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A state Department of Health and Human Services grant will be used to train EMS staff in mental health and substance abuse assessment and intervention.

By Taylor Sisk

Smoky Mountain LME/MCO has received a $5,000 Crisis Solutions Initiative grant from the state Department of Health and Human Services that will be used to provide McDowell County’s emergency medical services staff with crisis intervention team training.

Rural Rx: NC Health News coverage of rural health issues. This week: mountain counties

Crisis intervention team, or CIT, training helps better prepare law enforcement and emergency personnel for encounters with someone who is experiencing a behavioral health issue or is at risk of one.

As part of the initiative, EMS personnel will visit people in their homes to address mental health and substance abuse concerns and help provide access to resources.

The nonprofit RHA Health Services will partner with Smoky Mountain in providing the training.

Smoky Mountain is the managed care organization responsible for public funds for behavioral health and developmental disability services in 23 mostly rural western counties.

Genny Pugh, Smoky Mountain’s senior director for community collaboration, pointed out while RHA has a behavioral health comprehensive care center in Marion, McDowell’s county seat, finding transportation to get to it is an issue for a lot of McDowell residents.

Plans are also underway to provide additional services and expand hours at the Marion center, and RHA will open a new behavioral health crisis stabilization facility early next year in Lenoir, in nearby Caldwell County.

Smoky Mountain CEO Brian Ingraham said, “We end up with way too many people in crisis that could have been helped in a more preventive way.” Photo credit: Taylor Sisk

‘Jostled around’

Smoky Mountain CEO Brian Ingraham said that the home visits will be in keeping with Smoky Mountain’s efforts to identify behavioral health issues before they become crises.

In the past decade, Ingraham said, the state’s mental health, substance abuse and intellectual and developmental disability system of care has “really been jostled around quite a bit.” He cited the state’s attempt at reforming that system and the economic downturn as the primary causes of unrest.

“As a result,” he said, “we end up with way too many people in crisis that could have been helped in a more preventive way.”

And when patients do spiral into crisis, they end up sitting in hospital emergency departments, waiting for treatment, often for days. According to DHHS statistics from last December, the average wait in emergency departments before admission to a state-funded psychiatric facility was 75 hours.

This initiative, Ingraham said, is aimed at “working against this unfortunate path to the emergency department for folks, trying to create these avenues to care in the community. We need to get people to a better place so they don’t need the ER to begin with.”

The grant money will be used to augment an earlier initiative: McDowell was the first of the counties Smoky Mountain serves to develop a community care paramedic program, which is designed to promote wellness and identify physical health issues early, and includes scheduled visits with high-volume users of EMS services.

McDowell County EMS Director William Kehler said in its first year of operation, that program has prevented nearly 300 emergency department visits and 36 inpatient readmissions, saving the county about $460,000.

RHA Health Services in Marion will provide training to McDowell County EMS staff in early detection of mental health and substance abuse issues. Photo credit: Taylor Sisk

Pugh said the crisis solutions grant allows McDowell to move more toward an integrated care model by incorporating early identification and intervention of behavioral health issues into the community paramedic program.

She said this will be the first county in which Smoky Mountain will provide CIT training to an entire EMS force. Training includes information on diagnostic categories, treatment methodologies and medications, and will help develop communications skills. Staff will also learn about other resources available in the community.

The training will “address the recovery-oriented system of care philosophies: how people can live in recovery and recover successfully,” Pugh said.

She said that in keeping with the recovery-oriented approach, RHA has certified peer-support specialists in McDowell County.

RHA Vice President of Operations Sandy Feutz said EMS staff will visit RHA’s Marion clinic to observe provider-client interactions.

This partnership with EMS, she said, is “pretty different from any other programming we have going on in our other counties. We’re hoping this will be the first of many.”

In March, Smoky Mountain announced it had received just under $2 million in DHHS Crisis Solutions Initiative money to open a 24-hour urgent care and crisis facility for mental health and substance abuse treatment in Asheville.

The facility will help address the needs of some of the most underserved counties in the state.

Madison, McDowell, Mitchell, Transylvania and Yancy are among the Western North Carolina counties that don’t have a psychiatrist.

Ingraham said while it’s unfeasible to have a facility like the one in Asheville in every county Smoky Mountain serves, “we have whatever scale of that we can in every county.” Each county, he said, has a care center that provides walk-in crisis assessment and treatment.

[box style=”2″]This story was made possible by a grant from the Winston-Salem Foundation to examine issues in rural health in North Carolina. [/box]

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