2017 Policy & Legislative Priorities

All North Carolinians living with mental illness should have access to an array of services that enhance their quality of life, regardless of age, gender, race, ethnicity, religion, disability, language, sexual orientation, or gender identity. NAMI NC advocates across the lifespan, for children, adolescents, adults, and older adults affected by mental illness.

  1. Ensure those who need mental health services receive timely, appropriate, affordable, and high-quality care

Many with mental illness still experience disparities in the quality, timeliness, and consumer choice with mental health services based on where they live.[i] Additionally, the availability of services is greatly impacted by the type of (or lack of) insurance status and the statewide enforcement of existing parity laws. The public mental health system, LME/MCOs, and private insurance companies are responsible for creating networks that serve their members with the highest-quality providers. Policies must support a robust array of services, including crisis-based services, that are easy to access, affordable, recovery-focused, have measurable outcomes, and are customized based on the needs identified by a community of stakeholders. People with mental illness, across the lifespan, need the right services, at the right time, at the right place and the right price.

Here’s how:

Monitor the three pilot sites for case management through DHHS and the Governor’s Task Force for Mental Health and Substance Use and advocate for expansion if pilots are successful.

Creating a ‘State of the State’ report for policymakers and the general public about the landscape of mental health services in North Carolina.  Advocacy efforts will be targeted to areas of the state that are lacking in services and mental health professionals.

Provide training and tools for NAMI members to help educate and organize local advocacy efforts.

  • Grow NAMI Smarts for Advocacy program within local affiliates
  • Provide training about avenues for advocacy with local LME-MCOs

Support legislation that expands and strengthens access, availability, and quality of mental health services across the state for youth and adults.

  • Support statewide network adequacy standards for insurers
  • Support Medicaid expansion
  • Support repeal of HB2
  • Advocate for increase in state funding for MH/DD/SAS services, including an increase in state-funded services and single stream funding to LME-MCOs
  • Ensure money from Dorothea Dix sale is used for community-based services
  • Create behavioral health caucus to develop legislative champions within the General Assembly

Monitor acute psychiatric rural hospital bed pilot approved by the General Assembly and advocate for beds to be: 1) staffed appropriately; 2) placed in areas with the most need.

Provide information about access to mental health care for people who are transgender or gender non-conforming to inform local and statewide advocacy efforts.

Advocate for CMS IMD “instead of” rule to be implemented in North Carolina.

Monitor implementation of ABLE accounts for qualified participants. Continue to advocate for the repeal of age criteria for ABLE account eligibility.

Increase availability and access to specialized crisis mental health treatment in communities. Examples include behavioral health urgent cares, facility-based crisis centers, and peer-run drop-in centers.

Support and monitor expansion of paramedicine pilot to encourage hospital diversion.

Educate statewide and local policymakers about the public mental health system through Pathways to Hope, an online simulation experience which depicts common challenges within the current public mental health system.


  1. Extend life expectancy for people living with mental illness by integrating physical and behavioral healthcare

People with serious mental illness die on average 25 years younger than the general public.[ii] People with mental illness have higher rates of other chronic health conditions, such as diabetes and heart disease.[iii] Integrating patient care is crucial to ensure there is a holistic perspective to keep people well in their communities. While integrated care has upfront costs to the state, there is evidence to suggest cost savings in the long term.[iv] Integrating care may have a direct impact on crisis-based care, employment, and incarceration rates.

 Here’s how:

Promote and expand the use of Psychiatric Advance Directives (PADs) to improve care in crisis situations.

Support local and statewide projects that integrate behavioral and physical health services within local practices. Additionally, supporting policies and payment structures that incentives integration.

Support legislation that expands and strengthens integration between mental health and physical health across the state for youth and adults.

  • Create behavioral health caucus to develop legislative champions within the General Assembly
  • Support Medicaid Expansion
  • Monitor Medicaid reform legislation and implications for behavioral health integration.

  1. Advocate for humane treatment of those with mental illness in the criminal justice system, with emphasis on access to appropriate, recovery-focused mental health treatment along the criminal justice continuum.

Jails, prisons, and juvenile detention centers have become the de facto psychiatric hospital for many living with serious mental illness. Over half of all people incarcerated in a state prison or jail have a mental illness.[v] However, far less receive treatment once they enter the criminal justice system, which further exacerbates their condition. To ensure individuals have access to appropriate and continuous assessment and treatment, policies and funding must support the resources needed to change the criminal justice culture from one of control to treatment.

Here’s how:

Expand mental health services within the prison system, such as the Therapeutic Diversion Units (TDUs).

Advocate for policies that eliminate the use of solitary confinement of both youth and adults.

Support policies that strengthen and expand CIT partnerships across the state.

  • Ensure adequate amount of CIT-trained officers in each jurisdiction
  • Expand CIT to jurisdictions that either does not have any trained officers or low proportion of trained officers
  • Monitor implementation of CIT for Youth
  • Advocate for strong CIT partnerships that have shared ownership of the local CIT program

Create statewide coalition to identify barriers for people with a mental illness re-entering society after being incarcerated.

Advocate for changes in jail rules to better identify and treat mental illness across county jails.

Advocate for state funding within the budget for mental health services in prisons, detention centers, and probation and parole programs.

Advocate for state funding for mental health services in local jails.

Provide training and tools for NAMI members to help educate and organize local advocacy efforts.

  • Grow NAMI Smarts for Advocacy program within local affiliates
  • Provide training about advocacy avenues within local jails
  • Connect NAMI affiliates to re-entry councils across the state

Support efforts to raise the juvenile age from 16 to 18 within the criminal justice system.

Advocate for reinstatement of state funds for specialty mental health courts in the state spending plan.


  1. Increase availability of stable and affordable supportive housing

Simply put, housing is a basic human need that is essential for initiating and maintaining wellness. Housing, in conjunction with services and supports, not only builds self-esteem but also decreases mental health symptoms and need for hospitalization.[vi]  NAMI NC recommends policies that expand supportive housing to critical areas and provide needed services, such as tenancy supports and individualized mental health services.

Here’s how:

Support efforts through the DOJ settlement agreement to create and increase the availability of affordable supportive housing.

Provide education about the importance of housing in recovery to NAMI members, the general public, and legal guardians.

Advocate for eliminating barriers to housing, including mandatory criminal record checks and credit reports. 


  1. Improve the quality of life for people living with mental illness through competitive employment and employment supports

It is a common myth that people with serious mental illness cannot and do not want to work. However, 60-70% of those unemployed with serious mental illness have a desire to work.[vii] Expanding evidenced-based supported employment gives many individuals a sense of purpose and productivity, along with elevating their financial stability. The structure and routine provided by work are often a critical part of someone’s recovery plan.

Here’s how:

Expand local advocacy efforts through the family advocate role within IPS teams across the state.

Support and expand competitive employment options that are based on the individual’s desires and preferences.

Provide education and targeting of employment supports to transitional youth and young adults.

  • Education campaign with NAMI on Campus groups
  • Advocate for creation of IPS-SE programs within first episode psychosis programs

Advocate for the creation of IPS-SE Medicaid service definition to expand funding.

Expand education about supportive employment with NAMI North Carolina members.

  • In person presentations to local NAMI affiliates
  • Embedding education about supported employment within NAMI signature programs
  • Use NAMI NC social media and communication platforms to provide education and resources regarding IPS-SE in NC

Educate statewide and local policymakers about the principles of supported employment through local education events with IPS providers, job seekers, and NAMI NC family advocates.


[i] Knisely, M.B. (2016). Report of the independent reviewer in the matter of United States of America v. the state of North Carolina (Case No. 5:12-cv-oo557-F). U.S. Department of Justice.

[ii] Parks, J., Svendsen, D., Singer, P., Foti, M. E., & Mauer, B. (2006). Morbidity and mortality in people with serious mental illness (13th ed.). Alexandria, VA: National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. Available from http://www.nasmhpd.org/sites/default/files/Mortality%20and%20Morbidity%20Final%20Report%208.18.08.pdf

[iii] Azrin, S.T. (2012, September). Improving health and reducing premature mortality in people with severe mental illness. National Institute of Mental Health. Retrieved from http://www.nimh.nih.gov/funding/grant-writing-and-application-process/concept-clearances/2012/improving-health-and-reducing-premature-mortality-in-people-with-severe-mental-illness.shtml

[iv] Druss, B.G. & Walker, E.R. (2011). Mental disorders and medical comorbidity. Research Synthesis Project, 21, 13. Retrieved from http://www.integration.samhsa.gov/workforce/mental_disorders_and_medical_comorbidity.pdf

[v] James, D.J. & Glaze, L.E. (2006). Mental health problems of prison and jail inmates. Bureau of Justice Statistics, 1-12. Retrieved from http://bjs.gov/content/pub/pdf/mhppji.pdf

[vi] Bazelon Center for Mental Health Law. (2009). Permanent Supportive Housing: The most effective and integrated housing for people with mental disabilities. Judge David L. Bazelon Center for Mental Health Law, 1-7. Retrieved from http://www.bazelon.org/LinkClick.aspx?fileticket=q6FsuL6o_Jw%3D&tabid=126

[vii] Dartmouth Supported Employment Center. (n.d.). Recovery from mental illness through a job. Dartmouth Community Mental Health Program. Retrieved from http://www.dartmouthips.org/wp-content/uploads/2014/11/advocacy-handoutupdated.pdf