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DHHS Announces Statewide Initiative to Improve Mental Health and Substance Abuse Crisis Services in North Carolina

 

For Immediate Release
Thursday, November 7, 2013
Contact: news@dhhs.nc.gov
              919-855-4840

Raleigh, NC -- DHHS Secretary Aldona Wos announced today the McCrory Administration’s Crisis Solutions Initiative, a new statewide effort to improve mental health and substance abuse crisis services in North Carolina. This initiative will bring healthcare, government, law enforcement, and community leaders together to identify help for individuals experiencing a mental health or substance abuse crisis so they receive the most effective care.

"Improving mental health and substance abuse services is a top priority of our administration," said Governor Pat McCrory. "By bringing people together to implement strategies that work, we can better serve the thousands of North Carolinans who struggle with mental illness and substance abuse."

Secretary Wos was joined by Dave Richard, director of the Division of Mental Health, Developmental Disabilities and Substance Abuse Services, as well as Dr. Brent Myers, director and medical director of the Wake County EMS System, and Dr. Bill Roper, CEO of UNC Health Care, at the announcement event at the WakeBrook Crisis Center in Raleigh.

"With today’s announcement, we begin a focused, long-term effort to ensure that individuals and families who are experiencing a mental health or substance abuse crisis know where to turn for the help they need," said DHHS Secretary Aldona Wos, M.D. "In turn, we can begin to reduce the tremendous burden that these issues place on hospital emergency departments and law enforcement."

Each year, there are an estimated 150,000 visits to emergency departments in North Carolina related to an acute psychiatric or addictive disorder crisis. 13 percent of patients with a mental health crisis who are treated in an emergency department will return within 30 days. In addition, national studies indicate that about 17 percent of people in jail have a serious mental illness.

As a part of this initiative, a Crisis Solutions Coalition will be created to address the inefficiencies that currently exist surrounding crisis services in the state. Secretary Wos has charged Dave Richard, director of the DHHS Division of Mental Health, Developmental Disability and Substance Abuse Services, with leading this coalition. Patient advocates, along with leaders from healthcare, government, and law enforcement communities will be invited to join the coalition to help:

  • Recommend and establish community partnerships to strengthen the continuum of care for mental health and substance abuse services.
  • Promote education and awareness of alternative community resources to the use of emergency departments.
  • Make recommendations related to data sharing to help identify who, when and where people in crisis are served, and what the results of those services are.
  • Create a repository of evidence-based practices and provide technical assistance to Local Management Entities/Managed Care Organizations (LME/MCOs), law enforcement and providers on how to respond to crisis scenarios.
  • Recommend legislative, policy and funding changes to help break down barriers associated with accessing care.
  • Assist with the creation of LME-MCO Local Business Plans to provide a roadmap for mental health investments in the community.

"By bringing all stakeholders together, we can begin to focus our resources and energy on solutions that already are working in some of our local communities," said Dave Richard. "This effort is about finding practical solutions that will allow us to move away from a crisis-based system to one that is truly focused on patient outcomes."

A primary goal of the Crisis Solutions Initiative is to ensure that individuals experiencing an acute mental health or substance abuse crisis receive timely specialized psychiatric treatment in coordination with available and appropriate community resources. The initiative seeks to identify ways to expand existing best practices that have been proven to work on the local level, such as:

  • Walk-In Crisis Centers and Short-Term Residential Treatment Options
  • Youth Mental Health First Aid
  • Person-Centered Crisis Prevention Plans
  • Telepsychiatry
  • EMS Pilot Programs
  • Crisis Intervention Teams

"It is tremendously important to Wake County that we find ways to help people in crisis receive the treatment they need, in the right place, from the right provider, the first time," said Dr. Brent Myers. "Our comprehensive, community-wide approach includes partnerships with hospitals, mental health facilities, detox facilities, and the Capital Care Collaborative so that patient's encountered by EMS may choose from a menu of services rather than be transported only to an emergency department that may not have the resources to address the cause of their crisis. This concept, referred to as Mobile Integrated Healthcare, is receiving national attention and can be replicated in other communities."

At the center of this initiative is a new scorecard system to help track the progress and success of these initiatives in three key areas over time:

  1. Percentage of emergency department visits for primary diagnoses related to mental health or substance abuse issues;
  2. Wait times in emergency departments for inpatient psychiatric and substance abuse placement;
  3. Number of individuals with mental health crises, who have been admitted to emergency departments that are readmitted within 30 days.

"I want to thank Governor McCrory, Secretary Wos and the Department of Health and Human Services for their commitment to this issue," said Dr. Bill Roper, CEO of UNC Health Care. "We look forward to partnering with you and the community to solve the mental health problems facing our state."

North Carolina Hospital Association President Bill Pully added: "NC hospitals support the renewed efforts of Secretary Wos and the Department of Health and Human Services to reduce the amount of time behavioral health patients spend in emergency departments. Hospitals know first-hand that the current system of care for North Carolinians with behavioral health needs is dysfunctional and unsustainable. We look forward to working with the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, the Local Management Entities and Managed Care Organizations and other stakeholders to develop and implement concrete, cost-effective, and evidence based, steps to improving the behavioral health service delivery system in NC for all North Carolinians."

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Additional Background Information:

Walk-In Crisis Centers and Short-Term Residential Treatment Options
Walk-in crisis centers are great alternatives to emergency departments in most crisis cases. They allow a person in crisis to be assessed and treated quickly by clinically appropriate staff. Crisis Centers serve as an alternative to jail or the emergency department where individuals in distress might wait for days until they get the correct treatment. They have shown to decrease the utilization of an emergency department for mental health and substance abuse crises in communities where they are located.

Walk-In Crisis Centers also offer the advantage of being more directly connected with community based alternatives for inpatient care. Due to complex regulations, ED’s often have little choice but to refer to a psychiatric inpatient facility. Walk-In Crisis Centers, however, can access short term residential beds to assist a person who needs only a few days of crisis intervention for stabilization of mental health or detox needs. These Crisis Recovery Centers and Non-Hospital Detox Centers are closer to home and their ongoing support systems for most people.

Youth Mental Health First Aid
Youth Mental Health First Aid is an exciting new tool that, similar to CPR certification, is an evidence-based program that trains adults to be attentive to mental health issues in young people and intervene before the problem escalates. This will include training about unique risk factors, warning signs of mental health problems in adolescents and how to help youth who are experiencing a mental health crisis or substance abuse challenges.

Person-Centered Crisis Prevention Plans
Person-centered planning is a framework for providing services, treatment, supports and interventions that meet the individual’s or family’s needs. The standardized crisis plan, which is a component of the Person-Centered Plan, was implemented in April of 2006. Since then, we have realized that crisis plans must take a more comprehensive approach with an emphasis on promotion, prevention, and recovery strategies in order to decrease the number of individuals utilizing emergency departments.

Telepsychiatry
In August 2013, Governor Pat McCrory announced a statewide telepsychiatry program that builds on existing networks to improve access and quality of mental health services in North Carolina emergency departments. The start date for this program is January 1, 2014, and the Department of Health and Human Services has already met its goal of signing up 60 hospitals across the state to join the telepsychiatry network.

EMS Pilot Programs
Walk-in crisis centers have successfully partnered with EMS paramedics developing opportunities to divert individuals in crisis to alternative locations for care. A Wake County pilot program included advanced mental health training for EMS paramedics. As a result, 248 individuals were able to avoid a trip to an emergency department and get care directly at a mental health or substance abuse treatment facility in 2012. This resulted in conservative estimated savings of 3472 bed hour resources in the ED, enough time to evaluate 1,157 chest pain patients.

Crisis Intervention Teams
Crisis Intervention Teams (CIT)are a police-based, pre-booking jail diversion approach that provides law enforcement (including school resource officers) and other first responders the training and tools needed to understand mental health and substance abuse crises and symptoms, as well as helping them make decisions that get youth needed services in lieu of incarceration. CIT is spreading across the state through the Local Management Entities-Managed Care Organizations (LME-MCOs) through which North Carolina’s mental health system is administered locally, in partnership with various local entities including local law enforcement, community colleges, county commissioners, advocacy organizations and similar groups. To effectively expand CIT, DHHS will continue to educate police chiefs, sheriffs, LME-MCOs and other local entities as to the benefits of CIT and how various sites are identifying resources for the training and materials, as well as provide technical assistance regarding best practices for implementing CIT programs.

Crisis Solutions Initiative Scorecard
image of CSI scorecard

 

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