Feeling emboldened, NC agencies taking ASAP approach to DEI efforts
Some have done it quietly. Others publicly. In eliminating diversity initiatives, North Carolina is joining a host of companies and colleges.
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NC moves to end police involvement in transporting mental health patients
By Taylor Knopf
When someone is having a mental health crisis — whether they’re thinking about suicide, acting erratically or experiencing hallucinations — they frequently end up in a hospital emergency department, mostly because there are few places for them to go.
If a medical provider determines that the patient is a danger to themselves or to those around them, it’s standard practice to petition a judge for an involuntary commitment order.
These types of orders typically bring law enforcement officers into the process.
Involuntary commitments are supposed to be a last resort to mandate psychiatric care at an inpatient facility for a specified amount of time. These experiences are often emotional for the patient and their loved ones. In that vulnerable moment, a uniformed officer arrives at the emergency department to drive the patient — handcuffed in a patrol car or an inmate transfer van — to an inpatient psychiatric facility that has an available bed.
It’s a practice that many patients find traumatizing. But it will soon be changing in North Carolina.
One mother in Wilmington recounted to NC Health News her deep distress watching her 25-year-old daughter shuffle out of the hospital in handcuffs and ankle shackles attached to a chain around her waist as two officers led her to an inmate transfer van headed for another hospital. Another committed patient believed he’d been arrested and was going to jail after officers handcuffed him and drove him away from an emergency room in Chapel Hill. Parents have pleaded with medical staff to let them transport their children between facilities — some as young as 11 — but were told no.
All this occurs even as North Carolina sheriffs say they don’t want to be the ones moving patients, arguing that it should be done by mental health workers. They also say driving patients across the state to available hospital beds strains their resources, diverting sheriffs’ deputies from responding to crimes and other emergencies, sometimes for hours at a time.
For years, NC Health News has received scores of calls and emails from patients and their families shocked and traumatized by the presence of law enforcement and use of handcuffs in the course of mental health treatment. State officials and lawmakers receive the same frustrated calls from their constituents and have condemned this further stigmatization of mental health. While there have been some legislative efforts to soften the response to people experiencing mental health crises, those largely fizzled out — until now.
Out of North Carolina’s federal sign-on bonus for expanding Medicaid, state lawmakers allocated $835 million for behavioral health needs in their 2023 budget, including $20 million for a non-law-enforcement transportation pilot program for mental health patients under involuntary commitment. In December 2024, the state Department of Health and Human Services released a request for proposals from qualified transportation vendors with a plan to operate the pilot in two regions of the state.
The existing system is “the antithesis of care, and it puts them on the backtrack to recovery,” former Secretary of Health and Human Services Kody Kinsley told NC Health News. “We have been eagerly and desperately trying to decouple these two systems, as are other states, and so we’re excited for this pilot.”
In North Carolina, involuntary commitments are sometimes ordered even if a patient comes to the hospital voluntarily or if they or their guardian agrees to inpatient treatment. The reasons for this vary — from the need for a safe transportation option to the incorrect perception that a patient needs to be committed to be treated in a psychiatric facility.
Counties are responsible for the transportation of patients under involuntary commitment, according to state law, and traditionally this role has fallen to law enforcement. Involuntary commitment petitions often trigger a transportation request to law enforcement if the patient needs to be picked up in the community and taken to a hospital for an evaluation and/or transported from a hospital emergency department to an inpatient psychiatric facility, even if it’s across the state.
In 2018, North Carolina lawmakers revised the state’s mental health laws to allow more flexibility, including alternative means of transportation for patients. County leaders were told to submit their transportation plans for these patients to the state health department. In 2021, NC Health News reviewed an incomplete number of available plans provided by the state health department and found the majority of counties opted for minimal to no changes to the practice of using police or sheriff’s deputies.
Law enforcement transports are the default for patients under involuntary commitment across the United States. In October, the Wilson Center for Science and Justice at Duke Law released a report that found that 43 states have some allowance for non-law-enforcement transportation of a committed patient, including North Carolina. However, the study authors wrote, most states largely rely on law enforcement because they haven’t established or invested in alternative models.
The Duke Law report evaluated responses to people in crisis nationwide and recommended that policymakers remove law enforcement from all mental health interventions as much as possible.
“Not only does law enforcement involvement blur the lines between treatment and criminalization of mental illness, people with serious mental illness are also overrepresented in law enforcement use-of-force encounters and law enforcement-related injuries,” the report authors wrote. “People with serious mental illness are over eleven times more likely to experience law enforcement use of force and over ten times more likely to be injured in law enforcement interactions compared to other individuals.”
Wrong job for law enforcement
Law enforcement officers across the U.S. have said they shouldn’t be responsible for transporting mental health patients. The North Carolina Sheriffs Association said that role should be turned over to mental health professionals.
N.C. sheriffs say that transporting mental health patients takes officers off of other duties, sometimes for hours or entire shifts, as they drive across the state to a psychiatric hospital. It can put a strain on smaller departments with fewer resources.
A national survey of 355 sheriffs’ offices and police departments found that an average of 10 percent of the agencies’ total budget was spent transporting patients under involuntary commitment, according to a 2017 report by the Treatment Advocacy Center. Based on the survey responses, the report estimated that law enforcement agencies spent $918 million nationwide transporting committed patients that year. The survey respondents estimated they spent 165,295 hours, which equated to 21 percent of total staff time, responding to and transporting mental health patients.
Additionally, officers often don’t have the training or tools to respond to mental health calls. Their presence alone — with marked vehicles, flashing lights, uniforms and firearms — often escalates a situation. A study that conducted in-depth interviews with 40 young people who had been involuntarily committed in Florida found that the majority had negative experiences with law enforcement.
“Major themes characterizing negative encounters were the framing of distress as criminal or of intervention as disciplinary rather than therapeutic, perceived aggression and callousness from police officers, and poor communication,” the study authors wrote in 2021.
The study quoted several participants, including a Latino college-aged male who said: “The sheriff’s officer […] was kind of a jerk. […] excuse my language, he’s like, ‘Don’t touch my [expletive] you [expletive] retard.’ Then, sitting in the car with that guy for an hour and 15 minutes on the drive . . . he wouldn’t shut up about how much of a piece of [expletive] he thought that people like me were. And criminals, and you know . . . he equated me with criminals. I was numb at that point.”
A multi-racial female college-aged participant said the male officer who transported her said: “Don’t mess around with me or I’ll show you who’s boss.”
“Very aggressive for the situation,” she told the study authors. “It was really scary.”
North Carolina is inviting companies to come forward with proposals for how to transport mental health patients differently. Kinsley said the Department of Health and Human Services has a high bar for this contract and will be paying a premium to get a transportation service that is high quality.
“We’re not just going to award it to whoever comes forward. Part of the reason why we have been moving slower on this than I would have liked is because we haven’t been able to find a perfect prototype in the nation,” Kinsley said when the proposal was released in December. “I have not seen another state really figure this out perfectly yet. There are some contractor companies that are doing this in a way that looks a little too law enforcement-adjacent to me.
“We really want to center this on: What does real care and support in transport with the right resources look like?” he added.
There are some examples of mental health crisis response units in other states that respond to 911 calls related to mental illness, homelessness and substance use. Among those are the CAHOOTs program in Oregon and, closer to home, the HEART program in Durham. Rarely have teams in either state needed to call for law enforcement backup. The Duke Law report pointed to both programs as examples of non-law-enforcement groups that are able to respond safely to people experiencing mental health distress.
“When determined to be safe, alternatives may include family, friends, medical providers, mental health professionals, ambulance services, and/or other authorized providers,” the study authors wrote.
They cautioned, however, that mobile crisis units, which are therapeutic teams that respond to people experiencing crises in the community, “in particular seem hesitant to be tied to the [involuntary commitment] process for fear of fostering mistrust.”
In North Carolina, one seemingly unknown allowance under state law is that a clerk, magistrate or district court judge can authorize either a health care provider of the patient or a family member or friend of the patient under involuntary commitment to transport them instead of law enforcement personnel. The health provider, family member or friend may request to transport a patient by submitting a form to the clerk’s office. Hospital staff and magistrates do not usually tell family members about this option and will not authorize it without a specific request.
The Duke Law study authors examined a model in Oklahoma called OK RIDE CARE which contracts with that state’s department of health and human services to provide “trauma-informed transportation services” in unmarked vehicles. The Oklahoma service requires its transporters to be trained in client rights, a therapeutic curriculum approved by the state health department, CPR/first aid, HIPAA compliance and patient confidentiality.
Trump elimina el Parole para migrantes venezolanos, cubanos, haitianos y nicaragüenses
Este programa buscaba gestionar la migración de manera ordenada y abordar las necesidades humanitarias en respuesta a las crisis en los países beneficiados.
After Helene and Milton, Farmworkers Play an Outsized Role in the Cleanup
North Carolina farmworkers on an H-2A visa had their visas extended to work on the dangerous cleanup of damaged fields after Hurricanes Helene and Milton.
Helene exacerbated rise in homelessness across western North Carolina
By Jaymie Baxley
The remnants of Hurricane Helene destroyed thousands of homes during its catastrophic sweep through western North Carolina in September, leaving many people without a fixed residence in a region where homelessness was already on the rise.
The storm displaced residents like Bonnie Goggins Jones, whose mobile home in Buncombe County was rendered uninhabitable by waist-high floodwaters. She and her two teenage grandchildren now stay in a donated camper that Jones keeps parked on the property of a local church.
“Being in a closed-in little spot and it’s something you’re not used to and never stayed in, and not having the clothing or the space to put the stuff that you have, and having kids — it’s just a hard thing,” Jones said of their living situation, adding that she misses the “little yard” and shade-casting trees of her old address in Black Mountain. “I mean, it’s not your home. It’s not like a home. You don’t have your own yard. I can’t even explain it.”
Jones knows she does not fit the stereotypical profile of a person experiencing homelessness. She “makes good money” in her full-time job as a transportation worker for the Asheville City Schools District, she said.
Still, the loss of her home and nearly all of her possessions is a setback that will take more than a few paychecks to recover from. Between keeping her grandchildren fed and filling her camper’s generator with fuel to stay warm during the frigid mountain nights, Jones has little opportunity to save up enough money for a new place.
“It’s a struggle, no matter if you’re working or not,” she said.
Tina Krause, executive director of Hospitality House of Northwest North Carolina, has met dozens of families in similar situations over the past three months. Her organization provides transitional housing services in several of the rural communities that were hit hardest by Helene.
“In the beginning, it was hard for us to identify who was truly displaced and who was going to be able to stay in their home,” she said. “But over the last few weeks, we’ve really seen a lot more movement in people actually coming to the realization that they are not going to be able to live in their home, whether it was a rental home or it was the house that they grew up in.”
Krause has noticed that most of the people currently reaching out to the nonprofit for assistance were not at risk of becoming homeless before the storm. Many of them are working adults with decent incomes or retirees on fixed incomes who had lived for decades in houses that were destroyed.
“There’s definitely a new face to homelessness now,” she said.
A worsening trend
Hospitality House is one of four organizations that are known collectively as a Continuum of Care — community partners that coordinate within an area to address homelessness. The Northwest NC Continuum of Care oversees the annual point-in-time count in seven of the counties in the federally declared disaster area for Helene.
Conducted on a single night each January, the point-in-time count is a survey of people who are unsheltered or sleeping in cars, tents and other places not meant for long-term habitation. Data from the count is used by the U.S. Department of Housing and Urban Development to develop strategies and policies to reduce homelessness.
Numbers from the 2024 count have not yet been finalized by HUD, but an NC Health News analysis of preliminary totals from Hospitality House and other Continuum of Care organizations serving western North Carolina found that at least 2,609 people were experiencing homelessness in the 25 counties that were later included in September’s disaster declaration — a 20 percent increase from 2023’s count of 2,166.
More than 330 people were reported to be homeless across the counties — Alleghany, Ashe, Avery, Mitchell, Watauga, Wilkes and Yancey — served by Hospitality House, up from about 270 people in 2023. Krause said the 22 percent increase was one of the largest ever recorded in her organization’s thinly populated swathe of the state.
“In the past, it may have been an increase of like 10 people,” she said, compared to 60 more in just a year. “This was a significant jump. While homelessness has always been a problem in our communities, we had improved on that number every year until [a couple of years ago] when it started to climb again.”
She believes the spike was caused, in large part, by the expiration of funding from the federal Coronavirus Aid, Relief and Economic Security — or CARES — act. The pandemic-era measure provided money for residents who were at risk of homelessness to stay in hotels to prevent overcrowding at local shelters.
“So many people lost the hotel rooms that were being paid for under that COVID funding,” Krause said, adding that several homeless encampments popped up in the area after the program was discontinued.
Continuums of Care serving other parts of the region also saw significant growth in their homeless populations before the storm — even in communities where the situation had previously appeared to be improving. Data from the Gaston-Lincoln-Cleveland Continuum of Care showed a 21 percent decrease in homelessness in the three counties it serves from 2022 to 2023, but then a 16 percent uptick during this year’s count.
The largest over-the-year increase was recorded by the Asheville-Buncombe Continuum of Care, which went from having 573 residents experiencing homelessness in 2023 to 739 in 2024 — a nearly 29 percent surge. Members of the organization’s leadership said a “change in methodology” contributed to the higher tally.
Hospitality House and the other Continuums of Care will conduct the point-in-time count for 2025 in late January. With an untold number of people now displaced by Helene, it is likely to be one of the most difficult counts in the region’s history.
One of the biggest challenges, Krause said, will be finding and counting displaced residents who are staying in hotels with vouchers issued after the storm by the Federal Emergency Management Agency. More than 4,900 people were still participating in the voucher program as of early December, according to FEMA.
“We’re going to have to be very purposeful in looking at who’s in a hotel that’s being paid for by an agency, because those individuals can be counted in the point-in-time because they are literally homeless as long as they’re not paying for the hotel themselves,” Krause said, referring to the definitions of homelessness used by HUD. “We’ll have to increase the number of outreach teams we have going out and actually talking to people to see what their situation is.”
Lack of homes
The upheaval caused by Helene has been exacerbated by the region’s scant inventory of houses and its dearth of affordable rental options.
“We already are in one of the worst markets for rental properties here,” Krause said, adding that apartment seekers — particularly in Watauga County — often find themselves “in competition” with students from Appalachian State University who cannot afford to live on campus. “The availability of housing is just zero at this point.”
Piles of debris from storm-battered homes sit waiting for collection next to a road in Boone on Oct. 29, 2024. Credit: Jaymie Baxley/NC Health News
The market isn’t much better for buyers. Western North Carolina’s popularity as a tourist destination has made it a lucrative setting for Airbnb operators, who have reduced the region’s long-term housing stock by converting residential units into short-term rentals.
In Asheville, the proliferation of short-term rentals has contributed to an 89 percent spike in home values, which jumped from a median of $199,800 in 2015 to $319,400 in 2021. A housing plan released by the city shortly before the storm noted that home ownership has become “unattainable” for workers earning “a median wage in Asheville’s top industries.”
“We have very high housing costs and very low vacancy rates,” said Emily Ball, manager of the city’s Homeless Strategy Division. “We know from national data that the primary indicator of rates of homelessness in any community are housing costs, and our housing costs have been just through the roof and increasing all the time.”
Ball’s department had been working with the Asheville-Buncombe Continuum of Care to develop strategies to address the city’s growing homeless population, but Helene forced the agencies to shift their focus to more urgent needs. One of the most pressing tasks, she said, was finding a replacement site for a flooded shelter the city operated for people experiencing homelessness in the winter.
“We’re transitioning, I would say, from response to recovery and thinking more about long-term strategic recovery around Helene,” Ball said. “But this has been a very significant event, and it’s really taking up most bandwidth for most people still.”
Raising awareness
Ball believes the disaster has at least led to “heightened awareness” about the basic needs of unsheltered residents.
“Before this storm, it was possible for people to not have a lot of empathy about, ‘If you’re homeless, where do you go to the bathroom, how do you charge your phone, and where are you going to take a shower,’” she said. “After the storm, we all lost power. We all lost water.”
The storm also had something of a silver lining, she said, for people who were already experiencing homelessness in the city.
“I think for a lot of folks who were unsheltered, their situation was probably a bit better after the storm than prior to the storm,” Ball said. “Newly across the community, we have people really caring about things like water and food distribution and the availability of portajohns outside.”
“People are in such extreme situations, having lost everything that they own, that there is a new awareness of the dangers of these kinds of situations,” he said. “Even though we’ve been living with this and people have seen it for a really long time, now that their neighbors who were housed lost their homes suddenly it’s like, ‘Oh, we’ve got to figure out how to deal with this. We’ve got to figure out how to get these resources so that folks don’t have to do this anymore.’”
In the storm’s wake, there was an outpouring of support from sympathetic citizens and charitable organizations.
Members of a Virginia-based ministry built more than 100 cabins for displaced residents in Black Mountain. Operation Halo, a charity formed in response to the storm, donated more than 160 RVs to people who lost their homes.
But it remains to be seen how long the public’s compassion will last.
“My hope is that long term, that urgency that we feel right now after the storm to get people back in housing extends to our homeless neighbors, too, who have been dealing with this for years in some cases,” said Alexander, who added that “everybody deserves a home.”
This story was made possible through a collaboration with Blue Ridge Public Radio. BRPR’s Gerard Albert contributed reporting from western North Carolina.
Nowhere to hide: Microplastics are polluting western North Carolina watersheds
By Will Atwater
People use single-use plastics multiple times every day — shopping bags, fast-food containers, disposable forks and spoons, sandwich wrappers and countless other items. Given the abundance of these items, it’s not a surprise to find increasing amounts of plastic debris in the environment.
However, a recent study examining the types and origins of microplastics in a western North Carolina watershed found that some particles are also hanging out in the air.
Jerry Miller, lead researcher and environmental science professor in the Department of Geosciences and Natural Resources at Western Carolina University, said his research has revealed that a big source for microplastics is in the atmosphere.
“The atmospheric particles end up in the water, they get into the sediment […], and then they can be transferred up the food chain,” he said.
Miller shared the research earlier this week at a North Carolina Water Resources Association event at Raleigh’s McKimmon Center.
The research focus was Haywood County’s Richland Creek watershed and two tributaries. One of the research goals is to fill in information gaps about the impact of microplastics in freshwater rivers and streams in the southeastern U.S., Miller said.
“We’re catching up with what’s been done in marine environments and coastal environments, but we still have a ways to go.”
Researchers discovered that roughly 90 percent of the microplastics were fibers, with three primary types of plastic present: polystyrene, polyamides and polyethylene. These plastics are used to make items such as sportswear and other types of clothing, takeout food containers, foam packaging and water bottles.
The study also revealed that the quantity of microplastics, as well as large pieces of plastic debris, increased in parts of the watershed that were closer to development, implying that human activity is likely the primary source of the contamination.
The graphic shows the size range of plastic debris. Credit: Illinois Environmental Protection Agency
But the report noted that “microplastics concentrations were also elevated” in remote parts of the tributaries with limited development, “suggesting atmospheric deposition was an important microplastics source.”
Miller’s discussion of the sources and distribution of microplastics in this western North Carolina watershed comes at a time when efforts to curb plastic pollution have stalled.
The fifth session of the international Intergovernmental Negotiating Committee on Plastic Pollution closed in South Korea earlier this month without a treaty. More than 100 major countries failed to reach any consensus on the terms of an agreement to curb worldwide plastic pollution.
Here in North Carolina, efforts by groups and municipalities across the state to establish single-use plastic bag ordinances have also been stymied as the General Assembly signaled that it doesn’t support such moves.
Meanwhile environmentalists say that recycling — which is what opponents of reducing plastic production point to as the fix for the global crisis of plastic pollution — is a profoundly broken system that doesn’t work.
A growing problem
According to the National Oceanic and Atmospheric Administration, microplastic compounds are fragments smaller than 5 mm in length, roughly the size of an eraser on the end of a pencil. However, microplastics can break down into smaller particles, some invisible to the naked eye, known as nanoplastics. These substances are believed to be able to last hundreds, even thousands, of years in the environment.
Globally, more than 430 million tons of plastic is produced annually. Some plastics break down into these microplastic particles, and a significant amount of them ends up in the ocean, where marine animals swallow them. That’s one way they enter the food chain, according to a report by the United Nations Environment Programme.
In 2021, the United States alone generated between 40.1 million and 51 million tons of plastic waste. Of that amount, somewhere between 32 million and 43 million tons ended up in landfills, according to data provided by Statista, a research and marketing firm.
Microplastics on a slide taken from Highlands Biological Station stream samples. Credit: Highlands Biological Station.
In 2023, Duke researchers led a study that revealed a possible link between nanoplastic particles and a brain protein that may result in increased risk for Parkinson’s disease and some forms of dementia.
Previous studies have revealed that humans ingest about a credit card-size amount of microplastics weekly and suggested links between microplastic ingestion in people and inflammatory bowel disease. There’s also some suggestion that microplastics can alter how hormones function in the body. A study published in 2019 estimates that humans may inhale 74,000 to 121,000 microplastic particles annually.
“We ingest microplastics all the time,” said Anna Alsobrook, watershed science and policy manager at MountainTrue, an environmental advocacy group based in western North Carolina.
“The more plastics that get produced, the more microplastics we ingest. We are continuing to see more and more linkages of microplastics to chronic health problems.”
‘Culture of convenience’
Despite the mounting evidence that plastic pollution poses a risk to the environment, animals and humans, getting people to curb dependence on single-use plastics has proven to be a challenge.
“We live in a culture of convenience,” said Jason Love, one of the co-contributors of the watershed research and associate director of Western Carolina University’s Highlands Biological Center. “Instead of going and getting tap water, why not get a plastic bottle out of the fridge?”
He noted, “All these things contribute to the issues we’re having now. It’s going to take some deep discussion about what we want as humans and what’s most important.”
UNC Chapel Hill Institute of the Environment students collecting stream measurements after a storm event. Credit: Erin Flanagan.
Further complicating the discussion about the dangers of microplastics is the fact that they are hard to detect in the environment, said Annika Willis, a UNC Chapel Hill undergraduate majoring in environmental science. Willis is one of several UNC students involved in research projects at the Highlands Biological Center.
“Even though I was aware of microplastics, until doing this research, they weren’t really on the top of my concerns because I was never really visually interacting with them,” Willis said.
“This research is really important to educate the public on the fact that these particles are in our bodies and they are having impacts,” she said. “But I feel like that’s not necessarily common knowledge or knowledge that people want to take into consideration when enacting policy.”
Where do we go from here?
Part of the conversation society needs to have about plastics has to include an economic perspective, said Erin Flanagan, an undergraduate environmental studies major at UNC Chapel Hill. She is also part of the group conducting research at the Highlands Biological Center.
“With a lot of environmental pollution, I think you can’t talk about mitigation and policy without talking about classism,” Flanagan said. “If you can’t afford a nice glass water bottle or to wear all natural fibers, [or ] to not eat frozen dinners in a plastic container every night…”
“There’s the issue of people not being able to afford more safe alternatives to plastic and the influence that plastic companies or corporations that use plastic to package their products have,” she said.
Textile fibers were part of the microplastics researchers found in the Richland Creek watershed. When clothes are washed, they release microfibers and contribute microplastics that end up in the environment and the food chain.
There are some bags on the market that are designed to limit the release of microfibers when washing clothes. One item on the market is the GUPPYFRIEND. Priced at around $35, the instructions say to place “synthetics and other delicate clothes” into the bag during the laundry process. The microfibers are trapped in the bag and can be discarded into the trash.
Want to make less waste? Here are some recycling tips:
Place empty cans, bottles, paper and cardboard in the recycling container. Keep everything else out. Rinse plastic bottles, jugs and tubs, and empty all bottles and cans of liquids before placing them in a recycling container.
Do not bag recyclable items for bin disposal. Be prepared to empty bags of recyclables at the Container Site.
Do not put plastic bags, cords, hoses and other string-like items in the recycling container as they can tangle around rotating equipment.
Avoid putting other things that could be hazardous to workers who sort recycling — like batteries, needles, sharp objects and food residue — into the recycling container.
Do not put Styrofoam cups and containers in the recycling container.
Numbers don’t matter. When it comes to plastic, recycle by shape: bottles, tubs, jugs and jars are recyclable.
Requiring plastic producers to take responsibility is the only way to create lasting change when it comes to reducing plastic waste, environmental advocates say. They argue that multinational petroleum companies, such as Shell, should be required to help fund recycling programs and mitigation strategies like installing microfiber filtration systems at municipal wastewater treatment facilities.
Given the complexity of the problem, it’s going to take multiple strategies to resolve it, Alsobrook said. Engaging local elected officials is an essential first step.
“The best thing we can do as a society is to produce less plastic, and to start that yesterday,” she said. “To do that, we need policies that limit single-use plastic production and their products. Contact your state legislators today and tell them to enact policies that protect us from plastics and their toxins.”
