Wake seeks better options for the mentally ill

December 30, 2013 

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Anyone who has had the misfortune of spending a long night in a hospital emergency room has seen the drama play out: Among the people with medical crises are those with no apparent physical problem but who are clearly, and sometimes loudly, suffering.

The situation is disruptive for them and for others. And yet too often in emergency rooms all over North Carolina, this is the scene because the ER has become the stop of first resort for people suffering mental crises.

Now Wake County, as noted in The New York Times, is looking for alternatives for the mentally ill in crisis.

In one example, a Wake County emergency worker finds a man who tells the paramedic that he is bipolar and schizophrenic; he’s also homeless. Conventional procedures would have the man being taken to WakeMed, where he likely would wait a while for help, given the acute threat of many of the illnesses and injuries for which people are treated there.

Instead, in this case, he was taken to Holly Hill, the private psychiatric hospital next to WakeMed. The decision makes common sense and medical sense.

“The good news,” says Michael Lyons, a paramedic supervisor for the county, “is that he’s not going to an ER. That’s saving the hospital money and getting the patient to the most appropriate place for him.”

ER alternatives

The program of taking mentally ill people in crises to alternatives other than emergency rooms is really part of a long, ongoing attempt to respond to increasing demand for services. The need spiked following disastrous changes in mental health care a decade ago. Those changes sought to move care from state hospitals to the community level. But the new system was exploited by providers who charged inflated amounts for services and by what appeared to be utter chaos in the system’s organization.

This new local program, done in agreement with the state, may offer alternatives that could work in other communities. Certainly providing adequate care for the mentally ill isn’t some down-the-road crisis. It’s here, right now.

One study said the number of mental patients going into North Carolina’s emergency rooms was twice the national average in 2010. At WakeMed, there are over 300 patients a month treated for psychosis, up a third from just two years ago.

One obvious problem with crowded emergency rooms handling the first treatment involving a mental illness situation is the danger that other patients with more acute, life-threatening conditions will not get attended to as quickly. That’s not the intent of emergency room personnel, of course, who are diligent in setting priorities. But it’s a case of simple numbers.

The need to figure out how to deliver quality care to the mentally ill, in emergency or regular treatment situations, isn’t exclusive to North Carolina. The Times cited national statistics showing that visits to emergency rooms nationwide that involved mental illness or substance abuse are up 28 percent from four years ago.

Troubled transition

The reasons for the increases aren’t simple, but the truth is, in many states, the idea of mental health reform took the same shape as that reform in North Carolina. States have let go of the state hospital approach to treating mental illness but have struggled to find arrangements that allow the mentally ill to live in small settings in their communities.

It was not necessarily a bad idea when North Carolina moved in that direction, but the state clearly wasn’t ready for the transition, and those in charge of it did a poor job of implementation. The state and individual communities have been struggling ever since.

It’s commendable that this area seems to be on to something, with a small, pilot program that is working. Let us hope that it can be expanded and that other ideas can be put into practice that might help the state solve the mental health care puzzle for its residents.

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