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Expand Options for Behavioral Health

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Tuesday, 02 June 2026

Written by John Hood

Do you or someone you know suffer from mental illness? I suspect most readers will say yes. According to the National Alliance on Mental Illness, behavioral-health disorders affect a fifth of adults and a sixth of school-aged children in North Carolina. One in 18 of us lives with a “severe mental illness,” defined as “a mental, behavioral, or emotional disorder that results in serious impairment and interferes with or limits one or more major life activities.”
My own family history is full of such cases, ranging from alcoholism and depression to schizophrenia and bipolar disorder. Several of my ancestors and relatives died as a result of their afflictions. Others were incarcerated or institutionalized.
Again, none of this sets me apart. Mental illness isn’t rare. It directly or indirectly touches millions of North Carolinians, and tens of millions of Americans.
One way our state is distinct from others, however, is that it is particularly challenging to seek treatment for such conditions here. A North Carolina Institute of Medicine study published in 2025 ranked us last in the nation for access to behavioral health. All but six of our 100 counties are considered “professional mental health shortage areas,” with nearly a quarter of counties lacking a single practicing psychiatrist and more than a quarter lacking a single practicing psychologist.
Although funding is always an issue, we don’t appear to be significantly out of alignment with our peers. According to an analysis published last year, per-capita public expenditures on mental health in North Carolina were higher than those of any of our neighbors, or of such large states as Ohio, Florida, Texas, and Illinois.
It’s a complicated picture, one so daunting to interpret that some policymakers may be tempted to throw up their hands in confusion. That would be unwise. In addition to the obvious human suffering, untreated mental illness has larger social consequences. It imperils public safety and lowers student achievement. It reduces labor-force participation and makes it hard for employers to fill key jobs. And despite North Carolina’s many attractive assets and amenities, it harms our ability to compete for households, businesses, investment, and talent.
Here’s a set of reforms state lawmakers and regulators can tackle right now: strike a better balance between provider access and training.
A massive, costly effort to train and deploy psychiatrists with M.D.s all across North Carolina would likely yield modest results and fail a cost-benefit test. Behavioral health encompasses a far broader spectrum of providers, including advanced-practice nurses, psychologists, social workers, marriage and family therapists, and peer and pastoral counselors. We should remove any barriers that unnecessarily limit their capacity to meet the behavioral-health needs of North Carolinians.
Seven states allow specially trained psychologists to prescribe medications to treat mental illness. This practice “is not only safe and evidence-based,” wrote researcher and licensed psychologist Jacqueline Marie Gallios in Regulation magazine, “but also a vital solution to America’s escalating mental health crisis.”
Other states allow nurse practitioners to operate independently, social workers and counselors to deliver a broader array of services, and peer counselors to obtain certification with less time and expense. Telehealth is another promising tool. North Carolina has taken some steps in these directions but should go further. Jarrett Dieterle, a Manhattan Institute fellow, noted that studies conducted before and after the COVID-19 pandemic found comparable results for behavioral-health treatment in the office vs. treatment by telehealth — but the latter is, naturally, less expensive and more accessible.
“Americans’ mental-health challenges are complex, nuanced, and multi-variated,” Dieterle wrote in National Affairs. No single reform, or even set of reforms, “cannot be expected to magically ‘fix’ the problem overnight. But policymakers are not powerless to respond, and neither are the rest of us.”
I agree. My argument isn’t merely that, given the stakes, we can’t afford to let the perfect be the enemy of the good. There is no such thing as perfection here. There are only differences in priorities. Let’s elevate access to the top.

Editor’s Note: John Hood is a John Locke Foundation board member. His books Mountain Folk, Forest Folk, and Water Folk combine epic fantasy with American history (FolkloreCycle.com).

Budget Deal Sets Up a Busy Week in June

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Tuesday, 26 May 2026

Written by John Hood

By Monday, June 15, the academic year will be over for colleges, universities, and most grade schools. Family trips and summertime sojourns will commence. Tourist venues and recreational attractions will be bustling.
For the North Carolina General Assembly, however, the week of June 15 will be no vacation. If current plans come to fruition, lawmakers will vote that week on a new state budget as well as at least two constitutional amendments to appear on the fall ballot: one capping the growth of property taxes and the other capping the rate of personal income tax at 3.5%.
I suspect both amendments will pass the legislature and gain voter approval. Proponents believe their combined effect will be to constrain the growth of state and local expenditures over time by depriving big spenders of the handiest tools at their disposal. The amendments’ most vociferous opponents agree on the effect but think that consequence will harm North Carolina, not help it.
A third group — let’s call them skeptics rather than opponents — note that neither amendment affects sales taxes, excise taxes, and other forms of government revenue.
Might future senators, representatives, and county commissioners respond to the new constitutional constraints not with a renewed commitment to fiscal discipline but by expanding the base of the sales tax, hiking its rate, or approving new gambling enterprises?
According to the Tax Foundation, North Carolina derives about 29% of its state and local revenue from personal income taxes, about the same share from sales taxes, 22% from property taxes, 3% from corporate income, and the rest from excises and other levies. Compared to the nation as a whole, we rely more on income and sales tax and less on property tax than the average state.
As I’ve previously explained at (literally) book length, it might make sense for North Carolina to rely more on sales taxes if they were properly structured. Alas, they never will be.
A properly structured tax on retail sales wouldn’t distort the economy. It would tax services as well as goods, and in particular the medical, legal, and financial transactions that together comprise most of the service sector. On the other hand, it wouldn’t tax business-to-business transactions, which by definition aren’t retail sales — and the taxation of which creates artificial incentives for vertical and horizontal integration. The income tax base is too broad, yes, creating artificial disincentives against savings and investment. But the sales tax base is too narrow (as is the property tax base).
I understand the skeptics’ argument. But there’s another side to the story. As best I can determine, the presentation of the constitutional amendments made the budget deal between House and Senate possible. That deal is, in turn, both fiscally and politically advisable.
It is wise to modify the revenue triggers to ensure lawmakers can sustain their tax-reform momentum while also meeting high-priority needs in public safety, health care, and education. Incumbents are also loath to enter the fall campaign without a new state budget in place.
As lawmakers finalize the details of that budget, I hope they take one more factor into consideration: North Carolina is not adequately prepared for another natural or economic disaster. Could there be another recession, pandemic, or catastrophic hurricane in our future? Of course. It’s only a question of time.
According to the Pew Charitable Trusts, North Carolina has approximately 53 days' worth of state spending socked away in our rainy-day fund and unreserved credit balance. That places us below the national average. Tennessee (72 days), Georgia (147 days), and South Carolina (174 days) are much better prepared, as are Pennsylvania (79), Florida (125), Texas (129), and even the likes of California (84) and New York (198).
The General Assembly ought to make a larger rainy-day deposit than required by current statute. The ultimate goal should be to boost savings to at least to the national median of 92 days worth of spending.
Yep, there’s lots to get done by mid-June.

Editor’s note: John Hood is a John Locke Foundation board member. His books Mountain Folk, Forest Folk, and Water Folk combine epic fantasy with American history (FolkloreCycle.com).

Pitt Dickey: Gnomenclature for fun and profit

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Tuesday, 26 May 2026

Written by Pitt Dickey

How do you feel about Gnomes? Take a trip into Once Upon a Time land, courtesy of the Brothers Grimm to learn some Gnome lore. Gnomes are the first cousins of the Trolls who bothered Billy Goats Gruff. Trolls also write mean comments on Social Media.
Trolls live under bridges or in their parents’ basements. Gnomes live underground, usually working as miners. You may recall Snow White became involved with Seven Dwarves, who are the double first cousins of Gnomes.
But that is a story for another day. Let us return to Gnome lore.
Most fairy tales start with a King who has at least one beautiful daughter. Today’s King had 3 beautiful unmarried daughters. He also had a palace garden with his famous apple tree that only he could pick. Anyone else who picked an apple would be transported 100 fathoms underground.
Does this sound familiar—a woman plucks a forbidden apple and all heck breaks loose? Sure enough, the youngest princess believes Dad won’t send her underground.
She grabs an apple, takes a bite, and convinces her sisters to chow down. Each sister then sinks deep underground.
The King can’t find his daughters. He offers to marry one to whomever can find the girls. Lots of men look without success. Finally, three brothers take up the challenge.
They discover a large empty castle in the deep forest with a banquet table full of hot food. The oldest brother is chosen to remain in the castle while the two other brothers go on Princess Quest.
After they leave, a Gnome enters the castle and asks the brother for a piece of bread. When the brother hands the bread to the Gnome, the Gnome intentionally drops it. The brother goes to pick it up, but the Gnome beats him with a stick.
The next day, the second brother stays at the castle and gets beaten by the Gnome. The next day, Hans, the youngest brother, remains at the castle.
The Gnome tries the same stunt. When the Gnome asks him to pick up the bread, Hans whups the tar out of the Gnome.
The Gnome begs Hans to stop beating him, promising to tell him how to find the Princesses. The Gnome shows Hans a deep well which has no water. Hans lowers himself into the well in a large basket.
He finds three caves, each with a Princess and a dragon. The Princesses are combing the heads of the dragons. This seems odd, but this is a fairy tale. Odd happens.
When Hans tells his brothers what happened, they get so angry they turn green and yellow because Hans found the Princesses. Hans agrees to show them the well. They let the eldest brother down first, but he chickens out halfway and rings a bell to return to the surface. The second brother does the same. Finally, they lower Hans into the well.
Hans finds the dragons are still sleeping in the Princesses’ laps having their hair combed. Hans chops off their heads, saving the Princesses.
He sends each Princess back to the surface in the basket. He is suspicious of his brothers. He pretends to get in the basket but puts in a large stone. The wicked brothers pull the basket up halfway, then cut the rope, hoping the fall will kill Hans. Hans is stuck below and wanders lonely as a cloud.
He finally finds a flute hanging on the wall and plays it. A gaggle of grateful Gnomes appears and jives to the music. Flushed with flute-induced fellowship, they grant Hans his wish to return to the surface.
Hans goes to the King’s palace, where the first Princess is about to marry his brother.
The King asked what had happened below. The Princesses tell him they can’t say because they promised not to reveal the truth. The King orders them to tell their story to the stove while he listens outside the kitchen door. This allows them to keep their promise not to tell him.
Technicalities matter.
On hearing the truth, the King sends the two brothers to the gallows, where they are hanged by the neck until they expire.
Hans marries the most beautiful sister, and they live happily ever after.
What have we learned today? Don’t eat forbidden apples. Beware of hungry Gnomes. Some dragons are more concerned with their hair looking fly than remaining awake for possible danger. You can tell a stove things you can’t tell a King.
If you are stuck in a cave and find a flute, play it. Siblings do not always play fair. No Gnomes were harmed during the production of this column.
That is all.

(Illustration by Pitt Dickey)

Finding depth in connections

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Tuesday, 19 May 2026

Written by Dan DeBruler

Relationships thrive in the deep. One key is to move beyond the shallow and into the kind of authenticity where you’re not always the hero of your own story.
That kind of depth doesn’t happen by accident. It happens in moments—often small, unguarded, and easily overlooked. Around a dinner table. On a front porch. In a circle of people sharing a meal, a story, or even just silence. Those moments have a way of changing people. They shape relationships, and over time, they shape culture.
Jesus seemed to understand that. Many of His most meaningful interactions didn’t happen from a stage or at a distance, but in close, personal settings—meals, conversations, shared space. There’s something about being face-to-face, without pretense, that invites honesty. And honesty is where real connection begins.
The problem is, those moments have been slowly disappearing.
Most of us can smile at the old lyric, “video killed the radio star,” because in many ways it rang true. Technology replaced something simpler, something more personal. I once heard someone make a similar observation: “Air conditioning killed the family.” It sounds strange at first, but the idea sticks. There was a time when people gathered outside in the evening—on porches, in yards—because it was cooler there. Families talked. Neighbors drifted over. Conversations unfolded naturally. And when we moved inside, into perfectly controlled environments, something shifted. We traded shared space for separate rooms.
And now, we’re here. More reachable, but less connected. Social media has given everyone a voice—not inherently bad—but it has also created a constant stream of noise. Opinions come fast, reactions come faster, and before long, we’re not really listening anymore. We’re just responding.
At the same time, there’s a tendency in all of us to look for something bigger, better, or more satisfying just over the horizon. We want the “promised land”—the ideal version of life, relationships, or success—while overlooking the “daily bread” already in front of us. The ordinary moments. The conversations we could have if we’d just slow down long enough to have them.
We also tend to lean on voices that tell us what we want to hear about the future—pundits, influencers, commentators—rather than grounding ourselves in what’s real and present. So we speculate rather than engage. Scroll rather than sit across from someone and be known.
Depth requires something different.
It requires presence. It requires listening. It requires the humility to step into a conversation without needing to win it—or to be seen as the hero in it.
If relationships really do thrive in the deep, then maybe the way forward isn’t more noise, more speed, or more distance. Maybe it’s a return to the table. A return to shared space. A return to conversations where people are seen, heard, and known—not for their best moments, but for who they really are.
That’s where connection lives. And it’s still available—if we’re willing to choose it.