North Carolina's alarming mental health crisis services

Dec. 11, 2013 @ 10:51 PM

It’s a Saturday in the middle of the busy holiday shopping season. A disheveled man is disrupting traffic in a popular shopping center, preaching loudly and scaring customers. A police officer responds to calls from merchants, but without any local options for crisis treatment services, he takes the man off to jail on a trespassing charge and hopes the jail nurses will be able to get him some help.

A hundred miles away, a woman who has been clean for months relapses after losing her job. She is alone, depressed and frightened.  After several weeks of drinking, she returns to crack cocaine. She knows she needs help, but without a car or money to pay a cab, she calls 911.

Late one night in a quiet suburb, a teenager threatens suicide. Not knowing what else to do, her parents call their family doctor, who suggests they go to the nearest emergency department. They wait in a crowded treatment area for most of the night until someone can help them ease this young woman’s mental health crisis.

In many North Carolina communities, the only place for people in mental health crisis is the local ED or jail. Those needing inpatient hospitalization may have to wait there for hours, even days, for an appropriate place to begin treatment. The only available bed may be hours away; the only transportation, the back of a sheriff’s car.

As I travel around the state, I talk with family members, advocates and mental health care professionals worried about the alarming state of crisis services in North Carolina. Currently, hospitals and law enforcement are carrying most of the burden associated with crisis episodes because too many communities lack the appropriate resources to help people and their families during mental health crises. They tell me the system is not working.

Recently, Gov. Pat McCrory and Department of Health and Human Services Secretary Aldona Wos announced a new initiative to improve mental health and substance abuse crisis services in North Carolina. The governor and Secretary Wos had invited mental health care professionals, hospital administrators, members of law enforcement and patient advocates to join them Dec. 9  for the first meeting of the Crisis Solutions Initiative Coalition.

The primary goal of the Crisis Solutions Initiative is to address the tremendous strain on the current mental health and substance abuse crisis system. High levels of emergency department usage, extended wait times in emergency departments, increased incidence of mental illness in jails and prisons – all of these contribute to higher costs – and just as important, they don’t get the job done.

Previous attempts at change have taken a wholesale transformation approach: Throw everything out and start over. This administration’s approach is more pragmatic: we’ll look to see what’s working well and expand it. Instead of “reform,” this will be a practical plan that focuses on long-term solutions. We want to look at evidence-based best practices that are working and use them to build a system that addresses the whole person and provides the right care at the right time.

We have a number of pilot programs that are showing great promise, and this solution-oriented group also will explore new options that include funding and policy changes.

One of the first steps will be to reduce the strain on hospital emergency departments: reduce the number of people in crisis who use them, reduce the wait times for those who must use them, and reduce the number of people readmitted within 30 days of a previous visit. 

Key to the success of the Mental Health Crisis Solutions Initiative will revolve around bringing the right people together and understanding the entire crisis continuum. The governor and his administration are committed to the effort, and the people of this state have everything to gain from its success.

Dave Richard is director of the DHHS Division of Mental Health, Developmental Disabilities and Substance Abuse Services.