North Carolina to expand peer-led crisis services to push for more mental health support

By Taylor Knopf

North Carolinians in need of mental health support now have more places to call and will soon have more places to ask for help. The state health department is investing more money in a greater variety of mental health crisis services, including those led by peer support specialists.

In addition to 988, the renamed North Carolina National Suicide Prevention Lifeline recently added a statewide Peer Warmline.

A Warmline is a non-crisis mental health support line made up of specialist peer support people living in recovery from mental health problems who may also have experienced substance use, psychiatric hospitalization, homelessness, incarceration or a combination of these.

People with a history of mental illness sometimes prefer to talk to people they feel they can relate to, who may have had similar experiences. And unlike 988, the North Carolina hotline will not call for law enforcement or EMS unless the caller requests it. Although emergency services are rarely dispatched after calls to 988, it does happen from time to time and the possibility deters some people from calling.

Callers can reach the Peer Warmline 24/7 at 1-855-PEERS-NC (1-855-733-7762). The 988 call center also connects callers to the Warmline on request.

The state Department of Health and Human Services recently partnered with Promise Resource Network, a Charlotte-based peer-led mental health organization, to launch the Peer Warmline statewide. Promise Resource Network has been operating a hotline for several years for Mecklenburg County residents, and was briefly expanded to answer calls statewide during the early months of the pandemic. Funding constraints then led them to cut local calls.

Historically, North Carolina hasn’t always invited peers to crucial mental health services meetings or invested heavily in the kinds of peer-led services that some advocates have called for. Now, there seems to be a change in this trend.

In addition to the Warmline, the state health department is investing $22 million in community crisis centers, including a new peer-led center opening in Wake County. The facility will be in Raleigh, operated by Promise Resource Network, and will mirror the services of its peer respite center in Charlotte.

A peer respite is designed to be a voluntary alternative to hospitalization for people with mental health problems, allowing them space and time to de-escalate their emotional crises without the hospital. Fully staffed with peer support specialists, respites are calm, family-friendly environments where people can stay and receive help from trained peers who are on their own recovery journey.

In response to the multitude of people showing up to emergency rooms and psychiatric hospitals seeking help during their mental health crises, North Carolina is investing more in crisis alternatives such as the Warmline and the respite between equals, as well as new community crisis centers. DHHS recently announced financial support for five new centers for adults in Alamance, Forsyth, New Hanover, Pitt and Vance counties and three new centers for children in Gaston, Pitt and Vance counties.

Funding for many of these new initiatives comes from state lawmakers’ $835 million investment in mental health services last year. The money comes from a federal bonus that came to North Carolina when the state expanded the Medicaid program.

We have money to invest in the crisis system, said Kelly Crosbie, director of the division of mental health, developmental disabilities and substance use services at NCDHHS. We will invest in some of the more traditional things that make up a good crisis continuum, from 988 to crisis teams to crisis reception facilities, which are a much better and more appropriate alternative to the emergency room for to many people who need this level of care instead.

Peer support on demand

With the launch of the national 988 crisis line, statewide data showed that 45 percent of the more than 90,000 calls per month were from repeaters, according to the 988 dashboard.

They’re looking for someone to talk to, so we wanted to give them an opportunity to talk to someone with lived experience who can share their recovery experience and their experience of the system in North Carolina, Crosbie said of Warmline. We just know it’s a valuable resource.

Helplines have been shown to reduce loneliness and participants’ use of mental health crisis services. Additionally, a review of several studies found that digital forms of peer support improve the lives of people with serious mental illness by improving participants’ functioning, reducing symptoms, and improving program utilization.

Even before Warmline expanded statewide, Cherene Caraco, executive director of Promise Resource Network, said the 988 call center was transferring people to their Warmline organizations, especially during the pandemic when Warmline of Mecklenburg attempted to increase and answer calls throughout the state. He believes that when the 988 call center began referring callers to the Warmline, a non-traditional mental health resource, it gave him a level of validation within the system that otherwise didn’t exist.

[The 988 call center] we saw the value of that before we were funded statewide. Their endorsement is very important, Caraco said.

The statewide Warmline continues to gain strength. Noah Swabe, director of operations for Promise Resource Network, said financial support from the states allowed Warmline to double the number of full-time peers answering the phones, which he said is necessary as the volume of calls continue to increase. Warmline recently received more than 4,000 calls in a one-month period, he said.

In addition to the Warmline, Promise Resource Networks peer-to-peer respite has been in high demand. Charlotte’s Respite, which opened in 2021, is always full. Swabe said there is about a month long waiting list to get in. People with mental illness appreciate the non-judgmental environment where they can stay in an unlocked facility for up to seven days while being supported by peer support specialists. Promise Resource Network also has what the organization calls a recovery center nearby, which has classes, groups and programs to support people.

Swabe said the plan for Wake County is to open a respite care and recovery center to provide comprehensive services for those seeking alternative mental health support. Funding will come from DHHS, Wake County and Alliance Behavioral Health.

Joining state and national leaders

During Warmline’s ribbon-cutting ceremony, Crosbie visited the peer-to-peer respite in Charlotte for the first time and said it was beautiful.

It is a peaceful environment. It offers dignity and provides a safe space. Gives damage reduction for people using it [drugs]. It’s very comprehensive, he said. We want to build more. These are the kinds of places we need.

In addition to the respite DHHS is helping to fund in Raleigh, Crosbie said she wants to see more peer-led spaces, such as peer lounges or day programs, and places of support for those with mental health issues that leave hospitalizations, such as the one operated by GreenTree in Winston-Salem.

We believe that peer-to-peer services are evidence-based, excellent outcomes and resources for people. So we just know that, and so we’ve been looking to update our peer portfolio because it’s effective, Crosbie said. And we are also in the middle of a [health care] work crisis, and we have many colleagues, and peer support are effective treatment resources.

Historically, peer-run organizations have struggled to raise funding to keep their programs going. Crosbie’s new open support and new waves of funding could be huge for the peer movement in North Carolina.

Caraco, who has been a leader in the peer-led recovery movement for nearly two decades, said support from the federal government and other national groups has also helped those in the more traditional mental health system recognize peer support as essential.

The Biden administration has created a unity agenda and is naming peer support as a necessary component of a healthy matrix to prevent suicide, support people, create access, [help with] the labor shortage, he said. They were […] endorse peer support for a variety of different reasons where our system is struggling, has gaps, or is simply not well equipped to do so.

So not only do we have more recognition at the federal and national level, but more push to states and communities to make it a sustainable and healthy part of their community, Caraco said.

Crosbie said she couldn’t speak to the culture at North Carolina’s mental health division before she took the position, but said for her, peer services are non-negotiable. She has seen the power of peer support in her own family.

For my father in particular, who had a serious mental illness, for so many reasons he did not receive traditional treatments, she said. But he was always significantly helped by colleagues. This was the only kind of help that really made a difference to him and therefore to me and my family.

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