By Taylor Knopf
It’s no secret that North Carolina’s mental health system leaves a lot to be desired, and one of the biggest holes in the safety net is a dearth of crisis services.
That’s why state lawmakers are moving forward with a bill that would direct all seven state-funded mental health management organizations to create community crisis-services plans.
Senate Bill 630 (and its companion bill in the House) is a 39-page document that deals with processes around community treatment for people with mental health and substance abuse issues. They frequently have nowhere to go when they’re feeling suicidal, when they’re acting strangely, or having other symptoms of mental health crisis.
The bill also lays out a number of changes to laws around when and how someone can be committed to a mental facility, either voluntary or involuntary. For example, the bill allows treatment facilities to disclose a patient’s admission information to their next of kin. Or, when a person who is committed to a mental health facility is facing a district court hearing, the bill would allow that person’s attorney to get copies of mental health examinations and records, even without the client’s consent.
Each of the seven LME-MCOs will need to create community crisis plans.
“Currently, I will tell you that we have no plan for mental health patients,” said primary bill sponsor Sen. Ralph Hise (R- Spruce Pine) during a Senate Health committee discussion on the bill Wednesday.
“They show up in the emergency room… as we’ve seen over and over again,” he said. “There are complications, there are days, weeks, months and sometimes, unfortunately, years that these patients are being held in an emergency type environment, because there is no bed space.”
Less than “ideal”
In an ideal situation, mental health patients would not be taking up beds in the emergency department or sitting at a hospital waiting for a bed with law enforcement officers by their sides. Under the terms of this measure, they could instead be taken to an appropriate mental health facility so long as a plan has been worked out ahead of time between the mental health providers, law enforcement, hospitals and the judicial system.
According to Hise, the bill is just a start in the right direction for mental health treatment following the consolidation of LME/MCOs, the mental health management entities for the state.
“This bill doesn’t do everything to solve every problem,” said UNC School of Government attorney Mark Botts. “It doesn’t do arguably big things, but it does medium size and small things that cumulatively create a lot of efficiencies.”
He added that policymakers could be doing a lot more to help North Carolina’s mental health system.
Hise said that this bill makes clear that it is the responsibility of the LME/MCOs to develop a plan “county by county” and “area by area.” He said it’s up to these organizations to answer questions such as, “What’s the appropriate place to take individuals?” or “Where are the 24-hour treatment sites?”
He added that allowing LME/MCOs to set up a comprehensive plan will reveal the gaps in the system.
“We have varying LME/MCOs across the state, and several have worked closely with police officers and hospitals and have plans close to, or similar to, what we are asking for with this bill,” Hise said. “But that is in no way what you will find across this state.”
Sen. Terry Van Duyn (D-Asheville) expressed concern that the bill would become an unfunded mandate for the LME/MCOs.
“It’s an awful lot of focus on the LME/MCOs, providing them with no resources to do that,” she said. “And mysteriously beds are going to appear? I want to know how a plan creates beds where no beds currently exist.”
“A degree of fear”
Corye Dunn, director of public policy at Disability Rights North Carolina said there has been a long process leading up to this bill, and it has an “ambitious scope.”
But she did express concerns with one section that deals with immunity from liability for people who interact with patients. The bill says that if providers and their staff follow accepted professional standards “in good faith” and are not “grossly negligent,” then they are not liable for what happens to the patient.
“I want to point out that this reflects the degree of fear from providers, that they don’t know how to handle this,” Dunn said. “I am concerned that it represents a significant expansion from liability. They can be negligent but not liable.”
That’s because “gross” negligence can be a high hurdle to clear.
Fewer cases are being brought these days after a sweeping medical malpractice bill passed in 2011 with similar language about gross negligence, according to Richard Taylor, CEO of North Carolina Advocates for Justice.
“Most are being turned down unless there are high damages and obvious liability,” he said.
Dunn said she understands the fear because she’s heard from providers concerned that they are being asked to do something outside their training.
“This is a big caution for us as we proceed,” she said. “We need some measure of care for those experiencing mental health crisis.”
Scaled back
Botts, who is a consultant on the legislation from UNC School of Government, said he spent more than 100 hours talking to different interest groups affected by the bill.
“Everyone wants something, but no one wants to be made to do anything,” he said.
Botts said in reaction to concerns expressed by LME/MCOs lawmakers scaled back the language of the bill.
Some of the LME/MCOs span more than 10, even 20 counties and have a more regional flavor. Botts said the bill will require LME/MCOs to identify smaller, local areas within their region, compare with state resources, and engage in community crisis planning.
“To sit down and talk with law enforcement, hospitals, community providers and 24-hour facilities,” Botts said. “That’s what’s required.”
Botts related a situation he witnessed in the Winston-Salem area where an LME/MCO asked the Davie County Sheriff to transport patients to Forsyth County where it had contracted with a mental health provider. The sheriff was uneasy about crossing county lines.
Botts said this bill would address those kind of situations and makes it clear that crossing a county line would be OK. The bill empowers the LME/MCO to set the plan for dealing with mental health patients.
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