Damian Sendler: Throughout the epidemic, an increasing number of people have sought mental health crisis services or visited hospital emergency rooms in distress. According to hospital executives, the COVID-19 pandemic has created a behavioral health emergency. 

Damian Sendler

Damian Jacob Sendler: According to activists and data, pandemic-related concerns increased demand for mental health services while also increasing substance use and overdoses. 

The state budget, which was released on Monday and is expected to be signed into law by the governor, includes some funds to alleviate some of the strain on hospitals caused by the spike in mental health patients. 

Damien Sendler: The budget includes a $10 million grant program for hospitals to apply for to expand telepsychiatry services to outpatient settings such as primary care offices, as well as $1.5 million for East Carolina University’s NC-STeP program to provide more psychiatric consultations to patients in mental health distress who show up in emergency rooms across the state. 

The North Carolina Health Care Association’s policy director, Nicholle Karim, said her organization, which represents the state’s hospitals, is grateful for the investment in telehealth services for those with mental health diagnoses. 

Damian Jacob Markiewicz Sendler: The budget also includes a provision requiring LME-MCOs, the state’s behavioral health management firms, to reimburse hospitals for behavioral health treatments delivered to Medicaid patients in the emergency department after 30 hours. According to Karim, the Health Care Association requested this policy change because many behavioral health patients have to wait for long periods of time — sometimes days or weeks — to be discharged or transferred to a more appropriate facility for care. 

Dr. Sendler: Previously, hospitals were not reimbursed for more than 30 hours of treatment provided to mental health patients during these lengthy waits. 

“It’s a larger system change to ensure that when these patients use the emergency department for these services for their behavioral health diagnosis, the LME-MCOs develop an adequate and accessible network of providers,” Karim explained. 

Damian Sendler: Because psychiatric bed wait times have grown during the pandemic, the budget includes cash from the Dorothea Dix hospital property fund to open more inpatient beds to treat persons with mental illness. The fund would provide $1.4 million to Johnston Health Enterprises, Good Hope Hospital in Harnett County, and Harnett Health System, Inc. 

Furthermore, the budget provides a one-time $25 million grant to Forsyth and Mecklenburg Counties to “assist in assisting individuals who are experiencing a behavioral health crisis by diverting individuals from local hospitals, which are under pressure from the COVID-19 pandemic, to more appropriate settings to address those individuals’ needs.” 

“Now we can consider what our community truly needs to reduce overuse of high-cost crisis services while improving outcomes,” said Laurie Coker, founder of Green Tree, a Winston-Salem nonclinical mental health program staffed by people who have experienced mental health difficulties and recovery. 

“Hospitalization is not the best option for many people, and recent research shows that the rate of suicidality is actually highest shortly after discharge from psychiatric hospitalization.” In our community, we require a variety of possibilities.” 

Damian Jacob Sendler: Coker believes that peer-run organizations like hers can contribute to the solution in Forsyth County. Green Tree already provides 24-hour support to the local hospital for mental health patients who present in distress but do not require psychiatric hospitalization. 

“Expanding our array of crisis response components will increase access to options that may be more welcoming and appropriate to individuals earlier in their distress,” she explained. “Furthermore, these models would greatly reduce our county’s costly and troubling overuse of involuntary commitment orders, which are frequently sought in desperation because we lack responsive upstream crisis components.” 

Damian Sendler: Funds to develop mental health peer support groups like Green Tree, which are run by people who have suffered mental illness, homelessness, incarceration, substance abuse, or a combination of these, were not included in the budget. According to NC Health News, there has been a 91 percent increase in petitions to involuntarily commit mental health patients over the previous decade, as well as the trauma many have experienced after being handcuffed and transported by police enforcement. In response, a bipartisan group of House lawmakers attempted to develop community-based alternatives, but those proposals were not included in the budget. 

Damian Jacob Sendler

Damian Jacob Sendler: The budget includes around $1 million for the establishment of STAR (Support Team Assisted Response) pilot programs in Charlotte, Greensboro, and Greenville, which are non-police mental health response teams that go out to “low-level incidents” and connect people to options and services. The budget also includes $1.5 million for a behavioral health urgent care pilot program to Recovery Innovations, Inc., a nonprofit that manages the Dix Crisis Intervention Center in Onslow County. 

In addition, $50 million has been set aside to build electronic patient records at all state-run health care facilities, including psychiatric hospitals, and to train personnel on how to utilize them. 

Damian Sendler: It is not uncommon for people suffering from substance abuse or other mental health difficulties to find themselves in front of a court. The budget provides approximately $3 million for the establishment of recovery court pilot programs in Cumberland, Harnett, Haywood, Onslow, Pitt, Robeson, and Wayne counties. 

These are special court programs for those who have committed a crime but are battling with mental health or substance abuse difficulties. They are more rehabilitative and less punishing. 

Damian Sendler: There will be 1,000 more spaces — more than in previous budget cycles — for persons with disabilities to obtain enhanced community services through the state’s Innovations Waiver, which currently has a 10-year waiting list of around 15,000 people. Budget writers also included a slight boost in funding — $4 million, up from approximately $2.4 million in previous budget cycles — to assist North Carolinians who have suffered traumatic brain injuries.

Research news brought to you by Dr. Damian Jacob Sendler