Western North Carolina healthcare leaders expect that a new $2.3 million initiative will help reduce overcrowding at Mission Hospital’s emergency department by ensuring people with mental health or addiction disorders receive proper outpatient care.
The N.C. Department of Health and Human Services (DHHS) awarded grant funds to Vaya Health, a managed healthcare organization serving western North Carolina, to fund the pilot program in conjunction with Mission Health and RHA Health Services. The initiative will provide comprehensive case management for people utilizing Mission’s emergency department (ED) for behavioral health needs, as well as women who are pregnant and using drugs or alcohol, and link them to community services and supports.
Nearly 600 people seek care for behavioral health needs at Mission’s ED every month. Some individuals needing psychiatric inpatient treatment wait at the ED for more than three days before a bed becomes available. Repeated visits are also becoming more problematic, with 230 individuals making a total of 770 visits during six months in 2016.
Hospitals across the state and nation report similar challenges. Last year, the N.C. Governor’s Task Force on Mental Health and Substance Use recommended comprehensive case management as a promising approach for reducing repeated visits to the ED and the amount of time people wait for treatment.
“Our region is fortunate to have an array of available outpatient behavioral health services,” said Vaya CEO Brian Ingraham, who served on the governor’s task force. “Our partnerships with Mission, RHA and other local organizations have been key in expanding treatment options and opening Asheville’s C3356 Comprehensive Care Center, which offers a variety of behavioral health services, including 24-hour crisis care. This pilot program will build on existing efforts and provide another link for people who visit Mission’s ED to community services to help them stay well.”
“Extended waits for inpatient beds in emergency departments is not the optimum care we want to provide for people in crisis,” said Jason Vogler, Ph.D., interim senior director of DHHS’ Division of Mental Health, Developmental Disabilities and Substance Abuse Services. “We’re looking forward to learning if this pilot program in western North Carolina could serve as a model for future efforts statewide.”
Sonya Greck, MSN, RN, Senior Vice President Behavioral Health and Patient Safety Net with Mission Health, stated, “Mission is enthusiastic about this opportunity to improve service for resource-intensive behavioral health patients. Adding this 24/7 availability of case management intervention to the work already being done with our partners in the community could be the ingredient we have needed.”
The grant will fund a 24/7 comprehensive case management team embedded in the ED, with a second team based in the community. Teams will reach out to people visiting the ED for behavioral health needs and connect them to appropriate outpatient treatment. Team members will work closely with existing case management providers and Vaya care coordination staff to assist in arranging care and monitoring participants for up to six months.
The initiative will also help participants find community resources, including social services and assistance with housing and transportation, to help improve their overall wellbeing.
Additionally, RHA will expand operating hours at its peer living room, housed at the C3356 center, to 16 hours a day, seven days a week, in the coming months. The peer living room opened in 2016 to provide a safe space where visitors can talk with peer support specialists, meet others in recovery and participate in wellness activities. Already, increasing numbers of people are visiting the peer living room instead of the ED.
“Too often, people don’t connect with routine outpatient care that can prevent a behavioral health issue from becoming a crisis,” said RHA CEO Gordon J. Simmons. “In addition to RHA programs in neighboring counties, C3356 offers 24-hour behavioral health urgent care, counseling, medication management, substance use treatment and peer support services. These programs promote personal recovery and help prevent future crises.”
The pilot program will serve people with unmet behavioral healthcare needs, regardless of insurance status, with a focus on people who utilize the ED frequently. It is expected to begin in July and operate through June 2018. State health officials will evaluate program successes in determining whether to fund similar programs in the future.
The initiative has garnered support from a wide variety of community partners, including healthcare and social services providers, advocacy groups and area local government, court and law enforcement agencies. The funding is allocated through DHHS’ Division of Mental Health, Developmental Disabilities and Substance Abuse Services.