How One Community’s “No Wrong Door” Initiative is Building Better Mental Health Care Navigation in WNC—And What We Can Learn From It
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In Western North Carolina, mental health and substance use are not emerging concerns. They are persistent community health priorities.
Regional data from the Western North Carolina Health Network show just how broadly these issues are felt. In the 2024 community health assessment cycle, mental health was identified as a priority by 16 communities across the region, while substance use was identified by 12. The WNC Health Network has also identified mental health, substance use, housing, and food security as major areas for regional research and action.
But identifying a need is different from building a system that people can actually navigate.
That distinction is at the center of a new episode of the WNC Health Policy Initiative podcast featuring Sheila Jenkins of No Wrong Door for Support and Recovery in Macon County. The conversation builds on an earlier episode examining the national No Wrong Door (NWD) framework and efforts to improve access to long-term services and supports (LTSS).
At the national level, NWD is a framework for making fragmented systems easier for people to navigate. In North Carolina, that work is becoming increasingly concrete. The NC Center for Health and Wellness at UNC Asheville, in partnership with the NC Division of Aging, Community Care Hub, and regional Councils of Government, is working to modernize and expand the state's NWD system for LTSS. The effort includes strengthening service coordination, reducing administrative burdens, and using systems such as NCCARE360 to improve how people connect with services.
NCCHW has also been convening people working on NWD and LTSS across the state to better understand how these systems operate in practice and what an improved statewide approach could look like.
The Macon County conversation adds another perspective: What does No Wrong Door look like when it is built from the ground up by people responding to the realities of one community?
From a resource list to actual navigation
No Wrong Door for Support and Recovery was not initially created as an implementation of a national NWD initiative. It emerged from local conversations.
Six years ago, community agencies and providers in Macon County came together to talk about gaps in the local system. One problem surfaced repeatedly: people did not know how to navigate the network of available services. If someone was turned away from one program, they might not know where to go next—or might simply stop trying. The organization that emerged from those conversations sought to fill those gaps without duplicating services that other organizations were already providing.
It began with $12 in a bank account.
Today, the organization averages roughly 700 visits a month and works across mental health, substance use, homelessness, housing, transportation, peer support, and other needs.
The important distinction is that its work goes beyond information and referral. A person may need an ID before accessing another service. They may not have transportation. They may need to leave Macon County to receive treatment. Their eligibility may depend on their legal situation, family circumstances, veteran status, or previous treatment history. In those situations, giving someone a phone number is not necessarily navigation.
Staff at No Wrong Door may help identify the appropriate service, make the call, provide transportation, coordinate with probation or the courts, and continue working with the person if the first option does not work. In other words, the organization absorbs some of the complexity that would otherwise fall on the person seeking help. That distinction matters for the broader NWD conversation.
The complexity is structural
North Carolina has 100 counties. Within those counties are different combinations of public agencies, nonprofit organizations, health systems, behavioral health providers, housing programs, transportation services, managed care organizations, eligibility rules, and funding streams.
Those systems do not necessarily line up neatly. A person seeking help therefore encounters more than a shortage of services. They encounter a system in which the “right door” depends on who they are, where they live, what they need, whether they qualify, what funding is available, and whether they can physically get there. That is particularly consequential in rural communities.
Macon County residents may need to travel outside the county for specialized behavioral health or substance use treatment, which means that transportation itself can become a barrier to care. Housing instability can make it difficult to maintain employment or treatment. Lack of an identification document or even a physical address can prevent someone from accessing basic financial services. None of these problems fits neatly inside a single program.
This is where the distinction between information and navigation becomes important for health policy.
North Carolina already has tools designed to help people find services, including 211 and NCCARE360. Those systems can be valuable parts of an NWD infrastructure. But a searchable directory cannot by itself solve every problem created by fragmented eligibility rules, transportation barriers, limited capacity, or a person receiving a “no” from the first organization they contact.
The Macon County model illustrates what happens when navigation becomes an active, relational function rather than simply a referral.
A timely question for North Carolina’s new rural health infrastructure
This conversation is particularly relevant as North Carolina builds out its Rural Health Transformation Program.
The state has selected regional NC ROOTS Hub Leads to develop locally governed networks connecting medical, behavioral health, and social supports. The program is explicitly designed to tailor strategies to regional needs, improve care coordination, and build partnerships across sectors.
For Western North Carolina, Impact Health has been selected as the Region 1 ROOTS Hub Lead, covering Macon and the other western counties. Its existing work includes coordinating a network of community-based organizations and connecting participants, providers, and health plans through the region’s Health Opportunities Pilot.
That creates an important policy moment.
The state is investing in regional infrastructure intended to connect systems. At the same time, communities such as Macon County already have organizations doing this work on the ground. As this investment looks at connecting more partners across healthcare, a standing question will be how to recognize, connect, and strengthen the systems our communities have already built—and take those lessons outward.
Impact Health has experience with a NWD model, connecting eligible Medicaid recipients to services. As it takes on a much broader set of the population around a larger set of healthcare needs, creating NWD systems for our communities will be both a significant challenge and an opportunity.
What policymakers can learn from the ground level
The Macon County experience suggests several considerations for the broader health policy conversation.
1. Navigation needs to be defined by the experience of the person seeking help.
“No Wrong Door” can mean very different things. It can mean that someone can find information online. It can mean that a call center can identify resources. Or it can mean that someone has a person who stays with them through the process of finding and accessing the service that actually fits. Those are different levels of infrastructure and require different investments.
2. Funding streams can create the gaps that communities then have to fill.
Jenkins describes an organization that has developed a collection of funding sources to support services that do not fit neatly into a single program. That flexibility is an organizational strength, but it also raises a policy question: Why should local organizations have to stitch together numerous funding streams to create a functional pathway for one person?
When transportation is funded separately from behavioral health, housing separately from employment, and treatment separately from recovery support, someone still has to connect those pieces.
3. State policy needs local implementation knowledge.
A policy developed in Raleigh does not encounter the same conditions in every county. Rural geography, transportation, workforce availability, provider capacity, and existing community relationships all affect implementation. That makes people working on the ground important policy partners—not simply recipients of policy decisions.
4. Coordination should include what already exists.
Jenkins repeatedly returns to the importance of avoiding duplication. A new program may be well intentioned and still fail to strengthen the local system if it arrives without understanding who is already doing the work.
This is particularly relevant as North Carolina invests new resources in regional coordination. The state’s ROOTS framework explicitly calls for networks that include health systems, local health departments, behavioral health providers, community-based organizations, nonprofits, and other partners. The challenge will be making those networks genuinely additive.
5. “No Wrong Door” should not mean “one model everywhere.”
Perhaps the most important lesson from Macon County is that the answer is unlikely to look identical in every county.
Jenkins’s recommendation to communities considering a similar approach is essentially to start by understanding their own landscape: bring the relevant people together, identify the gaps, and determine what is already working. That is also a useful principle for state policy.
From framework to implementation
The national NWD conversation provides an important framework for thinking about fragmented health and human services. North Carolina’s work on LTSS is an opportunity to translate that framework into stronger statewide infrastructure. But the Macon County experience shows why the conversation cannot remain at the systems level.
A person experiencing homelessness, seeking recovery, trying to access mental health care, or simply attempting to find the right service does not experience “the system” as a set of programs. They experience it as a series of doors. Some open. Some do not. Some lead somewhere useful. Some lead to another phone number.
The policy challenge is not necessarily to eliminate every door. It is to make sure that people are not left alone to figure out which one to open next.
That is where national frameworks, state infrastructure, and local organizations need to meet. The national conversation can provide the framework. State policy can provide resources and infrastructure. But communities provide the knowledge of how those systems actually work—and where they break.
For North Carolina’s emerging NWD and rural health efforts, listening to those communities may be one of the most important ways to make sure the right door is actually accessible.
Resources
Featured resource:
No Wrong Door for Support and Recovery in Macon County
Other resources:
NC Rural Health Transformation info page
NCCARE360 statewide coordinated care network
211 information and referral service provided by United Way of North Carolina
NC PATH (Partners for Access, Trust, & Health) Community Care Hub
Disclaimer
This content was developed by the WNC Health Policy Initiative in consultation with people and organizations with connections to the health of people of Western North Carolina. Individual or organizational opinions, findings, conclusions, or recommendations are those of the relevant author(s)/interviewee(s) and do not necessarily reflect the view of the WNC Health Policy Initiative, its host institutions of the University of North Carolina Asheville (UNCA), Mountain Area Health Education Center (MAHEC) or our funders.