This article mentions several mental and behavioral health illnesses, including suicidal ideation and self-harm. If you or a loved one are in immediate crisis, call or text 9-8-8 for 988 Lifeline’s 24-hour hotline. This hotline will not automatically call the police or emergency services.
CityView has also compiled a list of local crisis, long-term and support group behavioral health resources. You can find it here.
More than half the county is concerned about one thing: mental health. Preliminary results of Cumberland County Department of Public Health’s latest community health assessment show that over 63% of respondents believe mental health is one of the county’s most important health problems.
From 2022 to 2023, the county saw an increase in the number of people going to the emergency room for suicidal ideation, according to data from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool. The same data shows an increase in residents going to the emergency department for self-inflicted injuries.
“The numbers have really skyrocketed since Covid,” said John Bigger, corporate director of psychiatric services for Cape Fear Valley Health. “Especially in adolescents, even reaching down as young as 10 years old.”
Depression is the most prevalent diagnosis in Cumberland County, according to a report from the county’s public health department sent to the Cumberland, Harnett and Lee Counties’ chapter of the National Alliance on Mental Illness. Rounding out the top five mental health issues are anxiety, substance use disorders, post-traumatic stress disorder and mood disorders.
Even with a large health system like Cape Fear Valley Health, Hannah Carroll, president of the local NAMI chapter, said she believes the county is limited in its resources to address residents’ behavioral health problems.
“We do need more mental health providers,” Caroll said. “But we need a new system.”
Finding a physician is a 24-hour job
In 2021, Sarah began experiencing mental health issues. She started having severe anxiety and depression, was not sleeping and had manic episodes.
“I was staying up late at night, like researching things that didn’t even make sense to be researching, like nail polishes,” said Sarah, who lives in Cumberland County.
As a school counselor, Sarah, who asked to omit her last name because of the stigma surrounding her bipolar disorder, knew something was wrong. A counselor friend confirmed Sarah’s suspicion: she needed professional help. With her husband deployed, she also needed additional familial support.
Her mother came down and as she helped care for Sarah’s two young sons, Sarah dove into finding a psychiatrist and therapist. For an entire day, she sat outside her home making call after call to find someone who would see her in person.
“All day, I kept calling places,” Sarah said. “And I was getting like, ‘We don’t take TRICARE [the servicemember medical insurance provider].’ I was getting, ‘We don’t take we don’t take new patients.’ Or I was not getting an answer at all.”
Over a dozen phone calls later, she had nothing to show for it.
“Here I am, somebody that has TRICARE, I’m a counselor myself, and I can’t find anybody,” Sarah said.
Mental health services can be hard to come by in Cumberland County, even with insurance. The Rural Health Information Hub classifies the entire county as a mental health professional shortage area. Cumberland County only has one mental health professional for every 230 residents, according to County Health Rankings and Roadmaps data.
“We don’t have enough psychiatrists or psychotherapists in our community to meet the need,” Bigger said.
Over half of U.S. psychologists have no openings for new patients, according to a 2023 survey of psychologists from the American Psychological Association. At Cape Fear Valley Medical Center, Bigger said outpatient appointments can have a three-month waiting list. Stable patients sit in the medical center’s emergency department, sometimes for 90 days, for an inpatient bed to open up, which Bigger said there is a lack of in the area.
Even the military is not immune. On Fort Liberty, Mike, an active duty soldier who asked for his last name not to be published due to concerns about mental health stigma, said his appointments are often scheduled six weeks out because of physician availability.
Lieutenant Colonel Julie Shin, deputy chief of behavioral health at Womack Army Medical Center, told CityView that staffing has been a priority across the post’s seven clinics.
“We have one clinic that is fully staffed and one clinic that’s only missing one substance use provider,” Shin said. “And in itself, that is great, because it’s hard to find clinics that are fully staffed and stay fully staffed all the time. So I mean, I think we’re in a much better boat than we were a year ago.”
Waitlists could be even longer for those seeking professionals with specific racial or gender identities. In Sarah’s case, she recalls coming close to settling for a male therapist who would take her before a friend helped her find a female provider.
“I ended up asking the counselor that I saw,” Sarah recalled. “I said, ‘You know, did you accept me as a favor?’ And she said, ‘Yes.’ So I got accepted because I knew somebody who she knew. They were neighbors.”
Even with connections, any of the over 135,000 Black Cumberland County residents who want to see a Black mental health professional might have a tough time getting an appointment. Only 5% of all U.S. psychologists are Black, according to data from the American Psychological Association. Between 2% and 4% of America’s psychiatrists are Black, according to the American Psychiatric Association, while about 11% of professional counselors are reported to be Black, according to the Black Mental Health Workforce Survey Report.
Donelle Barnett is the author of the report and former president of the Association of Black Psychologists.
“For a lot of Black folks who come into a therapy space because they can’t wait and find someone who has some shared understanding, a worldview, they end up getting harmed in the process more often than not,” Barnett told CityView. “Which then changes perceptions about behavioral health care for generations.”
Stigma: another barrier to care
While Sarah got the care she needed, that care came with a diagnosis: bipolar disorder. It’s a diagnosis she still struggles with.
“There’s just so much stigma with the term ‘bipolar,’” said Sarah. “And you’ll hear people call people bipolar [casually]. Sometimes they’ll be like, ‘Oh, she’s crazy. She’s bipolar.’”
Carroll said the stigma around behavioral health often stops people from seeking help, despite the American Psychological Association finding Americans are more open about mental health today than in the past. Strong public stigma can also produce self-stigma in a person with a mental illness, said Carroll.
“You create so much doubt in the person that’s already suffering,” Carroll explained. “Just imagine you woke up one day and you knew for sure that something mentally wasn’t right with you. But you’ve lived in this society for so long that you’re really afraid to get treatment.”
On Fort Liberty, some soldiers fear seeking behavioral health care will negatively impact them, said Shin.
“There’s a lot of people that are like, ‘I don’t want to go to behavioral health. It’s going to ruin my career,’” Shin said. “We hear that a lot, and I still hear it, and I’ve yet to see it ruin a career. I’ve seen folks in brigade command that have had a suicide attempt when they were young captains, and they’ve gotten help and gotten better and been able to stay in and succeed.”
Mike joined the Army in his 30s. He sailed through basic and airborne training. But, a year into being in the airborne, Mike noticed a “downward curve” in his mental and physical state. He pushed through until enough red flags were raised for his primary care manager to send him for an MRI.
The MRI showed a pituitary tumor, Mike said. He also has a suspected traumatic brain injury from frequent jump landings that come with his job. Today, he manages multiple anxiety attacks a day. He said he loses his thoughts because of his pseudodementia, a symptom of his major depressive disorder.
“I can only imagine what joy feels like because I haven’t felt it in a while,” Mike said. “It’s painful to laugh.”
It was not until recently that Mike said he let his medical team and command — who he has worked with for around two years — know how low he had gotten.
“When I got to the point where my mental state was going to impact my life, I made the decision to seek help,” recalled Mike. “I didn’t care if it impacted my career anymore, because no life, no career.”
Fear of negative repercussions for seeking behavioral health treatment is particularly pervasive among senior, higher-ranked soldiers, said Shin. While they are supportive and even advocate for their younger soldiers to seek help, she said they struggle to advocate for themselves.
“Deep down inside, there is still that fear that it’s not okay and that someone’s going to find out, or it’s going to impact them,” Shin said.
While Mike recognizes the need to talk more openly about mental health, he also believes more needs to be done to preserve people with behavioral health issues’ privacy, especially in the Army.
“It’s why, I think, a lot of people take their lives, because they’re too afraid to talk to people and it’s easier at that moment to internalize it,” Mike said.
Improving Cumberland’s access
Orland Smith, a social worker with the Cumberland County Department of Public Health, has seen the evolution of mental health services since he began working at the old Cumberland County Mental Health Center in the ‘80s. As part of his job, Smith responds to patients screened into the department who are struggling with anything from food insecurity to mental health.
“We see a lot of unaddressed mental health issues here,” Smith said. “Folks who were disconnected during the pandemic from their provider, or some who just never really dealt with their mental health issues and are now just kind of getting by or compartmentalizing those issues and just moving on.”
Without enough physicians to meet Cumberland County’s needs, Smith said public agencies like the public health department have had to become “de facto mental health service providers.”
However, not every social worker is prepared to handle clients with complex behavioral health issues, explained Smith. One of Smith’s most difficult cases involved a young woman originally from Bladen County. She had a history of mental illness since she was a teen. The department worked with the woman through psychotic breaks and violent behavior that Smith said would have gotten her kicked out by other care providers.
To alleviate the load on places like the county’s public health department in addressing behavioral health issues, Smith said wants to see more collaboration between the county’s agencies, hospitals and other local organizations.
“What’s the plan to address this 63% [of Cumberland County residents that believe mental health is one of the most important health problems]? And are we all on board with it? Is there a commitment by everyone who hears what the problem is?” asked Smith.
For Carroll, part of the need is a health system that is better equipped to handle complex behavioral health issues. She points to UNC Health and Duke Health systems; U.S. News and World Report ranks Duke University Hospital as the 20th best hospital in the country for psychiatry, while UNC Hospitals closely followed in 24th.
Cumberland County’s health systems are trying to fill the known gaps in care. Last month, Alliance Health, the county’s public mental and behavioral health services provider, added 16 new facility-based crisis beds at the Cumberland Recovery Response Center. The beds are an alternative to the emergency room, providing care for up to two weeks for those 18 and older in behavioral health crises.
Alliance Health also brought Southlight Healthcare into the area. Southlight, a mental health and substance use treatment provider in the Triangle region, brings with it teams to treat those with severe mental illnesses and substance use disorders.
The Methodist University Cape Fear Valley Health School of Medicine, Cumberland County’s first medical school, could be a solution to Carroll’s worries. Speaking at the medical school’s groundbreaking last month, medical school officials said that the school and availability of residencies through Cape Fear Valley Health should keep physicians in the region. Those physicians include psychiatrists and other mental health professionals.
“It’s going to dramatically improve health care outcomes in this county and in this region of the state,” Cape Fear Valley Health CEO Michael Nagowski told CityView in March.
CityView has compiled a list of behavioral health resources in Cumberland County. You can find it here.
CityView Reporter Morgan Casey is a corps member with Report for America, a national service program that places journalists into local newsrooms. Morgan’s reporting focuses on health care issues in and around Cumberland County and can be supported through the CityView News Fund.