Dave Richard headshot
Dave Richard heads North Carolina's Medicaid program. Image courtesy: NC DHHS

By Taylor Sisk

A group of some seventy-five people gathered on the Dorothea Dix Hospital campus in Raleigh on Monday to discuss a topic of mutual concern: keeping individuals in need of mental health and substance abuse care out of emergency departments.

Dave Richard headshot
Dave Richard, director of Division of Mental Health, Developmental Disabilities and Substance Abuse Services

Dave Richard, director of the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services convened the meeting, inviting people from throughout the state who represent families, service providers, the hospitals, law enforcement and state and local government to be part of what’s being called the Crisis Solutions Coalition.

The meeting was the first step in what is intended to be a yearlong process to find mutually agreed-upon solutions to reduce the number of people in critical need of mental health and substance abuse care who are waiting in emergency departments for up to days, even into weeks, before a bed in a psychiatric facility or other needed attention can be found.

The frequency with which emergency departments are dealing with behavioral health issues is high nationwide, but especially so in North Carolina, and is on the rise here.

According to the state Department of Health and Human Services, in 2012 there were 17,000 more visits to EDs related to behavioral health issues than in 2010. The average wait in an ED for admission to a psychiatric facility is more than three days.

“This is not another report, and this effort isn’t about writing another report,” Richards told the coalition at the outset of the meeting.

“Solutions is what we’re about going forward,” he said.

In a communication to her membership, Deby Dihoff, head of the North Carolina chapter of the National Alliance for Mental Illness called the suggestions made at the meeting “exciting.”

Dihoff expressed enthusiasm, in particular, about plans to link data from the criminal justice system to the mental health system in an attempt to get people with mental health problems who get caught up in the legal system into proper treatment.

“Collaboration between mental health and criminal justice will occur,” she wrote.

One initiative that was introduced on Monday was a crisis plan that all behavioral health providers will be required to maintain beginning in January for clients who are considered to be at high risk of a crisis incident.

Richard also said that DHHS was in the process of building a website that will provide contact information on all service providers and support groups throughout the state.

But the majority of Monday’s meeting was a sounding board for potential solutions offered by coalition members, with special emphasis put on what were referred to as the “low-hanging fruit,” measures that could be taken at little or no expense.

These included offering peer support in crisis facilities and making information on where psychiatric beds are available more readily accessible to ED staff. It was also suggested that if families are provided with the emergency numbers for crisis centers, they’ll be less likely to call 911.

“We had terrific participation, and people weren’t shy about saying what they wanted done, which is what we wanted,” Richard said after the meeting.

While some coalition members did wonder aloud about where any funding for the initiative would come from, Richard said he thinks they understand that it’s a process, and that the first step is determining how things can be done more efficiently and effectively.

“What we know is that we still spend money the way we did 30 years ago, and we’re not really efficient in getting the money out to the communities,” he said. “I think we can realign resources.”

If it becomes clear that additional resources are needed, Richard said, “then I think it’s time to talk to the governor and to the policymakers about that. But first we’ve got to make sure we’re spending it the right way.”

The coalition is tentatively scheduled to meet again in late January. Richard said that in the meantime he would be following up with members on their suggestions.

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Some suggestions that came out of Monday’s meeting:

  • Macon County is considering training, maybe even statutory changes to get magistrates to consider less restrictive options for involuntary commitment first evaluations – like crisis facilities rather than Emergency Rooms.
  • Start treatment while in the ER
  • Expand jail diversion programs
  • Ask people what would have kept them from going to the Emergency Department, then put that in the crisis plan
  • Train docs in how to release patients from an involuntary commitment
  • Expand walk in clinics, and keep them open past 5
  • Change policy so EMS can take people to facility-based crisis programs; right now EMS reimbursement is tied to dropping patients at a hospital

Information courtesy Deby Dihoff, NC-NAMI


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