North Carolina’s management and delivery of mental health, substance abuse, and developmental disability services (MH/SAS/DD) have undergone many changes since passage of the 2001 Mental Health System Reform Act.
In December 2013, the McCrory administration announced that the state’s 10 mental health managed care agencies (LME-MCOs) will be consolidated into four regional entities. LME-MCOs are state-created and funded but have boards appointed by county commissioners. Local management entities (LMEs) are designed to direct patients to the most appropriate sources of care, work to build the network of providers available, and ensure that patients receive appropriate care from those providers. LMEs contract with Managed Care Organizations (MCOs) that deliver authorized services to MH/SAS/DD patients.
Furthermore, a Crisis Solution Initiative has been introduced to reduce inefficiencies and capitalize on best practices within LME-MCOs. The primary goal of the Initiative is for localities to establish programs that anticipate crisis episodes among the mentally ill population rather than assessing an individual’s needs in an unnecessary and costly ER visit or jail. Many of the most seriously mentally ill patients end up in jail for public nuisance crimes, and sometimes for violent crimes.
Progress will be calculated based on the Crisis Solution Initiative Scorecard. Measurable goals for the Crisis Solution Initiative include reducing avoidable emergency room visits, emergency room wait times, and hospital readmissions. By addressing and measuring these matters, the Initiative is better able to care for MH/SAS/DD patients, save money, and reduce the burden on law enforcement and hospitals.
- Nationally, 17 percent of jail inmates have a serious mental illness.
- In FY 2013, approximately 150,000 emergency department admissions resulted from a primary MH/DD/SAS diagnosis.
- In FY 2013, the average wait time in emergency departments for state hospital admission was 3.52 days.
- In FY 2012, 13 percent of the mentally ill Medicaid population revisited the emergency department within 30 days.
- As the Crisis Solutions Initiative continues to unfold, the following best practices should be developed further:a. The NC Department of Health and Human Services reports that walk-in crisis centers are great alternatives to emergency departments in most crisis cases. This initiative has decreased emergency department admission rates and allows health care providers to access short-term residential beds to assist people who need only a few days of crisis intervention for stabilization of mental health or detox needs. So-called Alliance and Assessment Centers are located across the state, including Wake, Durham, and Cumberland counties.b. Localities should continue to work with their assigned LMEs, the law enforcement community, and community leaders to utilize their allocated MH/SAS/DD funds efficiently. The severely mentally ill should be effectively directed to proper care rather than waiting for days, even weeks, in emergency rooms or incarceration. Wake and Durham counties have made progress tackling this issue by establishing Crisis Intervention Teams (CIT), an approach supported by the state chapter of the National Alliance on Mental Illness (NAMI NC). Taking advantage of such pre-booking methods will help stabilize the mentally ill and enable them to become full productive members of society instead of wards of the state.
- North Carolina has taken steps to address the psychiatrist shortage in 28 rural counties of the state by spreading the practice of telepsychiatry. A form of telemedicine, telepsychiatry allows for a psychiatrist to treat mentally ill patients through personalized audio-visual sessions. $4 million has been appropriated for this statewide telemedicine initiative through FY 2015. In order to use taxpayer money most efficiently, the Crisis Solutions Initiative should track the most cost-effective technology that can be used by patients and providers.
- Competition among care managers across pre-defined LME-MCO borders could also improve efficiencies and help spread best practices more rapidly.