FIT Wellness, part of the North Carolina Formerly Incarcerated Transition (NC FIT) Program, is dedicated to supporting justice-involved individuals by providing comprehensive behavioral health services and substance abuse treatment for patients with Severe Mental Illness (SMI). Recently, FIT Wellness and the North Carolina Department of Health and Human Services (NCDHHS), which supports the program, held a tour and panel discussion at UNC REACH Primary Enhanced Care clinic in Raleigh, where FIT Wellness is based. The event emphasized the importance of addressing the mental health and substance use disorders that affect a significant portion of the incarcerated population in North Carolina.
The NCDHHS estimates that 50% of people in prisons and jails identify as having a mental health need, and 75% identify as having a substance use disorder. The services that FIT Wellness provides are crucial for their successful reentry upon release. “We are undertaking a national leading effort putting eyes on this,” NCDHHS Secretary Kody Kinsley stated, noting the $99 million the NCDHHS budgeted to support people involved in the justice system by increasing services including 29 reentry programs like NC FIT. “Far too often, people who leave jail or prison quickly find their way right back because they’re not able to have those stabilizing forces in their lives, they’re not able to manage those critical essentials that they need, and they’re not able to get their healthcare under control and that often results in them back in jail which in turn runs up our costs for society,” stated Kinsley.
FIT Wellness client Anthony Ferrera shared the transformative impact FIT Wellness has had on his journey. Ferrera commented on how the inclusive, co-located mental health and primary care services at UNC REACH helped him overcome severe mental and physical health challenges, stating, “Without this place, I don’t know where I would be…I really wish I would have known (previously) that there is an option and that people care.” His story underscores the vital role of these services in facilitating successful reentry and long-term recovery for formerly incarcerated individuals.
Ferrera’s mother, Barbara Nagel, joined him on the panel, noting how the unique co-located mental and physical health care model that UNC REACH operates is important. “The way this is designed is a game changer,” she stated. “This collaboration is really what underlies better outcomes,” UNC REACH family medicine doctor Daniel Whitesides, MD, added, noting that having a physical location where you can receive both mental and physical care significantly reduces barriers to patients showing up to and following up on appointments. Whitesides added, “It’s been really beautiful to work in a space where all of these resources are co-located.”
Ferrera and Nagel noted the importance of the services coordinated by NC FIT Community Health Worker (CHW) Shawn Baker. NC FIT’s employs CHWs at each of the program’s eight locations across the state. These employees are people with lived experience of incarceration – another unique model of care that helps build trust with patients who, in many cases, have not had positive interactions with the healthcare system. CHWs work with patients to help them with all basic services upon reentry – coordinating mental and physical health care and helping find housing, clothing, food, and more. Baker states, “I’ve been there – I’ve had to overcome those barriers.” Evan Ashkin, MD, founder and Director of NC FIT, states, “To have a person come into the room that has lived experience of what they are going through is key to this program’s success. You can see the patient immediately start to open up.”
Panelists also discussed what else is needed to care for people reentering. “Housing is our number one problem we have with patients. Some people don’t have the same family support. When that housing piece is missing, it’s a great challenge,” stated Ted Zarzar, MD, the Lead Psychiatrist for FIT Wellness. More support was suggested for emergency and transitional housing, and helping people find a permanent home. “Another challenge is, especially in more rural areas, is lack of consistent mental health services. More infrastructure is needed,” added Ashkin. “Mental health directly effects physical health outcomes – for instance, patients with SMI who have diabetes live twenty to twenty-five years earlier than those without.”
Earlier this year, NCDHHS announced a $5.5 million investment in FIT Wellness to expand its services to additional counties and improve resources. This investment will allow the program to serve an estimated 100 additional patients per site annually through new FIT Wellness locations.
FIT Wellness is a collaboration between the UNC Departments of Family Medicine and Psychiatry. The program’s success is evident, with 75% of patients reporting no emergency department visits and 81% reporting no hospitalizations after release. By working closely with peer support specialists and other care team members, the program ensures that participants receive the necessary support to rebuild their lives and reintegrate into their communities.
UNC REACH Enhanced Primary Care, formerly UNC Wakebrook Primary Care, has been dedicated to meeting the primary care healthcare needs of North Carolinians with severe mental illness since 2015. REACH is an enhanced primary care clinic, meaning established patients receive services above and beyond typical primary care. Nearly 100% of clients served through the clinic have lived experience of severe mental illness, substance use disorder, incarceration, homelessness, and/or disability.
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