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Group seeks issue input
Mental-health care in ER vexes local officials By Richard Craver
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Published: July 5, 2009
CenterPoint Human Services has called for a high-profile meeting Tuesday to discuss an increasing public concern -- how to better handle mental-health patients in the emergency room.
The issue has vexed local law-enforcement, health-care and mental-health officials for years, financially, logistically and in terms of security.
CenterPoint described the meeting at its headquarters at 4045 University Parkway "as an opportunity for everyone to voice their problems, solutions and ideas."
Betty Taylor, the director of CenterPoint, said she requested the 90-minute meeting because "it's becoming more evident that local officials need to come up with local solutions" to fix what is perceived to be a broken state mental-health system.
Among the invitees are: Scott Cunningham, the police chief of Winston-Salem; Bill Schatzman, the sheriff of Forsyth County, Dudley Watts, the county manager; officials at Forsyth and Wake Forest University Baptist medical centers; and officials affiliated with CenterPoint in its four-county area.
But among those not invited by CenterPoint are local mental-health advocates and the media.
Some advocates are frustrated about being excluded, particularly because they are providing special training to Winston-Salem police and Forsyth deputies for dealing with a mental-health crisis.
Andy Hagler, the executive director of the Mental Health Association in Forsyth County, said that although he will honor Taylor's request that the meeting not include the public, he questions why advocates are not being allowed to provide their perspectives on the issue.
Mary Annecelli, a local advocate, also said she is disappointed by Taylor's decision.
"I am grateful that finally people from law enforcement, the hospitals and CenterPoint will be combining their knowledge to develop a better plan for ER supervision of patients in crisis due to their mental illnesses," Annecelli said.
"I would hate for an unworkable plan to be developed because the committee lacked input from the very people it was designed to serve,'' as well as from volunteers with the Forsyth chapter of the National Alliance on Mental Illness, who often receive calls on weekends or after CenterPoint's workday has ended.
Taylor defended the limited invitations for what she called an "internal management meeting."
Limiting the participation will provide a better avenue for "venting," she said, and then "hopefully some hard discussions on hard issues, and some brainstorming."
"All of these parties have experienced how the broken system is affecting their operations and finances," Taylor said.
According to police, sheriff's and Wake Forest Baptist officials, their organizations 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, often on overtime pay for both law enforcement and hospital personnel.
Advocates and mental-health officials also said that the sour economy has contributed to more people with mental illnesses lacking jobs and health insurance, making the problem worse.
Cunningham said at a recent fundraiser for the local mental-health association that police response to mental-health crises have doubled in the past four years.
"Last year, we had over 600 calls that consumed 2,600 hours of personnel time. That is almost two calls a day," he said.
Local advocates said they are worried 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.
Maj. Brad Stanley, a spokesman for the sheriff's department, said that although confinements of eight days are the exception, it is becoming more common to have someone held in the emergency department for one to three days.
"These commitments, mandated by state law, are taxing and draining to our already limited resources for our patrol personnel," Stanley said. "We want to express our concerns and help with determining what can be done to develop a better response plan for the person having the episode."
Cunningham said that having local residents going through a mental-health crisis "warehoused and secured like this delays their treatment and, in some cases, aggravates their situation."
Part of the solution may be the 24-hour psychiatric-emergency department that Old Vineyard Behavioral Health Services is pursuing as part of a proposed $13.8 million center at 3637 Old Vineyard Road. The center would have 50 beds. CenterPoint is participating in the application.
A decision on the proposal is pending from the N.C. Division of Health Service Regulation.
Local advocates are concerned that the 50 beds will be of limited use to adults ages 21 to 64 who depend on Medicaid to pay their bills. Specialized psychiatric operations, such as Old Vineyard, are not allowed to bill Medicaid for services, according to federal law.
Some advocates said that there has been increasing tension between law-enforcement and hospital officials over handling mental-health patients in the emergency departments.
James Bryant, the director of Emergency and Transport Services for Wake Forest Baptist, said that the decline in funding for mental-health programs and beds "presents all of us with a challenge we are working to meet."
"These are unfunded and/or underfunded mandates that require a lot of human and facility resources on the part of local emergency departments and law enforcement because mental health is not prepared to offer the services," Bryant said.
Cunningham said that because each group in the mental-health system has its own rules and laws, coordination between groups "is not as they should be."
‘This leads to frustration amongst and between our personnel and partners," Cunningham said. "This translates into occasions when our service may not be at its best.
"If we work together better, with more understanding of relevant issues, our people will experience less frustration and our citizens will receive better treatment and services."
■ Richard Craver can be reached at 727-7376 or at rcraver@wsjournal.com.
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