Mental health is a new health priority for Transylvania County, related to mortality and morbidity statistics, an understanding of the relationship between substance abuse and mental health issues, and a lack of necessary mental health treatment and counseling options in the county, especially for those who have little income or no insurance.

Mental health is closely tied with many other health issues. One study suggested that more than 68 percent of adults with a mental disorder had at least one medical condition. (Goodell, Druss, & Walker, 2011) Medical disorders may lead to mental disorders, mental conditions may place a person at risk for certain medical disorders, and mental and medical disorders may share common risk factors. It is also closely tied with our first priority: substance abuse, and with our three causes of death that rate higher than the state average.

Transylvania County has experienced much economic turmoil in the past decade, resulting in a lack of good-paying jobs for those without higher education. Although some sectors of the community are quite wealthy and the county attracts many tourists and retirees, many others in the community are stuck in poverty with no job prospects and no way to improve their life circumstances.

Mental health issues in Transylvania County are compounded by the lack of adequate mental health care facilities, especially for those who have additional barriers to care such as lack of health insurance, poverty, and lack of transportation. When talking to employers, social workers and law enforcement, the issues of mental health and substance abuse are often identified as problems that have not be adequately addressed in Transylvania County or North Carolina.

Support improvements to mental health care through screening, referrals, and collaborative care

• Educate providers on available community resources for mental health services; update resources on a bi-annual basis
• Provide training and support for local primary care providers and ob/gyns (and their staff) to improve routine screening for mental health disorders and referral to treatment
• Improve clinical and community support for active patient engagement in treatment goal setting and self-management

Provide information about navigating the mental health care system to community members

• Engage local mental health providers to participate in a community forum to educate patients and families on navigating and overcoming challenges in the mental health care system
• Produce easy-to-understand printed and electronic resources for patients and families describing available services, how to access them, and when to access them
• Update and disseminate resource list on at least a bi-annual basis

The following progress was made in 2016 on Mental Health in Transylvania County.

• Transylvania Public Health partnered with Transylvania County Commissioners and Vaya Health to host a community forum on mental health services in the county in October 2016. A panel of providers shared information about the services offered by their agencies, how to contact them, and when to seek support. Panelists represented Vaya Health, RHA Health Services, Meridian Behavioral Health Services, Mission Health, Blue Ridge Health, local private practitioners, and the local affiliate of the National Alliance on Mental Illness. In addition, 25 mental health and behavioral health providers were available for one-on-one questions and discussion with attendees after the panel presentation. The forum was attended by 42 community members.
• Based on information gathered at the forum, Transylvania Public Health compiled a listing of services offered by the providers who attended in November 2016. This listing was supplemented with other resources, including data from Vaya Health and professional listings from Psychology Today (as recommended by one of the local providers). This listing will be shared with the United Way 2-1-1 referral system and published for distribution.
• Transylvania Public Health and Transylvania County Commissioners partnered with Vaya Health in efforts to bring a mental health screening kiosk to the county. The kiosk offers anonymous screening of six common mental health concerns, gives feedback on screening results, and provides referrals to treatment, including a direct VoIP line to the Vaya Health customer call center. The same screening tool will be available online for use in other places. 

The following progress was made in 2017 on our action plan interventions for mental health in Transylvania County.

• Support improvements to mental health care through screening, referrals, and collaborative care
  • A MindKare mental health screening kiosk was installed in the first floor lobby of the Community Services Building located at 106 E. Morgan St. in downtown Brevard. The kiosk was unveiled at a presentation with remarks from Vaya Health CEO Brian Ingraham, Transylvania County Commissioner Page Lemel, Transylvania County Commissioner Chair Larry Chapman, and Transylvania County Health Director Elaine Russell. In addition to media coverage of the kickoff event, posters, palm cards, and social media have been used to promote use of the kiosk and online screening tools. TPH staff receive monthly updates of kiosk usage.
• Provide information about navigating the mental health care system to community members
  • TPH staff attended a local forum hosted by a local church on addressing suicide. Panel members and community members requested a common source for local resources on mental health and suicide, and TPH staff volunteered to add any requested materials to the Community Resources page available at transylvaniahealth.org. 
  • Multiple social media posts regarding mental health and access to resources were published and promoted by TPH in 2017, with a total reach of more than 300 people.
  • Mental health resources listed on the TPH Community Resources webpage were updated at least twice in 2017.
  • In early 2018, TPH staff were selected to moderate a panel discussion on suicide hosted by a community collaborative with members that include Transylvania County Library, SAFE (domestic violence prevention agency), The Family Place (parent resource center), Transylvania County Parks and Recreation, and others. Panel members included a school social worker, the local EMS director, RHA regional crisis response coordinator, a parent of a son lost to suicide, and a suicide survivor. TPH staff was able to share information about accessing resources and screening tools, as well as increasing awareness of warning signs and knowing what questions to ask.

Additionally, the following progress was made in 2017 on mental health in Transylvania County.

• Local provider Meridian begin offering mental and behavioral health services in Transylvania County Schools. TPH school nurses are able to make referrals to counseling as needed.