Meeting focuses on costs of care

Rise in psychiatric patients alarms officials

By: Richard Craver | JOURNAL REPORTER
Published: July 08, 2009

Reducing the time that law-enforcement personnel spend monitoring psychiatric patients in emergency departments emerged as the top priority from a high-profile community meeting yesterday.

The meeting attracted about 40 officials involved in health-care, mental-health care and law enforcement, and elected officials from Davie, Forsyth and Stokes counties. It was initiated by Patricia Murray, a Winston-Salem police captain, and CenterPoint Human Services was the host.

Local mental-health advocates and organizations and the media were excluded, but several officials who attended agreed to be interviewed afterward.

The group also agreed to set as a priority how to better coordinate the cost of transporting mental-health patients, particularly for evaluation and treatment at Central Regional Hospital in Butner.

The issues have vexed local law-enforcement, health-care and mental-health officials for years, financially, logistically and in terms of security.

"It was a productive meeting in helping the groups at the table better understand the viewpoints of others as we all try to address common issues and serve the local community better," said Scott Cunningham, the police chief of Winston-Salem.

According to police, sheriff's and Wake Forest University Baptist Medical Center officials, their organizations have spent at least a combined $1.4 million in 2008 and thus far in 2009 on handling mental-health patients.

That includes transporting patients to and from local and state health-care centers and hospitals, and providing security services for involuntary commitments in emergency departments.

Advocates and mental-health officials said that the sour economy has contributed to more people with mental illnesses lacking jobs and health insurance.

"We're all trying to apply finite resources to a big and growing problem," said Bill Schatzman, the sheriff of Forsyth County.

Local advocates say they worry that long waits are becoming more common because of a lack of beds in local and state hospitals and psychiatric facilities.

For example, in late May the lack of beds for psychiatric patients meant that a local man who was having a mental-health crisis spent more than eight days in the emergency department of Forsyth Medical Center -- at times in handcuffs -- before being admitted to the hospital.

Cunningham, Schatzman and Betty Taylor, the director of CenterPoint, said that patient-oversight issues are as much about liability as security and expenses.

"When we discussed a reasonable time for a law-enforcement officer to stand guard over a psychiatric patient, the range ran from four to 12 hours before hospital security took over," she said.

James Bryant, the director of emergency and transport services at Wake Forest Baptist, said that its security force handles about 2,700 patient watches a year, with an average watch time of six hours.

"The numbers are up by 30 percent over last year," he said.

Many advocates were frustrated about being excluded from the meeting, particularly because they are providing training to Winston-Salem police and Forsyth deputies for dealing with a mental-health crisis.

Taylor said she plans to get the input of local advocates on the two priority topics. She denied accusations by some advocates that she had threatened to call off the meeting if they tried to attend.

Pamela Corbett, a local psychologist, advocate and former member of CenterPoint's board of directors, questioned why Taylor "banned input from groups that have studied the problem -- the Mental Health Association and the Forsyth County Mental Health Collaborative."

"Is this just another CenterPoint public-relations event to give the appearance of doing something?" she said. "For years, we've encountered closed meetings, vacuous paper-pushing and a mounting public-relations budget with little to show for it.

"The local mental-health system has been made unnecessarily complicated and secretive. Both those who understand the problem and the decision makers need to work together to accurately identify root causes."

■ Richard Craver can be reached at 727-7376 or at rcraver@wsjournal.com.