert Wood Johnson Foundation’s 2015 County Health Rankings, Henderson County ranks 13th overall out of 100 counties in North Carolina.”
But while the county is relatively healthy compared to other counties, it does have some surprising threats. “Henderson County mortality rates for unintentional injuries, Alzheimer’s disease, suicide and chronic liver disease are higher than comparable state mortality rates,” the report says. Among the leading causes of death are “unintentional injuries,” including drug overdoses.
The report is a profile of the current health of Henderson County residents based on socioeconomic factors, key health indicators, local data and community resources. It identifies gaps in health care coverage, including the mental health and substance abuse areas. An overview of key data and key issues were presented at a community forum attended by almost 100 community leaders, elected officials, stakeholders, residents and media.
The top four health priorities the team chose to focus on over the next three years were:
1. Access/Quality of Mental Health Services
2. Substance abuse
3. Obesity
4. Safe and affordable housing
The next step in the process is for county residents, local hospitals and community partners to form Community Health Assessment action teams to draft strategies to address the priorities and fill the gaps, the Health Department says.
The Community Health Assessment Team was made of Tanya Blackford, of Safelight; Milton Butterworth of Blue Ridge Community Health Services; Diana Curran, of the Henderson County Department of Public Health; Graham Fields, of Park Ridge Health; Elisha Freeman of the Children and Family Resource Center; David Jacklin of Homeward Bound; Judith Long of The Free Clinics; Kristen Martin of THRIVE; Elizabeth Moss of Pardee Memorial Hospital; Jesse Shepherd of the Henderson County Family YMCA; Steve Smith of the Henderson County Department of Public Health; Trina Stokes of the Council on Aging; Marcia Stoneman of Blue Ridge Community College; and Stacy Taylor of Henderson County Department of Public Health.

“Opioids caused the highest proportion of drug overdose deaths in Henderson County and in the state,” the report says, including hydrocodone, oxycodone, morphine, codeine and related drugs. “Henderson County’s rates are higher than the state’s for these overdoses,” it said. “A general characteristic of the WNC region is high mortality rates due to unintentional poisoning, especially by medication and drug overdose.”
The state’s mental health reform efforts in 1999 led to the closing of some state facilities and a reduction in treatment beds and behavioral health services as the state tried to shift the burden to counties and regional management agencies. The reduction in service was dramatic. From 2006 to 2013, the number of county residents receiving services at a state psychiatric hospital plunged from 128 people to three.
“However, decreased access does not mean decreased need,” the assessment noted. “Due to funding cuts and organizational changes, many patients are left to seek services from hospital emergency rooms and many more are left with no services at all. Blue Ridge Community Health Services currently reports more than 10,000 patients with a behavioral health diagnosis, The Free Clinics reported 436 unduplicated mental health patients in 2015 and Pardee Hospital reported an average of 250 mental health visits a month in 2015 — up from an average of 170 in 2014.”
Other findings of the report included:
• Infant mortality and low birth weight rates have decreased overall since the 2002-2006 reporting period. “Both rates are lower than the WNC regional average and the state average. The teen pregnancy rate has been steadily decreasing overall since the 2002-2006 reporting period and continues to be slightly lower than the state rate. Rates for chlamydia, gonorrhea and HIV have been consistently lower than state averages.”
• 18.2 percent of the participating children in Henderson County age 2-4 were deemed “overweight,” and an additional 14.1 percent were deemed “obese.” “Being overweight or obese is a major factor in increasing one’s risk for chronic diseases such as diabetes and hypertension. Sedentary lifestyle, the high cost of nutritious foods and the lack of safe walking and biking areas in some areas of the county make it difficult for people to make healthy choices.”
• The county’s estimated population in 2014 was 111,149. Ninety-three percent of the population is white and 3.4 percent is African-American. In 2014, Hispanics (of any race) made up 9.9 percent of the county population.
• Access to mental health services and substance abuse treatment for low-income clients became more difficult in 1999 when the state implemented mental health reform. Between 2006 and 2013, the number of Henderson County residents served by the Area Mental Health Program decreased 15 percent, from 3,014 to 2,559. “Over the same eight-year period, the number of Henderson County residents served in state psychiatric hospitals decreased 98 percent (from 128 to 3). During the same period, a total of 464 Henderson County residents were served in NC State Alcohol and Drug Abuse Treatment Centers (ADATC’s), with the number varying considerably but averaging 58 persons annually. It’s not likely that the decrease in utilization of state psychiatric hospitals means decreased need for psychiatric services for the most severely impaired mental health patients. In many cases, patients dealing with mental illness and substance abuse
• are left to seek services from hospital emergency rooms and many more are left with no services at all.”
• The people providing input talked a lot about the lack of safe and affordable housing and identified that as a problem that’s getting worse. “Everyone from community leaders to participants in the focus groups and client interviews talked about this need in our community,” the assessment team said. “This was not included as a top priority in the last CHA process, but was clearly important to many in 2015.” Under a federal definition of “affordable housing” that costs no more than 30 percent of a household’s monthly income, Henderson County flunks the test. “In 2008, the area median income for a household of four in Henderson County was $52,500. Given the county’s fair market rent of $695 for a two-bedroom unit, “a low-income family would have to spend 66 percent of their monthly income for housing, instead of the suggested 30 percent, to be able to afford a two-bedroom unit in Henderson County.”

The breakdown of the state’s mental health system has directly affected local agencies. Smoky Mountain, the regional agency responsible for delivering mental health care, reported specifically on the new burden on local agencies. Blue Ridge Community Health Services served 5,328 active behavioral health patients, the Free Clinics 436 and Safelight 123. Pardee’s emergency room saw an average of 250 mental health patients a month in 2015, up from 170 in 2014, and its behavioral health unit admitted an average of 20 clients a day in 2015.