Are mobile clinics the key to addressing mental health needs in rural North Carolina?

By Ivey Schofield

Caitlin Faulk stood inside an orange and white RV that serves as a mobile health clinic and watched the dozens of cars lined up to get meals from the food bank across the street in Tabor City. 

Then, a man with red hair approached. A medical assistant checked his vital signs and administered a drug screening. The man used a laptop inside the RV to speak with a doctor for a few minutes via telehealth and then left. 

As the mobile clinic coordinator for Coastal Horizons, Faulk travels across Bladen, Brunswick and Columbus counties to provide counseling and medication-assisted treatment such as Suboxone for people struggling with opioid addiction. 

“We need to get to some of the areas that don’t have access at all,” said Faulk, a licensed therapist from Riegelwood. 

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Mobile health clinics like the one run by Coastal Horizons, a Wilmington-based nonprofit that provides mental health services across the region, have gained popularity. Officials say mobile units break down many of the barriers that prevent people from getting the help they need, including a lack of transportation or health insurance. 

In 2021, the N.C. Department of Health and Human Services awarded $4.4 million to three mental health organizations to operate a total of 15 mobile units. The money included more than $1.4 million to Trillium Health Resources, which serves several eastern North Carolina counties, including Bladen and Columbus. Eastpointe, which serves Robeson, Scotland and several other counties, got $2.5 million. 

At mobile clinics, patients have access to doctors and therapists via telehealth and also on-site certified medical assistants and peer-support specialists who might have experienced drug addiction and are now in recovery. 

Caitlin Faulk, mobile clinic coordinator for Coastal Horizons, grew up in Columbus County and now helps serve residents with mental health and substance misuse issues.
Photo by Ivey Schofield

Trillium funds one therapy appointment per month for those who qualify, Faulk said. Other grants and insurance providers cover almost all other expenses.

“Our goal here is really for every person to have equal access to health care in behavioral health or physical health,” said Christie Edwards, vice president of innovative development and member solution at Trillium, which partners with Coastal Horizons and RHA Health Services to serve Bladen and Columbus counties.

Need for mental health care

Residents in the state’s Border Belt region of Bladen, Columbus, Scotland and Robeson counties need better access to health care, providers say.  

In Columbus County, there is one primary care physician per 3,040 residents and one mental health provider per 600 residents, according to County Health Rankings. Statewide, there is one physician per 1,310 residents and one mental health provider per 340 residents. 

Meanwhile, the opioid epidemic continues to ravage local communities. Health officials say mental health issues are often a factor for people struggling with addiction. 

Thirty-seven people in Columbus County died of drug overdoses in 2021, up from 14 in 2017, according to the N.C. Department of Health and Human Services. The overdose death rate in the county was nearly 1.75 times the statewide rate in 2021. 

Coastal Horizons has seen an increase in the number of patients since it opened its first mobile clinic in August 2022, Edwards said. 

To help meet the demand for services, Trillium opened another mobile health clinic in February with RHA Health Services, which has several local behavioral health offices. 

Now, the three mobile clinics in Bladen and Columbus counties each serve about 50 residents each week, Edwards said.

Arielle Coleman, the certified medical assistant for the Coastal Horizons mobile clinic, schedules all referrals and walk-ins. She said she is booking a month out due to the high demand. 

Faulk said she offered positions to two more virtual therapists to help meet the need in Bladen, Brunswick and Columbus counties.

But local providers say they want more people to become aware of the services offered by mobile health clinics. 

In Bladen County, Coastal Horizons’ mobile unit parks at fire stations off  main roads. As a result, Faulk said, the clinic rarely sees walk-in patients and mostly serves those who have been referred by medical providers, the Department of Social Services or probation officers. 

Many of the people who approach the Stephens Outreach mobile clinic in Robeson and Scotland counties have never heard of the mental health agency, although it has served the community for 20 years, said Alicia Moore, the clinical director for the program. 

For the last year, Moore said providers have met with local officials and attended events to spread the word about the existence and the benefit of mobile clinics.

“We understand it needs to be a continuous effort with community education,” said Michael Kondratick, a spokesperson for Eastpointe. “We have to break through to make sure people understand the resource is available.”

Coastal Horizons has advertised its services and locations with churches and radio and television stations.

“You name it, we’re trying to get in front of people,” Faulk said. 

Daisy Brooks, pastor of Facts of Life Church in Columbus County, said the Coastal Horizons mobile clinic has made a significant impact in Tabor City, where her church hosts a food bank every Wednesday.

Brooks said some church members have been dealing with depression compounded by food, housing and job insecurities. Some had been contemplating suicide until they got help through the mobile clinic, she said. 

“If it helps one person,” Brooks said, “then I’m good.”

Faulk, who said she has watched family members struggle with addiction, coordinated with Columbus County’s parks and recreation department to determine the best places to set up the mobile clinic. 

One of those spots is Riegelwood Community Park, where she played volleyball as a child. 

“I personally know how hard it is for people (in this area) to get the services they need,” said Faulk, who now lives in New Hanover County. 

Faulk said the key to addressing mental health needs is meeting people where they are. That’s why peer support specialists who can talk to clients on the phone, meet them at their home or a local McDonald’s and help them with resumes and applying for food assistance are so important, she said.

Todd Deisler, who is in recovery from alcohol and drug addiction, said it is rewarding for him to help people who are experiencing what he has already overcome. He regularly shows clients his police mugshots and tells them stories about his days in addiction. 

“I think peer support is an important thing because where else can you go?” Deisler said. “I think it means a lot.”

Deisler also regularly goes to health fairs and events at Southeastern Community College, which Faulk said has asked Coastal Horizons to station the mobile clinic on campus every week. Services also include training school employees who want to learn more about signs of suicide and other mental health issues. 

Brooks said parents have also been reaching out to her for help with their children’s behavioral problems. She said she has been trying to coordinate with schools in Columbus County, where she also delivers food every Friday, to use the mobile clinic.

In Bladen County, Faulk said, the public school system has already referred several patients. 

Plans for the future

Currently, all of Coastal Horizons’ mobile units are accepting new patients, Edwards said. 

“We would love to have too many people using it,” she said. “We would love to have that problem.”

In Bladen County, the mobile clinic is at the White Oak Fire Department on Mondays, Ammon Fire Department on Tuesdays, Hickory Grove Fire Department on Wednesdays, Bladen East Medical Center in Council on Thursdays and Kelly Fire Department on Fridays. 

Arielle Coleman, a certified medical assistant, checks a patient’s blood inside the Coastal Horizons mobile health unit in Columbus County.
Photo by Ivey Schofield

In Columbus County, the clinic is at the Riegelwood Community Park on Mondays, Fresh Foods IGA in Chadbourn on Tuesdays, Facts of Life Church in Tabor City on Wednesdays and the Waccamaw-Siouan tribal grounds in Bolton on Thursdays. 

The schedules for RHA Health Services in Bladen and Columbus counties and Stephens Outreach in Robeson and Scotland counties change every week.

Trillium and Eastpointe say they hope to provide more resources at their mobile clinics in the future. 

“The entire focus of (NCDHSS) has been delivering whole person care more effectively and making sure more people have access to it,” Kondratick said.

Currently, Stephens Outreach offers home visits to people who cannot or do not feel comfortable traveling to the mobile clinic, Moore said. Coastal Horizons might eventually do the same, according to Faulk.

In Bladen County, Coastal Horizons offers health checks, including flu and COVID-19 vaccinations, Faulk said. It hopes to soon expand those services to Columbus and Brunswick counties. 

Brooks said offering physical health checks in addition to mental health checks is key to reducing the stigma of using a mobile clinic.

“Nobody knows what you’re going in there for,” she said. “You can get your blood pressure checked or get drug treatment.”

Brooks said she is hopeful that the mobile clinics will make a difference in her community. 

“The more people who know about these free resources,” she said, “the quicker I do believe Columbus County will get better.”