The system is broken: An open letter on mental health and substance use issues

Yahoo

01-05-2025

Image: Adobe Stock
I have been working in mental health for 15 years. I started out working with individuals with autism and eventually began working with people struggling with mental health and substance use issues. Later, I supported adolescents and teenagers carrying deep trauma. Today, I work behind the scenes at a Managed Care Organization (MCO) in North Carolina. I help develop plans and connect individuals with intellectual and developmental disabilities (I/DD), including autism, to essential services.
I hold an associate's degree in psychology and a bachelor's in social sciences, and I am currently pursuing my master's degree in social work at NC State University. These credentials don't just represent my education—they represent a lifetime of witnessing how our systems fail the very people they are supposed to serve.
What I've seen—and what many of us working in the field see every day—is a system weighed down by red tape disguised as checks, balances, and accountability. Bureaucratic processes meant to ensure 'quality' have instead become barriers. I've seen life-changing care delayed or denied, not because of clinical judgment but because of outdated rules, disconnected policies, and constant administrative hurdles.
Worse, the people we serve are no longer seen as human beings — they are numbers on a spreadsheet, authorization codes in a portal, or units of service to be approved or denied. But behind every case number is a person — someone's child, parent, or friend — who deserves compassion, dignity, and timely care.
A glaring example of systemic failure is how county borders restrict Medicaid services. If a person on Medicaid moves from one North Carolina county to another, they may lose access to their provider simply because the new county operates under a different MCO. They haven't left the state. They haven't stopped needing care. But now they're disconnected from the providers they know, forced to start over, or worse, left with no care at all. That's not how a safety net is supposed to work.
Let's talk about the bigger picture:
In 2021, more than 150 million Americans lived in areas designated as Mental Health Professional Shortage Areas (KFF, 2022).
Black and Brown communities, LGBTQ+ individuals, and people in poverty experience higher rates of untreated mental health conditions, yet are less likely to receive care (SAMHSA, 2023).
The substance use crisis continues to claim over 100,000 lives a year, yet we continue to criminalize instead of treat.
And mental health workers? We're exhausted. A 2022 report found that more than half of behavioral health workers are experiencing burnout and considering leaving the field, not because we don't care, but because the system makes it impossible to provide the care, we know people need.
Many of the policies in place today were written by individuals who have no background in mental health or substance use treatment. Lawmakers and decision-makers, without training or input from frontline professionals, are drafting rules that dictate how care is delivered. It's not just frustrating. It's harmful.
This isn't just about inefficiency. It's about injustice. We need legislation that centers people, not paperwork. We need lawmakers willing to listen to social workers, therapists, peer support specialists, families, and those with lived experience. We need policies informed by practice, not politics.
To the public: demand better. This is your issue, too, because when systems fail one group, they eventually fail us all. Vote for those who understand or are willing to learn. Speak up when silence means complicity.
To policymakers: If you lack experience in mental health, listen to those who do. Invite us to the table. Include our voices when you write the rules. Our communities depend on you to transform the system, not manage it.
I am writing this letter because I believe change is still possible. But we can no longer afford to pretend the current system is working. Lives are being lost, families are being broken, and professionals are being pushed to the edge — all while the system protects itself instead of the people it was built to serve.
We deserve better. And we demand better.