A few days ago, we read a heartening tale of structural mental health reform, budgetary investments and a number of innovative mental health actions in North Carolina – all developed through a remarkable working partnership between the heavily Republican legislature and the Secretary of the Department of Health and Human Services (DHHS), an appointee of Democratic Governor Roy Cooper.

This is an example of government collaboration and relationship building that worked -- countering the more usual partisan battleship narrative that we’ve become accustomed to, particularly in states with a divided political power structure like North Carolina.

In the very late Fiscal Year 2024 budget – passed on September 28, nearly three months after the end of FY2023 – North Carolina made a total of $835 million of investments in its mental health care system. The details were spelled out in two excellent articles by Taylor Knopf on the North Carolina Health News website that are available here and here.  The changes put considerable power in the hands of the DHHS to oversee, fix and reform services by the state’s local behavioral health management companies, which have had a checkered history over the years, generating a chorus of complaints about multiple service and access problems. 

The investments are aimed at getting individuals with mental health issues out of overloaded emergency rooms, bolstering rural mental health, increasing pay rates for a wide variety of behavioral and mental health positions, funding new mobile crisis teams and respite facilities, providing more workforce training and initiating some innovations like  the development of a Psychiatry Access Line, which will provide primary physicians expert advice from the Department of Psychiatry & Behavioral Sciences at Duke University. 

Last week, we talked with the editor of North Carolina Health News, and she filled us in on the details of how a close relationship between DHHS Secretary Kody Kinsley and State Sen. Jim Burgin, the Republican chair of the Appropriations on Health and Human Services committee, served to build an impressive plan for better mental health care in a state with a polarized political environment. “It was truly nice to see them work together,” says editor Rose Hoban.

The relationship was aided by a mutual understanding of the problems of poor mental health access that has affected states and local governments across the U.S.  It blossomed as Sen. Burgin and Director Kinsely, along with other guests, attended a dozen town halls across the state. In the Health News article, Burgin praised the DHHS director for both understanding mental health needs and forming relationships that move action forward. This was echoed in the article by another member of the legislature, Republican Rep. Donny Lambeth, who praised the working relationship with DHHS as the best he’s had in his six house terms.

Kinsley has an impressive background that includes both federal and state experience and is known for his engaging manner and a focus on relationship building.  On the other side of this informal partnership, Sen. Burgin is known to care deeply about the problems of mental illness, and, according to Hoban, is a legislator who is “willing to reach across the aisle.”

Old fashioned civics classes that focus on things like “how a bill becomes a law,” generally ignore the human side of the equation. So, in fact, do many elected and appointed officials. But the more we’ve studied government the more we’re aware relationships between sincere human beings can be more important than many of the formal processes of governing. 

While reading Erik Larson’s excellent book,  The Splendid and The Vile, we were repeatedly struck by how world events in the 1940s were dramatically shaped by the relationship and friendship between Franklin Roosevelt and Winston Churchill; two very dissimilar men with distinctly common goals. 

The importance of relationships to effective policy development and implementation is not a new idea, but it can be easily forgotten. As editor Hoban said, “It’s amazing that this is an insight for people. It’s amazing to me that somehow people have lost this idea.”