The Kate B. Reynolds Charitable Trust started with the mission of improving North Carolina residents’ health and quality of life. Early on, the Trust focused on ensuring the health of newborns and their mothers, attracting health care providers to rural parts of the state, and ensuring “charity patients” had access to care. Thirty years into this work, it became clear there was a deep need to address challenges that weren’t just physical.
In the 1980s, the Trust began to see an increase in grant requests from the mental health field and started investing in mental health with a few individual grants. By the middle of the decade, the Trust would commit hundreds of thousands of dollars to fund programs, outpatient services, and mental health facilities. Since then, that investment has expanded and evolved to address societal factors contributing to poor mental health outcomes.
“The Trust has a history of being on the cutting edge of quality improvement work within the health system. We have also promoted and invested in innovative models of care, particularly in mental health care.”
Dr. Laura Gerald
President, Kate B. Reynolds Charitable Trust
The Trust’s initial investment in the mental health space funded facilities for those with mental disorders/disabilities. In 1983, the Nevins Center, Inc. in Charlotte received $75,000 to build a residential facility for mentally and physically disabled adults. A year later, the Trust gave Charlotte Rehabilitation Homes $75,000 to purchase a halfway house for mentally ill adults. It awarded T.L.C. Homes, Inc. in Sanford $18,000 for respite care for families with mentally and physically impaired members.
A shift in funding mental health programs occurred in 1985 when the Trust made six grants totaling $314,049 to fund programs aimed at helping people with mental illness function outside of psychiatric hospitals. The following year, the Trust pushed the Mental Health Association in North Carolina to establish a state plan to develop group homes and apartments and committed $450,300 to implement the plan. The grants from the Trust helped make North Carolina a leader in its approach to housing mentally ill adults and children by the early 90s.
North Carolina’s 2001 Reform Legislation
In October 2001, the North Carolina General Assembly ratified House Bill 381 on Mental Health System Reform. This required local jurisdictions to separate the management of mental health services from the delivery of those services, essentially dismantling the state’s mental health system. This legislation privatized mental health services by divesting clinical services from public area authorities. As a result, mental health facilities shut down, and people previously receiving care from mental health professionals ended up in the emergency room seeking care or being punished for their condition in the criminal justice system.
“Reform disrupted the mental health field in our state. The Trust started to invest in safety-net organizations, health care organizations, free clinics, Federally Qualified Health Centers, and hospital systems to expand some of their services and pick up the slack with private foundation dollars, but we still couldn’t compare to what government was previously doing.”
Senior Program Officer, Kate B. Reynolds Charitable Trust
Facing the challenges brought on by North Carolina’s mental health system reform, the Trust remained innovative in creating access to these essential services.
Addressing Youth Mental Health
While trying to fill the gaps left by mental health reform, the Trust has also invested millions of dollars in addressing youth’s mental health needs. In 2001, the Trust collaborated with the Robert Wood Johnson Foundation, the U.S. Office of Juvenile Justice and Delinquency Prevention , and the Center for Substance Abuse Treatment to launch the Reclaiming Futures initiative. This new approach helped teenagers caught in the cycle of drugs, alcohol, and crime. Through this program, the Trust worked with the justice system to expand mental health services for youth and expand opportunities for youth in the community.
The same year, the Trust awarded $10 million in grants to prevent chronic disease in North Carolina. The SELF Improvement program funded 16 projects designed to lower chronic disease rates in low-income areas across North Carolina. Along with addressing physical needs across 21 counties, the program aimed to create mental health services by establishing school-based health centers where students could receive medical care and mental health support.
“The Trust has invested in many school-based clinics, another innovative access to care issue where the Trust was one of the early adopters. School-based clinics are an excellent way for children to access mental health and physical health services in a setting where they are already located and where we see many of the problems manifest. It helps us treat what is really bothering the child so that they can better access education.”
Dr. Laura Gerald
The Trust also recognized that many patients seen in clinics for chronic diseases and other illnesses were not just suffering from a physical health issue. Often the condition may have been exacerbated by a mental health issue, or patients might have a mental health issue manifesting as a physical health issue. The Trust worked to ensure patients could get all their care in one place. Between 2007-2013, the Trust made 255 grants related to mental health access to care that pioneered the adoption of an integrated care model in North Carolina, which blends behavioral health services with general or specialty medical services.
“I went to the doctor the other day, and it was natural for them to ask you all these questions related to mental health and substance abuse. Ten years ago, that was not true. And the Trust was instrumental in making screening a part of the normal process and thinking about the mental health needs of youth, young adults, women, and mothers specifically.”
Former Senior Program Officer, Kate B. Reynolds Charitable Trust
To show how integrated care could work at a community health center, the Trust established a demonstration with Rural Health Group to provide consultation and a model clinic. The Trust also equipped providers with mental health resources and helped develop the Center of Excellence for Integrated Care at the Foundation for Health Leadership and Innovation to consult with providers interested in integrating physical and behavioral health in their practices.
“If a patient is seeing their primary care doctor and the doctor notices signs of depression or anxiety, they could immediately bring in a mental health expert to meet with the patient and discuss wrap-around needed services. It’s a much more holistic approach to medicine.”
Today, the state is prioritizing integrated care, and one goal of Medicaid reform is to create payment systems for both physical and behavioral health.
The Opioid Crisis
The Trust’s mental health funding continues to evolve. The Trust is currently working to address mental health on a systemic level, addressing the over-prescription of pain killers and the criminalization of substance misusers.
“From the very beginning, mental health and substance misuse are interwoven. Just talk to the folks that are providing care. There’s the mental health aspect. There’s the substance misuse, the treatment of it, the prevention of it, but then there are the social drivers that surround the whole thing.”
In 2013, the Trust awarded a $2.6 million grant to expand Project Lazarus, a Wilkes County-based model that addresses chronic pain issues and prescription drug overdose statewide. The model required collaboration between multiple community sectors, including coalitions, special interest groups, hospitals, medical providers, pharmacies, and law enforcement. As a result, Project Lazarus empowers communities and individuals to prevent prescription medication overdoses, champion responsible pain management practices, and promote substance abuse treatment and support services. Since launching in North Carolina, Project Lazarus has expanded to 24 states and other military and tribal groups.
In 2016, The Trust convened a task force through the North Carolina Institute of Medicine, which developed recommendations to increase and improve community-based and evidence-informed prevention, treatment, and recovery services and supports for individuals with mental health and substance use disorders.
“Mental health and substance abuse was a critical work area at the Trust. As the opioid crisis had really taken hold of the community, there was some transformational work happening in North Carolina. It has set the stage for work happening nationally around how you actually engage at the community and state systems levels to change the trajectories for those impacted by the opioid crisis.”
After years of negotiations, two proposed nationwide settlement agreements have been reached to resolve all opioid litigation by state and local governments against the three largest drug distributors, one manufacturer, and its parent company, Johnson & Johnson (“J&J”). The proposed settlements require the distributors and J&J to pay $26 billion over 18 years, with approximately $22.7 billion available to state and local governments to address the opioid epidemic. North Carolina will receive roughly $750 million through these settlements if all 100 counties and all municipalities with a population over 10,000 participate. These funds will be available starting in 2022 to support treatment, recovery, harm reduction, and other life-saving programs and services.
The Trust is working directly with the Attorney General’s office to determine the best use of the settlement funds. The Trust is also helping counties determine how they should address opioid abuse to ensure they aren’t just “throwing money at the problem,” but putting systems in place that get to the root of the issue. This includes engaging people impacted by substance misuse, building trust, bringing people of color and marginalized groups to the table, and correcting societal factors that influence substance misuse and mental health.
“Finally, substance misuse is seen as a health concern, but it’s rooted in many social and systemic problems. We are also addressing the fact that often substance misusers are criminalized instead of treated for a health condition. So, we’re working with communities on courts that would get people into treatment instead of jail.”
Dr. Laura Gerald
Adverse Childhood Experiences
The Trust will continue to work on mental health care access for young children by investing in efforts to mitigate the impact of Adverse Childhood Experiences (ACEs), caused by trauma and toxic stress. In addition, the Trust intends to fund community partners that aim to get to the root cause of social factors at the root of ACES, like economic challenges, poor nutrition, and child maltreatment, that can trigger or exacerbate mental health concerns later in life.
Locally, as a part of the Trust’s early childhood Great Expectations special initiative, Forsyth County nonprofits have collaborated to map trauma-informed organizations and institutions in the community and provide resiliency trainings. Importantly, grantees are working to change the conversation to one that recognizes trauma as a product of the system, rather than punishing children and families for their experiences.
Around the state, grantees like Rural Opportunity Institute are working to end generational cycles of trauma and poverty by preventing ACEs and toxic stress with a focus on investing in local leaders and public agencies.
The Public School Forum of North Carolina is working to implement a trauma-informed school model that engages the entire school and all personnel in the northeast and southeast parts of the state. At the state level, NC Partnership for Children and the Smart Start Network convened state leaders and coalitions to create a map of all of the ACEs coalitions around North Carolina. This coordinated effort tracks all existing ACEs work and pilots ACEs programs in communities without them.
“We want mental health to continue to be integrated with the rest of physical care. Mental health problems are health problems and not moral problems or failures of character. The Trust will continue working to evolve the health care system to focus on every aspect of a person’s health.”
Dr. Laura Gerald