Solutions pledged for NC mental health system

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Dr. Aldona Wos, Secretary of N.C. Department of Health and Human Services.

RALEIGH — Getting the right help to people in a behavioral-health crisis at the point of intervention has become a top priority, state health officials said Thursday.

It’s such a priority that the N.C. Department of Health and Human Services has asked to be judged quarterly for how well it is reducing hospital emergency department admissions, wait times and readmissions related to behavioral-health crises.

The issue is of particular concern as more people with behavioral-health episodes are winding up in local emergency departments because they or their parents either lack access to or can’t afford primary physician care.

DHHS Secretary Dr. Aldona Wos unveiled a statewide “crisis solutions” initiative that she said will encourage proven first-touch programs.

The programs include walk-in crisis centers and short-term residential treatment options; developing mental health first-aid training aimed at troubled youths; individualized treatment and post-recovery programs for individuals treated in emergency departments; a statewide telepsychiatry program involving at least 60 hospitals; and advanced training for emergency medical services personnel to treat someone having a behavioral-health crisis.

“We have too many individuals floating in and out of care, in and out of crisis, in and out of emergency rooms and sometimes, unfortunately, even jails,” Wos said. “We begin a focused, long-term effort to ensure that individuals and families who are experiencing a mental health or substance-abuse crisis know where to turn for the help they need. In turn, we can begin to reduce the tremendous burden that these issues place on hospital emergency departments and law enforcement.”

As has been the pattern with other DHHS initiatives announced this year, Wos provided few details in her prepared remarks on how and when these programs would be rolled out and customized in local communities, and how they would be financed. She did not take media questions and left after the formal presentation ended.

Some programs, such as the advanced EMS medical training and walk-in crisis centers, have been implemented in Wake County.

Last year, Wake County EMS officials assisted 248 individuals having a behavioral-health crisis get help in a walk-in crisis center rather than being taken first to an emergency department, according to Dr. Brent Myers, the medical director of the Wake EMS system.

He said the system is on pace to assist 325 people in 2013.

“Every person that is evaluated and sent directly to the appropriate treatment site means they are not only getting the care they need right away, but they also are freeing up an ED bed for someone else,” Myers said.

Wos said a coalition is being formed from advocates, and health-care, government and law-enforcement officials to guide the initiative. It is expected to provide an update within six months.

Advocates, local and statewide, have complained for years about the increasing number of individuals having a behavioral-health crisis ending up in emergency departments, often as involuntary commitments accompanied by law-enforcement officers.

The officers are required to stay with the person until the individual has been stabilized.

Advocates also have complained about local managed care organizations (MCO) doing a poor job of letting the public and first responders know how to access the behavioral-health system.

In June, the U.S. Centers for Disease Control and Prevention reported that 9.3 percent of emergency department visits in North Carolina are related to a patient having an acute psychiatric episode or for injuries and illnesses related to their mental-health condition.

The rate is 5 percent nationally, but it’s on the rise. The data was collected between 2008 and 2010.

DHHS said Thursday that during fiscal 2012-13, there were about 150,000 ED visits statewide attributed to a behavioral-health crisis.

Individuals experiencing a behavioral-health crisis spent on average 3½ days, or 84½ hours, waiting in a hospital emergency department to be admitted to a state hospital.

It said that 13 percent of people treated for a behavioral-health crisis during fiscal 2012-13 were readmitted within 30 days.

Dave Richard, the state’s director of behavioral health, acknowledged that the Wake initiatives, such as WestBrook psychiatric facility operated by UNC Healthcare, are beyond the financial reach of most communities.

Richard said he is confident the initiative can begin with existing financing being reallocated toward focused areas.

If DHHS and the projects prove successful, he said he believes the General Assembly would be willing to provide additional financing as it did to launch the state telepsychiatry program.

“We will tailor these programs to local community needs,” Richard said. “We will measure their level of success, of moving the bar, for these three measuring sticks. For those that don’t move the bar, we’ll adjust.”

Laurie Coker, a local advocate, has been asked to serve on the crisis coalition team.

She is the director of the N.C. Consumer Advocacy, Networking and Support Organization and recently was appointed to the CenterPoint Human Services board of directors as the representative of the Forsyth County Board of Commissioners.

“Secretary Wos has recognized that we can’t keep putting Band-Aids on those having a behavioral-health crisis and just turning them back out on the streets,” Coker said.

“Officials are recognizing that the initial contact with a person in crisis is not just the first step to stabilizing the person, but also potentially starting them on a long-term program that improves their condition and eases the burden on the health care system.”

Representatives with Novant Health and Wake Forest Baptist Medical Center said the systems are pleased that the McCrory administration is taking a proactive approach with the crisis initiative.

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