By Thomas Goldsmith
Like many hospitals across the state, emergency departments in the Triangle continue to deal with large numbers of patients who have been involuntarily committed and have no place else to go.
But in counties around Raleigh there’s a twist to the longstanding problem — state cuts that put a halt to the opening of a center dedicated to better treatment for patients in crisis.
More than 100 such involuntary commitment patients showed up on a recent Monday at WakeMed Hospital in Raleigh. The deluge of mental health patients resulted in WakeMed putting itself on “diversion,” where the emergency department closes for all-comers.
“That’s a serious condition when you have your hospital compromising services.” County Manager Jim Hartmann said.
“Our ERs have a large number of mental-health related patients and limited resources to deal with them,” Denise Foreman, assistant to the Wake County manager, told a packed work session of that county’s Board of Commissioners recently.
Alliance Behavioral Health, the local mental health management organization (called LME-MCO) for Wake, Durham, Johnston and Cumberland counties, initially got heat from local officials at the meeting. They had been anticipating an opening this year of a 16-bed adult crisis center at WakeBrook, a behavioral-health facility near WakeMed that’s managed by UNC HealthCare.
But Alliance and other North Carolina LME-MCOs have lost tens of millions from the state in single-stream funding, or money that covers services that Medicaid can’t pay for. The funding also pays for care for people with disabilities who might be uninsured and who also don’t qualify for Medicaid.
“The Adult Crisis Center is now on hold,” Board of Commissioners Chairman Sig Hutchinson said to Rob Robinson, Alliance CEO since 2014. “You’ve got enough money to fund it for two years.”
Operating the clinic would cost $6 million annually, and Alliance officials say there’s no guarantee that the funding would sustain it longer than a couple of years.
“We could probably get it up and running for two years, then we’d have to close it,” Robinson said.
In an interview with NC Health News in June, Robinson said the center “was designed to help primarily the un- and underinsured who are now sitting in many of our hospitals and who are waiting.”
Alliance is not the only LME-MCO struggling in the wake of legislative cuts to single-stream funding: Cardinal Innovations, which manages behavioral health care for people in a number counties, has been passing funding cuts on to behavioral health contractors; Vaya Health passed on cuts to providers of vocational training for people with intellectual and developmental disabilities in Wilkes County.
All told, the state budget cuts the single-stream funding paid to LME-MCOs by a total of $31 million annually and by $55 million in one-time funds in FY 2017-18 and by a total of $36 million in annual funds and by $54.6 million in one-time funds in FY 2018-19.
Nonetheless, legislators ordered the LME-MCOs to maintain the same level of service provision as during the past fiscal year.
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Mr. Goldsmith,
Were all of these patients really involuntary commitments, or simply patients in psychiatric crisis? Stunning number in either case.