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Mental Health & the ER

The N.C. Department of Health and Human Services shared the following statistics about the use of emergency departments and law enforcement in responding to mental health and substance abuse crises in North Carolina.

- In 2012, there were 17,000 more behavior health-related visits to ERs than in 2010.

- In North Carolina, "psychiatric boarding" stays in ERs average more than three days as individuals wait for care in a state-operated facility.

- A 2010 report estimated that more than $7 million is spent "boarding" psychiatric patients in emergency departments.

- The repeat rate for behavioral health-related visits was 27 percent in fiscal year 2012, with a repeat rate within 30 days of 13 percent.

- Current estimates indicate that close to 17 percent of the jail population nationally has a serious mental illness.

- Three-quarters of the jail population with a serious mental illness also has a co-occurring substance abuse disorder.

Originally published: 2013-12-02 10:13:36
Last modified: 2013-12-02 14:54:14

DHHS seeks to curb mental crisis ER visits

by Anna Oakes

A new Crisis Solutions Coalition meets for the first time Dec. 9 in a statewide effort to reduce the number of emergency room visits for those experiencing a mental health crisis.

At issue is a lack of alternatives for crisis treatment, which drives a growing number of patients in the state to hospital emergency departments or to jails.

In November, N.C. Department of Health and Human Services Secretary Aldona Wos announced the Crisis Solutions Initiative, which will work to ensure that individuals experiencing an acute mental health or substance abuse crisis receive timely specialized psychiatric treatment.

"Our current system of providing care for people in a mental health or addiction disorder crisis is not working," Wos said in a statement. "We have come to rely too much on local law enforcement and hospital emergency departments to provide mental health or addiction interventions."

The coalition meets at 2 p.m. Monday, Dec. 9, on the Dorothea Dix campus in Raleigh. Wos tapped Dave Richard, director of the DHHS Division of Mental Health, Developmental Disabilities and Substance Abuse Services, to lead the coalition.

"The overdependence on emergency departments and the lack of alternative resources ends up costing limited resources without giving the real help needed by individuals and families during crisis episodes," Richard said in a statement.

Billy West, CEO of Daymark Recovery Services, and Genny Pugh, senior director for community collaboration at Smoky Mountain Center, are among those invited to take part in the coalition effort, Richard said Friday.

Daymark Recovery Services is a private mental health and substance abuse service provider in 28 North Carolina counties; Daymark was named the local service provider in 2011, when the public New River Behavioral Health folded.

Smoky Mountain Center is the local management entity that supervises mental health services for Watauga and 22 other Western North Carolina counties.

Richard said the coalition would work closely with local management entities and others to identify best practices to achieve "what we know we have to do in the mental health system."

DHHS already has identified a number of best practices it says "have proven to work on the local level," including walk-in crisis centers and short-term residential treatment options, youth mental health first aid, person-centered crisis prevention plans, telepsychiatry, EMS pilot programs and crisis intervention teams.

The coalition will recommend and establish community partnerships to strengthen the continuum of care for mental health and substance abuse services; promote education and awareness of community resources other than the ER; share and evaluate data to identify who, when and where people increases are served, and to what effect; identify best practices and provide technical assistance to LMEs, law enforcement and providers on how to respond to crisis scenarios; recommend policy and funding changes; and create local business plans to provide a roadmap for mental health investments.

According to DHHS, success of the effort will be measured by three key criteria: percentage of emergency department visits for primary diagnoses related to mental health or substance abuse issues; wait times in emergency departments for inpatient psychiatric and substance abuse placement; and number of individuals with mental health crises readmitted to the ER within 30 days of a previous visit.

Richard said the agenda and meeting materials of the Crisis Solutions Coalition would be posted online at the DHHS website,

Richard will host a live Twitter town hall discussion about the initiative at at 3:30 p.m. Monday, Dec. 2.