North Carolina and Wisconsin are working to decouple law enforcement from crisis response, leverage 988 in care entry and conquer longstanding data silos.
State officials spoke frankly about the challenges they face in delivering equitable mental healthcare during policy sessions at the annual Behavioral Health Tech conference last week, held in Nashville.
In North Carolina, law enforcement officers spend so much time transporting people to the hospital for evaluation in response to mental health-related calls it limits their capacity to respond to actual crimes. The involuntary commitment process in the state is rife with issues, as reported by disability advocates. It is also not efficient: over 60% of those who get evaluated don’t meet the criteria for involuntary commitment. Still, over the past decade, involuntary commitments in the state have ballooned 100%.
“We’ve done a bad thing there, pushing everyone to the justice system,” said Kelly Crosbie, assistant secretary of mental health, developmental disabilities & substance use services at the North Carolina Department of Health & Human Services (NCDHHS).
There wouldn’t be as big a need for law enforcement if people had access to more crisis care, leaving legal resources for those actually violating the law or posing a real danger, per Crosbie. NCDHHS is building relationships with magistrates and law enforcement to direct non-violent people to care instead of jails or the emergency room. While Crosbie acknowledged the state could use more institutional beds, citing the acute behavioral health need in prisons, “it’s a balance. It’s not assuming everyone needs that.”
Wisconsin faces the same issue, with patients often not qualifying for involuntary commitment, getting released back into the community and restarting the cycle. Considering the state’s aging rural communities, many older people also need general psychiatric treatment or dementia care instead of a police response.
Oklahoma, a largely rural state, provides telehealth-equipped iPads to law enforcement officials with immediate access to licensed clinicians in a program called MyCare. “Law enforcement is not trained to do those mental health interventions,” Kelly Perry, director of clinical services at Oklahoma’s Department of Human Services, said on a separate policy panel. Those iPads are also available across other settings, including detention centers, group homes, schools and the homes of high-acuity youth.
Data silos hinder public health efforts
A major problem identified by state officials, which relates to criminal justice systems, is a lack of visibility into patient journeys. Many people in jail for petty crimes really need mental health treatment, but “we don’t have a line of sight into who those people are,” Kirsten Johnson, Wisconsin Department of Health Services’ secretary, said on the panel with Crosbie.
“All of us have pieces of the data that tell us about folks, … it’s shocking how none of us know any of it," Crosbie echoed. "It’s horrible, and you see so many points of failure."
Each county clerk’s office in the state records its own total number of involuntary commitments, which it reports to the Administrative Office of the Courts. The state reportedly groups them with other numbers and doesn’t report them separately to other agencies or the public. Crosbie later told Fierce Healthcare that NCDHHS only has visibility into fewer than half of involuntary commitments in the state, which it keeps track of on spreadsheets.
Wisconsin’s public health department recently experienced data silos in action: a new mom came into the public health department in crisis, seeking supplemental nutritional support, and the agency didn’t know where else she had previously sought care. “It really highlighted … the disconnect between people who need care and where they receive that care,” Johnson said.
To combat this issue, Wisconsin has used Rural Health Transformation Fund money to invest in a statewide EHR to bring all stakeholders onto the same system. It is rolling out to 10 providers every three to four months, with the goal of bringing on 100 providers in the next three years, so that no matter where a patient gets care, there is a shared medical record.
Access questions amid insurance changes
Officials universally praised the 988 suicide hotline, with Crosbie calling it “an incredible resource” for North Carolina. Most of the hotline’s utilization in the state is not for crisis, but for broader mental health support. The state wants to use the moment people engage with 988 to direct them into care. This applies to adults and children.
For at-risk youth, NCDHHS is extending capacity in schools and other settings by contracting with several virtual therapy programs. They reach kids who have “extraordinary need” but likely can’t access in-person care, like those in foster care or those who are justice-involved.
“They’re not cheap—but they are cheap,” Crosbie noted of the programs. “When you actually compare that to the cost of brick-and-mortar therapy … they’re actually incredibly cost-effective.”
Though North Carolina has expanded its infrastructure by building new behavioral health urgent cares and crisis care centers, future utilization is unclear.
“We’re really worried about that right now with H.R. 1 changes. We built the infrastructure, people will come … but I’m not sure about the financial sustainability right now,” Crosbie said.
Similarly, Wisconsin faces coverage questions. The state is not a traditional Medicaid expansion state, but it did expand coverage to adults with income up to the federal poverty level. Above that, Wisconsin residents have historically relied on the ACA marketplace. Temporary enhanced subsidies expired in 2025, leading to a sharp overall drop in people enrolled in marketplace plans. The Trump administration has also proposed controversial “program integrity” changes affecting ACA exchanges’ coverage access, currently being challenged in court.
“We depended heavily on the ACA and the Marketplace to capture those individuals who were above 100% federal poverty level,” Johnson said. “We are seeing, even outside of people who have lost their subsidies, a loss of coverage happening around the state.”