NC kids in crisis encounter a mental health system failing families

EDITOR’S NOTE: Because of the stigma that is often attached to mental illness, this article assigns the pseudonyms Laura, David and Ashley to protect the privacy of the people in this story. And a caution: This article mentions self-harm and suicide. If you need mental health support, call or text 988 or consult this resources page.

By Stacie Borrello

“Don’t leave me alone with knives” was the startling plea that echoed through two very different families in North Carolina—and exposed the one broken system that is failing children going through mental health crises. David, a 14-year-old in Raleigh, and Ashley, a 10-year-old in Fuquay‑Varina, each alarmed their parents by asking them to remove sharp objects from their reach. 

Both children expressed the fear that they might hurt themselves during episodes of emotional distress. 

The stories of these two North Carolina families represent a growing public health emergency — one where parents facing a family crisis must wrestle with overwhelming and systemic barriers to getting their children the mental health care they urgently need. 

From insurance companies that deny or limit coverage, to high out-of-pocket costs and monthslong waitlists for providers — many of whom don’t treat children at all — families are forced to navigate a fragmented system that too often fails them. Those delays can have costly consequences, and advocates and providers alike say changes are needed to better support the mental health needs of North Carolina’s youth.

A system full of cracks

At 14, David* began experiencing intense mental health struggles. One night, he told his parents, “I need you to take all the knives away from me.” 

His mother, Laura*, urgently sought help. First she called David’s primary care doctor, who she said didn’t return the call for two weeks. The family, which was covered by Medicaid at the time through one of North Carolina’s regional mental health management organizations, was connected to an Alliance Health mobile crisis response unit that visited their home to help David through a difficult episode. 

“They told us, ‘I think your kid is suicidal. You have to take him to the hospital,’” Laura said. “We had no idea. In an instant, our world dropped through.”

Alliance Health referred Laura and her family to a behavioral health urgent care in Raleigh that took Medicaid. After waiting a week and a half for the appointment, they encountered a provider whom they believed was ill-equipped to handle pediatric mental health needs.

“It was a horrible experience,” Laura said. The waiting room didn’t feel safe for children, she said, as it included unhoused adults weathering their own acute mental health challenges. While they were at the clinic in person, the provider met them through a video call.

“If you’re on Medicaid, this is what you get,” Laura said she remembered thinking. She felt dejected. 

Then, she said, the psychiatrist told her 14-year-old son on the video call, “If you don’t want to get better, I can’t help you.”

As Laura searched for other providers, she said she was repeatedly told they would have to wait six months to see someone who accepted Medicaid. She remembers sympathetic providers telling her, “You’re not the only parent going through this.”

With their child in severe emotional distress, the family scraped together funds to pay out-of-pocket for care and found a psychiatrist who could see David within a month.

Harmed instead of helped

Before David was able to get in to see the new psychiatrist, he had another acute mental health emergency, where he alternated between begging his parents to kill him and begging them to take him to the hospital, Laura said. 

The family waited for four hours in a local emergency room—a situation all too common in North Carolina. Psychiatric and mental health patients spend a median of 5.25 hours in the emergency room before departing, according to the most recent data from the Center for Medicare and Medicaid Services. Only 10 other states and Puerto Rico have longer average ER stays for psychiatric and mental health patients, the metric CMS uses to measure wait times.

When the patient needs to be admitted, the average wait time from an admission decision to movement to an inpatient bed is 9.7 hours, according to a report by the NC College of Emergency Physicians.

After their long ER wait, Laura recounts the doctor saying David required inpatient care, but that “there aren’t enough beds in the whole state.” David instead landed on the hospital’s psychiatric floor for a few days until a bed in a treatment facility opened up. His parents weren’t given a choice on whether to commit him, Laura said. 

She remembers the doctor telling her, “We must commit him. It can be voluntary or involuntary,” a situation that NC Health News has documented in other instances.

Any contact with David after he had been admitted was extremely limited. “On a scale of 1-10, he was ‘100’ scared,” Laura recalled. “They took away the one person your child trusts and isolated him.”

When a bed finally opened, David — as per policy — was transported in a police car alone to Old Vineyard Behavioral Health Services in Winston-Salem; his parents were not allowed to accompany him. When he first arrived, David vomited up a candy bar his mom had given him before the transport because she was worried he was hungry. 

“They didn’t even give him his clothes for two days because they said they were worried he would vomit on them again,” his mom recalled. 

She claims the hospital staff only gave David a hospital gown and underwear that didn’t fit, leaving his genitals exposed. Even worse, David alleged violent kids on the floor threatened to rape other patients, threw lunch trays at him and assaulted two of his roomates during his weeklong stay.

“He came out of the inpatient stay way more traumatized than he went in,” Laura said.

Old Vineyard is an inpatient behavioral health provider under Alliance Health’s managed care network. Doug Fuller, senior communications director at Alliance, replied by email to a request for comment. He said that beyond legal restrictions, Alliance maintains “an organizational policy of not discussing the treatment of our members in the media even if a member formally authorizes us to do so.”

Alliance conducts “routine monitoring of its behavioral health providers and targeted monitoring to investigate quality of care concerns (including those at hospitals when Alliance is made aware of them),” Fuller also wrote. The N.C. Division of Health Service Regulation, which licenses and oversees hospitals and behavioral health facilities, also is charged with evaluating whether patients are receiving safe and appropriate care in these facilities, he added.

Kerri Clark Cole, business development director at Old Vineyard, replied briefly to a request for comment: “Due to HIPAA patient privacy laws, we cannot offer comment on specific patients or their treatment or care.”

During David’s hospitalization, Laura said she spent “every day Googling,” trying to find help. After he was released, she found a specialist who diagnosed David with obsessive-compulsive disorder. 

The diagnosis came as a relief. The obsessive-compulsive disorder specialist confirmed that David’s symptoms weren’t actual signs of suicidality — instead, his violent intrusive thoughts were a manifestation of the disorder.

“No one understood what was really happening with David until then,” Laura said.

Noting that David was also on the autism spectrum, the specialist pointed them to one of the few places in the U.S. that treats obsessive-compulsive disorder and autism concurrently: Rogers Behavioral Health in Illinois. But North Carolina Medicaid wouldn’t cover the treatment, which cost $26,000 for seven weeks.

“I will put a mortgage on my house to help my son,” Laura recalled. 

David completed treatment at Rogers and is on a better track now, she said.

Insurance coverage can lead to dead ends

Amanda, a mother in Fuquay-Varina, faced a similar uphill climb after her daughter Ashley (a pseudonym), 10 years old at the time, expressed potential suicidal ideation. 

Ashley had severe mood swings and intense meltdowns, which she needed an extended amount of time to recover from. During one of these episodes, Amanda left Ashley in the bathroom to take a moment alone in her room to compose herself. 

“Mommy, you can never leave me when I’m like that ever again,” Ashley told her later. Her 10-year-old daughter revealed she thought about hurting herself in those moments. 

The first available therapy appointment Amanda found through an Employee Assistance Program was two months out. 

“That’s scary,” said Amanda, “When you’re on the edge, and the response is, ‘Well, I hope you can hang on for two months.’”

The toll on the family was heavy. 

“During those two months of waiting, I kept thinking: Is she safe to leave alone? Am I a bad mom?” Amanda shared. “It was anxiety-producing for me as a parent. You never know if the next meltdown will be the one you can’t come back from.”

When they finally saw the therapist, Amanda said she believes the woman wasn’t trained appropriately to treat children. Ashley had full-blown meltdowns during several sessions, and the provider responded by ending the session, she added.

“She was reading from a college textbook, quizzing my daughter with true/false questions like ‘Are people with anxiety crazy?’” Amanda said, arguing that the therapist’s actions triggered one of Ashley’s meltdowns. “My daughter needed help, not a quiz.”

Frustrated, Amanda called her insurance provider and was given a list of 20 covered therapists. She started dialing. 

“Every single one said they didn’t see children under 13,” Amanda said. 

On her own, she found a practice that offered an intern who was working toward licensure to work with children — but she was not covered by insurance.

“That intern turned out to be amazing,” Amanda said. “She’s licensed now, but we still have to pay out of pocket. We can manage the cost right now, but there are a lot of families who can’t.”

Providers also wrangle with insurance—and large caseloads

Mental health professionals NC Health News spoke with say they’re grappling with a high demand for care, long waitlists for specialty care and limited insurance reimbursement — all of which restrict access for families seeking help.

Erik Newman, a clinical psychologist with Newman Psychological Associates in Fuquay-Varina who administers psychological evaluations, said low reimbursement rates and administrative burdens discourage many providers from accepting certain insurance carriers — or insurance at all. 

Newman said he used to accept multiple major insurers, but that resulted in a six- to seven-month waitlist that left him feeling burnt out. Now, he only accepts one insurer. While the waitlist is shorter, new clients still wait two to three months for an evaluation. 

With high overhead costs and low reimbursement rates, most providers don’t perform evaluation testing through insurance unless they are just establishing their private practice, leaving patients responsible for out-of-pocket costs, he said. 

“When you think about insurance reimbursement rates, already mental health professionals are not reimbursed very well for their time,” Newman said. “When it comes to testing, there are overhead costs like testing materials that need to be purchased, so it results in a much lower rate for the provider to accept insurance.”

The access problem is only intensifying. According to a study by Thriveworks, a national online therapy company, demand for child therapy is up 9 percent nationwide, and therapy requests for children under 10 is growing five times faster than for older children.

Dana Torpey-Newman, also a clinical psychologist practicing at Newman Psych, claims insurance constraints shape how care is delivered — often to the detriment of children. 

“Our system tends to follow a symptom-reduction model instead of focusing on real functional improvement,” she said. “It’s like — ‘Well, your child isn’t going to kill himself, so I guess this course of therapy is done.’”

She said many young people cycle through care without ever receiving enough of it. 

“No one gets an adequate ‘dose’ of therapy,” Torpey-Newman said. She added that the  problem can be compounded by loss of insurance coverage if a parent loses or changes a job. 

The consequences of delayed or inadequate care can be dire. Many children who lack access to appropriate long-term care have an increased risk of self-harm, suicide, substance use disorders and eating disorders, Torpey-Newman said.

Cory Clark, a licensed clinical mental health counselor who co-founded Be a Problem Solver in Fuquay-Varina with his wife, Kate, during the pandemic, said their practice expanded to add a team of providers and a second location in Chapel Hill to meet rising demand for treating children with anxiety, depression, ADHD, autism and other conditions.

“There is a lack of systemic support for mental health challenges,” Clark said. Barriers like a shortage of after-school appointment times, insurance network limitations and a lack of providers in specific specialties can leave families stuck, he said.

Parents push forward, but change is needed

While there’s no single solution that will fix the crisis of unmet mental health care needs, one policy change that has shown promising results in other states is expanding scope-of-practice laws to allow psychologists to prescribe certain medications, a right currently limited in North Carolina to medical providers — even though they may not have expertise in mental health — such as pediatricians.

Phil Hughes, a research assistant professor at UNC’s Eshelman School of Pharmacy, analyzed nationwide data to determine that states that allow psychologists to prescribe medications have demonstrated statistically significant reduction in unmet mental health care needs for children and adolescents and a reduction in suicide rates.

Permitting psychologists to prescribe medication “appears to reduce suicide rates within those states by five to seven percent,” Hughes told NC Health News. “With suicide rates on the rise consistently over the last 20 years, if you can pass a policy that is safe and reduces suicide rates, that seems like a win for everyone.”

Granting psychologists the authority to prescribe medications to manage mental health conditions also allows patients to see one provider for therapy and medication management, rather than two.

An additional way to address the shortage of mental health professionals qualified to treat children is for existing professionals to obtain training and certificates to work with young people. 

“There is a call to professionals in the field,” Clark said. 

With no quick fixes, parents are left to navigate a still-broken system. Reflecting on the lessons from her experience, Amanda advises other parents to trust their gut and intuition and never give up. 

“Call the insurance companies, and also reach out independently to ask for referrals, reach out to social media groups to ask other parents,” she said. “Don’t stop advocating for your child.”

*Laura, David, and Ashley are pseudonyms used to protect the privacy of the children whose stories are shared.

Stacie Borriello is a freelance writer and storyteller who most recently was the director of communications for the North Carolina Community Health Clinic Association. She lives in Wake County with her children.

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