NC expands specialized mental health supervision to all 100 counties

By Rachel Crumpler

When Tracy Lee worked as a probation/parole officer in Mecklenburg County, he found himself supervising people with serious mental illness — and feeling ill-equipped to do so.

“I had no idea what I was dealing with,” Lee, now chief deputy secretary of the N.C. Department of Adult Correction’s Division of Community Supervision, told NC Health News. “I didn’t know what I was looking at. I didn’t know how to respond to their behavior. 

“That has always stayed with me.”

His experience — and that of many other probation/parole officers — led him to champion expanding the state corrections department’s Specialty Mental Health Supervision program. The initiative provides enhanced training to officers who focus on working with people who have behavioral health issues. Specialty mental health probation/parole officers carry smaller caseloads — up to 40 people with serious mental illness instead of the upwards of 60 cases usually managed by an officer — so they can provide more intensive case management and develop expertise in handling complex cases.

In April, the program reached a major milestone: designating and training at least one specialty mental health probation/parole officer and a chief probation/parole officer in all 100 North Carolina counties.

Probation/parole officers supervise more people with mental illness than any other segment of the criminal legal system. Nationally, an estimated 16 percent to 27 percent of people on probation have a mental health condition. The most recent North Carolina research — published in 2018 — estimated that 15 percent to 19 percent of the state’s probation population has a mental illness.

About 255 specialty mental health officers supervise roughly 1,800 people statewide. It’s a fraction of the roughly 2,000 probation/parole officers who supervise more than 74,000 people on probation, parole or post-release supervision across North Carolina.

Lee said that the statewide expansion helps the department more intentionally serve people with serious mental illness, who generally fare less well in the community. Research shows that justice-involved people with mental illnesses are at a higher risk of probation violations, having their probation revoked and being rearrested than people without mental illness. 

“We don’t want to criminalize mental health,” Lee said. “Over the years we’ve done that because we just didn’t know any better. We didn’t know what we were looking at or how to understand it, and so we thought that the best avenue for this would be to continue to specialize the caseloads.”

A specialized approach

North Carolina’s Specialty Mental Health Supervision began as a pilot in Wake and Sampson counties in 2013. It was created in recognition that it is often harder for people with serious mental illness under community supervision to find housing, employment and behavioral health services. Those barriers can make it harder to stay stable and successful in the community. That can lead to re-incarceration, at a high cost to taxpayers; it takes about $54,000 per person per year to house someone in state prison.

For officers who do not recognize the symptoms and behaviors associated with mental illness, these cases can be more difficult to supervise. Program leaders believed that officers with specialized training and stronger connections to treatment providers could do a better job.

Results from the pilot showed that officers with specialized training made more mental health referrals, and the people they supervised were more engaged in treatment than those on the standard probation caseload.

Program expansion was slow; it spread to only 24 counties by May 2023. Growth has accelerated since then, and the department hired four licensed mental health professionals to train officers and provide ongoing support as they navigate complex cases.

Ashlyne Carman is one such mental health probation/parole officer working in Wake County. She has carried a mental health caseload for about three years, primarily supervising people with schizophrenia, bipolar disorder and other psychotic disorders. 

Smaller caseloads mean specialty mental health officers can spend more time helping people access care, including scheduling appointments, transporting people to appointments, picking up medications and consulting with doctors, if the officers are granted consent. They also regularly consult with licensed mental health professionals who offer guidance on challenging cases. 

Carman said the program’s smaller caseloads and increased support allow her to “pour more” into higher need individuals. 

She said she’s seen meaningful results. For example, one young man with bipolar disorder whom Carman currently supervises has made what she described as a “complete 180” since joining her caseload in 2024.

“When I got him, he was very like, ‘I don’t need medication. Nothing is wrong with my brain. It’s chemicals. Other people are what’s wrong.’ He was just very, very resistant to help,” Carman said. 

Over the course of many months — including a period in jail after a new charge — Carman connected him to a mental health provider, even driving him to some appointments. 

“He realized his officer was someone who was willing to drive half an hour to go get him from his house to turn around and drive another half hour to get him to an appointment because he didn’t have a ride,” Carman said. “He started to value what I had to say. If I recommended something with mental health, I think he was seeing that I wasn’t doing it from a malicious or like, ‘oh, I think something’s wrong with you’ standpoint, but from a ‘you just need a little help’ type of way.”

Carman said he now takes medication, attends therapy and practices self-reflection and de-escalation strategies during meetings with her. 

“He has a son now, and he talks about wanting to get off supervision,” Carman said. “He wants to go to work. He has a life plan.”

Carman attributed his progress — and that of other people she works with — to the speciality mental health approach, which emphasizes connecting people to treatment while helping officers distinguish between behavior driven by mental illness, versus willful noncompliance in need of punishment.

‘A different way’

Tonya Van Deinse, a research associate professor at the UNC Chapel Hill School of Social Work who studies specialized mental health supervision and was involved with North Carolina’s initial pilot program, said implementing the program is a forward-thinking approach to addressing the needs of people with serious mental illness.

“Jurisdictions are realizing that they’ve got to do it a different way in order to improve outcomes — outcomes being both mental health-related outcomes … but then also criminal justice outcomes, so fewer probation violations, revocations and fewer jail stays,” Van Deinse said. “Community supervision officers have a hard time with this too. It’s not really good for anybody to just treat the population just as you would any other person, given all the other challenges that are there.” 

North Carolina’s program follows a national model of mental health supervision with several core components: 

• Designated mental health caseloads that are smaller than traditional caseloads. 
• Ongoing training and coordination with community resources and treatment providers.
• Problem-solving rather than punitive responses when possible.

North Carolina program leaders added two additional components. Four licensed mental health professionals are embedded within the program and conduct monthly clinical case consultations, helping officers learn and develop strategies for managing challenging cases. Community engagement is also a key part of the program so that officers build networks with local providers and resources to help people succeed.

Ashlee Barnes, behavioral health administrator for the Division of Community Supervision who oversees Specialty Mental Health Supervision statewide, said officers have responded positively, with many volunteering to take on the specialized mental health caseloads.

“We’re not identifying any new cases for community supervision that don’t already exist,” Barnes said. “It’s providing that extra layer of training and support and trying to consolidate the cases to a single officer or a group of officers within the county who are more specialized in this area.” 

Not everyone with a mental health diagnosis on community supervision is assigned to a specialty mental health officer. The Division of Community Supervision has prioritized people with unmanaged symptoms and higher levels of need, Barnes said. Many initially start supervision on traditional caseloads before being flagged and moved to the specialty program. 

“My vision for this program is that we start to take an even more proactive approach,” Barnes said. “Instead of waiting until an individual experiences a crisis or waiting for an individual to decompensate, I would like for us to start identifying folks that have lower needs and still make sure that we connect them with a mental health officer early in their supervision hopefully as a preventative measure.” 

She said it’s useful to have officers with “enhanced” knowledge who can be on the lookout for red flags and make referrals. 

“Now that we have officers in all 100 counties, we have the greater ability to do that,” she said. 

Wake County has six specialty mental health officers — more than any other county in the state. Barnes said she’ll be watching caseloads closely and looking to identify and onboard more mental health officers across the state based on the need and community supervision resources.

North Carolina is ahead of many jurisdictions in adopting specialized mental health supervision. A 2023 study led by Van Deinse found from a representative national sample that fewer than a third of counties across the country screen for mental health conditions, and only 27 percent of counties had specialized mental health supervision approaches.

“We’re going to continue to grow the program,” Lee said. “It is in the best interest of the citizens of North Carolina that we focus on this population, and so that’s what we’re going to do.”

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