Editor’s note: This is the fifth in a multi-part series where the Border Belt Independent looks at what has changed since The News Reporter’s six-part series in 2017 that reported on the opioid crisis and associated mental health issues. Today, Reporter Ivey Schofield looks at what treatment options for addiction are available and where people can find them in the county.
By Ivey Schofield
As a former employee of the disabilities service industry, Vickie Pait has personally witnessed the degradation of the mental health system in North Carolina. Now her Whiteville organization has been forced to address the need despite its lack of expertise or training.
“We’re letting our people down every day,” said Pait, director of Families First, Columbus County’s coalition against sexual and domestic violence.
Pait isn’t the only one lamenting the lack of options available for people who struggle with mental health, particularly drug use, in Columbus County. There is no detox center in the county and only one methadone clinic. There’s often a waiting list for a treatment center in neighboring Brunswick County.
Columbus County isn’t an outlier. Only 8% of rural counties in North Carolina have the recommended ratio of 50 psychiatric beds per 100,000 residents, according to Alan Ellis, professor of social work at North Carolina State University.
The coronavirus pandemic only made it worse, forcing clinics and treatment centers to close to mitigate viral spread before vaccines became readily available. It took months for trained clinicians to receive approval and funds to offer telehealth, which can’t reach patients in Columbus County who live in areas with little or no broadband access.
However, it wasn’t always so hard to find assistance for mental health issues, including substance use. Before 2001, the federal government funded public mental health hospitals across the country. Then, the North Carolina General Assembly transferred the management of mental health programs from state government to private agencies, giving local communities the responsibility of providing these services.
By 2007, the state spent $50.26 per person annually on mental health — the seventh worst in the country, according to the National Alliance on Mental Illness.
“Now that [the federal oversight] is gone, I think everybody realizes how much of a benefit it was to the community,” Pait said. “These people don’t have anywhere to go.”
As a result, places like Families First that have not received clinical training in drug misuse and addiction have to still address the issue. Pait says that late at night police officers sometimes drop off impaired women at her shelter because they don’t know where else to take them.
“We’re the catch all,” Pait said.
Organizations know where to get help
It’s difficult for Pait to think of available — and affordable — options for people who need help in Columbus County. But providers have been trying, with varying success, to get the word out.
The pandemic has made it especially difficult, since providers can’t host and participate in large outreach events. “The word is not getting out as much as it should,” said Dr. Devoria Berry, director of Community Support Agency, a certified behavioral health agency with offices in Whiteville and Delco.
But some entities like Trillium Health Resources, a managed care organization for 26 counties in North Carolina, know where mental health and substance abuse resources are. With an office in Whiteville, Trillium provides a 24/7 hotline for individuals experiencing behavioral health and substance abuse struggles. Trillium also coordinates care with local agencies like Community Support Agency.
Trillium also has state funds to pay for services for uninsured or underinsured people, but it has to distribute the money across 26 counties. “It’s a good source, but it’s a limited source,” said Dennis Williams, southern regional director.
If there’s no money available and a person isn’t eligible for Medicaid (a federal program that covers the cost of health care for low-income individuals), Trillium will coordinate care with about eight providers in the county that provide addiction treatment. Some nonprofits, like Men and Women United for Youth and Families, can help at that point.
Men and Women United, based in Delco and Riegelwood, operates a resiliency hub, offering free case management that links people with programs that enhance communication skills within family units and that provide job training. It also connects people, including those who struggle with addiction, to other local organizations.
“We fill the gap as a hub so that, whether it be substance abuse or any other need, we can do it here locally,” said Executive Director Randolph Keaton.
Around 2% of Men and Women United’s clients suffer from addiction, according to the Rev. Keith Graham, the workforce development manager. Mental health is an even bigger problem, with 40% of clients struggling emotionally.
Inpatient and outpatient treatment centers
As a pastor, Graham often assists locals with their emotional barriers, but he also refers them to Community Support Agency, which accepts insurance for outpatient substance abuse programs, medication management and therapy. (The Border Belt Independent asked for the cost of treatment without insurance but got no response).
The agency sees around 100 patients a year, according to Director Berry. Most of these patients are referrals from the probation office, social services and court system — and they don’t always want to be in treatment.
In other cases, Berry has seen locals try to seek treatment outside of the county. For example, Delco residents will travel to agencies in Wilmington or Whiteville — places where they can remain anonymous. “There’s a stigma to getting help,” she said.
That’s why some people decided to get inpatient treatment in Brunswick County with Christian Recovery Centers, a free, four- to six-month, Christian-based program for people struggling with drug addiction. It partners with Brunswick Community College to provide trade classes, offers community service opportunities like landscaping and catering, and hosts regular counseling sessions with clinicians and pastors.
Because of the pandemic, however, the waiting list for the 42 beds at Christian Recovery Centers has been getting longer and longer, according to Colton Reaves, director of operations at the Columbus Christian Recovery Center. Now, there are generally 10 to 30 people hoping to get empty beds, according to Reaves. Before, there were generally only a handful of people waiting.
During the pandemic, Christian Recovery Centers expanded its program through a partnership with the Boys and Girls Homes of North Carolina to include housing for children of parents in treatment. Bright Hope aimed to provide children with a place to live, recreational therapy and examples of healthy, sober parenting. By October, however, nobody had sent their child to Bright Hope, and the grant expired.
New mothers in Columbus County can seek treatment at Coastal Horizons Center, a Wilmington-based nonprofit that offers a Pregnant and Postpartum Women’s Program in Whiteville. The center offers drug education, relapse prevention, and wellness and trauma treatment.
“We know that women at that time frame are very likely to make lasting change,” said Jessica Canavan, assistant director of community based family services at Coastal Horizons.
When the pandemic hit, the program had to adapt, transitioning to telehealth and conducting at-home visits outdoors with their participants. “We will do anything we can to lay our eyes on them,” said Gayle Beese, the program coordinator in Whiteville.
Not all of the clients at Coastal Horizons, however, want to be there, since the court system sometimes refers them to treatment. That doesn’t deter Beese. “I always say that some treatment is better than no treatment,” she said. “When they’re ready, it’ll be really easy for them to continue.”
Thanks to a partnership with the North Carolina Department of Health and Human Services, Coastal Horizons can treat people, regardless of their insurance status, according to Canavan.
Regulated opioids may help
Some individuals, especially those who are early in their substance abuse recoveries, want support other than therapy sessions several times a week or hotline numbers.
Heidi Herring of Hope and Healing Center in Whiteville says that providing addicts with regulated doses of methadone, a long acting, full agonist synthetic opioid, could provide that necessary support. Full agonist opioids activate all opioid receptors in the brain, resulting in the full opioid effect. Partial agonist opioids only activate a specific opioid receptor.
Herring, along with her co-owner, Dr. Brack Jeffreys, recently opened what they say is the first methadone clinic in the county.
At the right dose, methadone at $12 per day can completely relieve withdrawal symptoms for at least a day, not create any mental or physical impairment and block the effects of consuming other opiates, according to Jeffreys.
“With methadone, you don’t have to be clean; you can come as you are,” Herring said. “Just get here before you end up in the graveyard.”
The Hope and Healing Center also offers treatment with Suboxone, which is a partial agonist synthetic opioid that lowers the risk of overdose and relapse, at $225 per month without insurance. The federal government doesn’t regulate suboxone as much as methadone, requiring Suboxone patients to see counselors once a month instead of every day like with methadone patients.
In 2020, Columbus County distributed 11,948 Suboxone prescriptions per 100,000 residents — which is much higher than the state’s average rate of 4,385 prescriptions per 100,000 residents.
Since Suboxone is classified as an opioid, its use in treatment is controversial. It still produces a high and gets rid of withdrawal symptoms. “I think you’re substituting one drug for another,” said Darren Mills of Celebrate Recovery, a free and confidential program that uses the Bible to help people struggling with hardships and habits, including addiction.
But Suboxone also has milder effects, making overdoses less likely and less deadly. “The best thing in the world is suboxone,” said Vickie Pait of Families First. Pait added that suboxone works best when paired with other services, including individual and family therapy.
Several people told the Border Belt Independent that they believe coordination among treatment agencies was lackluster, which could be due to the pandemic limiting big outreach events or due to the competitive nature of grant funding.
“In a rural area, it’s really important to be able to meet people where they are,” said Danielle Monroe Nolan at the Boys and Girls Homes. “We’re all going to be good at what we’re good at, so we need to work together to make a cohesive team.”
But funders like the Kate B. Reynolds Charitable Trust, which has provided grants to Men and Women United, are now encouraging their recipients to work together to increase their capacities to effect change in their communities. (The Reynolds Trust funds the Border Belt Independent.)
Not every organization, however, experiences the same emphasis from their funders. They also might not have the grant funding to advertise substance abuse and mental health services.
Ricky Creech of Boys and Girls Homes thinks the media and businesses should make advertisements free. “We need to find ways and find partners that are willing to say, ‘I don’t need to make a buck off of this. I need to help our society become a better society and promote some of these services,’” he said.
Creech added that providers also need to do a better job of marketing their services as confidential, which is especially important in small, rural areas where everyone knows each other.
But confidentiality doesn’t mean that someone should be ashamed of their addiction. That’s why Coastal Horizons emphasizes grace for its clients from Columbus County.
“If we can provide empathy and understanding to reduce that stigma, we could have a much greater impact on helping individuals get the treatment they need and ultimately make that difference for families and the larger community as a whole,” Canavan said.
Vickie Pait looks forward to the day that Columbus County can be a better place for all its residents, including those who struggle with addiction. Until then, her coalition will try to meet the needs of anybody who walks through its door, even if they’re not related to domestic and sexual violence.
“You’re going to have to eliminate marginalized communities and stop racism, misogyny and all the -isms before you’re going to be able to solve the drug problem,” she said.
The Border Belt Independent (borderbelt.org) is a nonprofit, online newsroom that provides in-depth reporting in Bladen, Columbus, Robeson, and Scotland counties, often in collaboration with the six newspapers that serve the region.