The public system of mental health treatment and services in North Carolina is provided by 39 Area Programs which cover the entire state. Each Area Program must provide services for mental illness, developmental disabilities, and substance abuse. And each Area Program may have one or more mental health centers where these services are provided, or it may contract with other entities to provide some services. Area Programs usually charge for services on a sliding scale based on an individual's ability to pay, or if the individual is Medicaid eligible then usually no fees are charged. No one can be denied access to Area Program services because of an inability to pay for them.

Obtaining treatment and services from an Area Program mental health center begins with making an appointment for evaluation and in-take. If you cannot find the phone number or address of the mental health center serving your location, you can get this information by calling the NAMI NC Helpline at 800-451-9682.

You may have to wait several weeks for a first appointment. If you are in crisis you should go directly to the mental health center for help (examples of crisis are suicidal thoughts or extreme anxiety). After the initial evaluation you may be referred to a staff psychiatrist. Area Programs generally do not operate in-patient 24 hour hospitalization facilities. However they are the preferred place to go for initial evaluation for admission to one of the 4 state mental hospitals. They may also contract with other local hospitals with psychiatric wards for in-patient services.

The quality and kinds of services available at Area Program mental health centers around the state is highly variable. The mental health center will usually have a range of services which may include:

• Diagnosis and treatment plan
• Individual or group therapy
• Case management
• Psychosocial day programs (clubhouses)
• Medication management

Case management could include: assistance in locating suitable housing, assistance in applying for SSDI or SSI, assistance in managing personal finance, or periodic follow on an individual's condition.

Individuals who have private medical insurance may seek the services of a private physician, and some physicians also accept medicaid covered patients. A general practitioner physician may be suitable for diagnosis and treatment of some types of mental illness. For example many GPs have appropriate training and experience to diagnose and treat mild to moderate depression. On the other hand a possible diagnosis of bi-polar disorder or schizophrenia would almost always be more appropriately diagnosed and treated by a psychiatrist. In any case, consultation with a GP would be an appropriate starting point, and might result in referral to a psychiatrist. The NC Psychiatric Association ( phone 800-553-1935 ) can also provide information about psychiatrists in your area.

Even when the option of going to a private physician is available there may be important reasons to seek services from the local Area Program. For example, case management is rarely provided by a private physician, and psychosocial programs are only available through Area Programs. On the other hand there is limited choice of therapist or case manager or physician in the Area Program. An individual who is already being treated by a private physician may be required to switch to an assigned physician in order to be accepted for treatment in an Area Program. Some Area Programs may provide latitude on this issue when the private physician and Area Program have an established working relationship.

North Carolina has 4 state mental hospitals which provide short term and long term treatment for mental illness. According to new rules established in 1997, admission to one of the state hospitals, whether voluntary or involuntary, should start with an evaluation at one of the Area Program mental health centers.

There are also many private and community hospitals which have psychiatric wards. As mentioned above, some of these hospitals may have contracts to provide services for Area Programs. More typically they treat individuals who have private insurance or self pay, and some will accept medicaid eligible patients. A patient may be admitted to a hospital under the care of a private physician, or may be referred by a private physician. Private or community hospitals are generally designed to provide acute or short term care and diagnosis.