Western North Carolina is facing a sustained mental health and substance use crisis. But improving behavioral health access and outcomes will require more than simply increasing the number of providers. It will require building a system that enables clinicians to stay in community practice, supports patients in accessing timely care, and aligns incentives with long-term health outcomes. In a recent conversation with clinician Lissa Carter, we learned about the challenges and opportunities facing mental health providers—and patients—in our region.

Data from the WNC Health Network shows a 39% increase in poor mental health in the region since 2012, alongside widespread impacts of substance use across households. In this episode of the WNC Health Policy Podcast, we begin to explore the mental health and substance use landscape of Western North Carolina through the experience of clinician Lissa Carter, who has worked across recovery, community mental health, education, and clinical leadership roles in Buncombe County.

Black women in the U.S. are three times more likely to die from pregnancy-related causes than white women, and bias or discrimination was identified as a contributing factor in 70 percent of North Carolina maternal deaths, per the state's own 2024 review committee. Bills covering doula access, community support programs and programs to reduce infant mortality have been introduced repeatedly, but many never receive a hearing, largely as a result of lack of political will and funding disagreements.

Medicare Advantage (MA), also known as Part C, has become the dominant path through which older adults receive Medicare coverage. More than half of all beneficiaries — roughly 33–34 million people — are enrolled in plans operated by private insurers. These plans promise convenience and financial protection, including caps on out‑of‑pocket spending and some extra benefits not found in Original Medicare. At the same time, MA brings challenges that stem directly from how the program is designed, and these structural incentives can affect access to timely care, especially for people with complex health needs or limited provider options.