By Rose Hoban
When you cut your finger chopping onions or need your medications refilled, a nearby urgent care or mini clinic can take the place of an emergency room visit.
That same logic prompted the development last year of a behavioral health urgent care; a place to go if your anxiety is ramping up, or you’re out of your psychiatric medications and it’s a month until your next appointment, or if the depression is really weighing on your soul.
Alliance Behavioral Healthcare, the state-funded managed care organization that covers Durham, Wake, Cumberland and Johnston Counties, tapped a group of therapists in Durham, asking them to create the clinic, located on 15-501, south of downtown.
It’s the only facility of its kind in the state.
“We had not done this kind of service before and it really hasn’t existed before,” said Tim Brooks, the CEO of Carolina Outreach, which is running the behavioral health urgent care. “The community identified a gap there between people who couldn’t make their regular appointments to see their psychiatrist or therapist, or go to the emergency room or the Durham Recovery Response Center.
“It’s clear there was this group of people who weren’t getting exactly what they needed and we’ve been able to fill that niche.”
Originally, Alliance was hoping Carolina Outreach would serve about 100 people per week. Instead, they’re seeing more like 40 or 50 per week.
So, Brooks and his staff held an open house on Wednesday to mark the six-month anniversary of the service, and to get the word out.
Usage has been slowly ticking up, Brooks said, they’ve seen people from Wake County and even folks who’ve driven up from Johnston and Cumberland counties.
“We’ve had some people who just paid out of pocket drive over from Orange County,” where they would otherwise be served by Cardinal Innovations, Brooks said.
The service is focused on people who have Medicaid and many uninsured people who otherwise would end up languishing in an emergency room. Brooks said once they’ve gained traction, he’d like to contract with big insurers to see those patients too.
“A hundred people a week would require more staffing than at our current capacity,” said clinic manager Marisa Holsten. “We’d need a few more clinicians, another doctor, but we’re set up to do it.”
Right now Holsten said they’re seeing about eight people a day, and have have enough staff to see 12 people. In particular, the clinic is providing a place to quickly address adolescents who act out at school by threatening to harm themselves or others.
“One kid had to be cornered into a room at school with several staff until his mom could come pick him up and that could be forever,” she said. “So we were able to get a [school] staff member to pick him up and bring him here [to] a little safer kind of calmer space and attend to his needs and then get him to the right level of service.”
In those cases, parents are told to get their child assessed by a psychiatrist before he or she can return to school.[sponsor]
“[Parents are] like, ‘I called the psychiatrist and it’s a month or two out and my kid can’t be out of school that long!’” Holsten said.
Carolina Outreach’s turnaround is a lot faster.
Holsten said that patients have been pretty pleased with the services and with how quickly they get help. They know because they survey everyone.
“It’s over 60 percent of people who said ‘I would absolutely have gone to the emergency department if I hadn’t come here,’” she said. There are also patients who report they ‘likely’ would have gone to the emergency department.
So, instead of the hours, days, even weeks that people spend on average in emergency departments around the state seeking mental health care, Holsten’s team is getting people seen and on their way in about two hours.
“They really don’t need to be there and the people that need the emergency care services, we want to make sure the emergency room is able to allocate that. So, we’re really filling that gap in the crisis continuum,” she said.
The slow growth in clients has had some positive side effects, Holsten said. For starters, it allowed the team to work out some kinks in the system, figuring out that it works best to have one therapist stay with each client throughout the length of their stay, rather than handing off to someone else. Meanwhile, other social workers can call the pharmacy to confirm medications, look up the client on the state’s controlled substances reporting system, or check on the treatment history.
“So by the time the therapist comes and says, ‘This is what we need to do,’ we can say, ‘This is what we know,’” she said.
Need to know
So, if the service is good and Alliance is pleased with the contract’s results, why aren’t more people showing up?
“It’s still something catching on for the officers,” offered Durham Police Officer Kendrick Hunter, who is an investigator with the force’s crisis intervention team. He handed out flyers with information and phone numbers for CIT officers at Wednesday’s party.
He explained that when someone calls 911 for help with a mental health crisis, police don’t automatically take that person to the emergency room. Instead, the CIT team offers people choices about where to get treated. In the past, that’s usually meant the ED or the local crisis response center. The urgent care has been added to those options.
“I’m sure there are some officers who have used it more than others.”
“Had I still had the robe on, I would be here and find out all I can,” said former judge Marcia Morey, who is now a Democratic lawmaker representing southern and western Durham at the General Assembly.
She said too often people with mental health issues end up criminalized and in the justice system.
“Having a drop-off place really identifying what’s the issue – if it’s mental illness, psychiatric – they don’t need to be in the criminal system,” Morey said. “This is a godsend.”
Members of the local medical community are starting to see some effect from the clinic, said Larry Greenblatt, a Duke physician who co-chairs the Durham Crisis Collaborative.
“We see this place as part of the solution or strategy for reducing people coming to the emergency department with psychiatric problems that could be best managed someplace else,” he said. “My understanding is that this is helping to drive down the traffic, and there is much less of a problem in Duke and [Durham Regional Hospital’s] emergency departments of people there who could have been served elsewhere.”