Dec. 28, 2012. The National Alliance on Mental Illness published a report in March 2011 titled “State Mental Health Cuts: A National Crisis.” These were the first two sentences in the report:
“The recent tragic shooting of Congresswoman Gabrielle Giffords and the killing of six innocent citizens in Arizona focused national attention on the state of the public mental health system in Arizona and other states. Many asked how a tragedy like this could happen again, with chilling references to Virginia Tech.”
Such it is again in the aftermath of the Sandy Hook Elementary School massacre.
Several months after the aforementioned study, NAMI released another one called “State Mental Health Cuts: The Continuing Crisis.”
That study found that North Carolina had the country’s fourth highest percentage reduction in state mental health funding from fiscal-year 2011 to 2012 that amounted to a $48.2 million reduction.
And this past summer, the N.C. General Assembly cut $20 million of block grants for the vulnerable to the Division of Mental Health, Developmental Disabilities and Substance Abuse Services and an additional $20 million in cuts to mental health services.
“State funding for mental health, substance abuse and developmental disability areas has been cut over the years, and the entire state was significantly hit earlier this year,” said Sarah Dunagan, regional director for Daymark Recovery Services, a substance abuse and mental health treatment provider serving 28 counties in the state including Ashe, Avery and Watauga.
An Obligation To Treat Mental Health Needs
Stephanie Greer, the director of behavioral health at Appalachian Regional Healthcare System, said that funding cuts haven’t significantly affected the mental health services at Watauga Medical Center in Boone and Cannon Memorial Hospital in Linville
“The funding cuts have not affected the services typically rendered by App Regional Health Care because we don’t have outpatient clinics with state contracts for indigent services like Daymark,” Greer said. “However, funding cuts have affected a large number of consumers in the region.”
Greer worked in Broughton Hospital in Morganton, one of the three psychiatric hospitals in the state, for 12 years before joining ARHS in 2008. ARHS has two outpatient clinics in Boone serving mental health needs and one inpatient clinic in Linville with a psychiatrist assigned to patients.
The typical length of stay at the inpatient clinic in Linville is five days, and those patients are involved in an acute crisis.
“Suicidality, Homicidality,” Greer said. “It’s not generally a hangout, get a break from life.”
She said regardless of tragic circumstances of the recent shooting, “we need to treat behavioral health like any other specialty service and optimize access to care for all individuals.”
She continued, “For example, if someone has a broken leg, if there wasn’t service available to take care of that condition that would be unheard of. As a community, we have an obligation to treat mental health issues with the same degree of importance as other health conditions.”
The Lack of Psychiatric Inpatient Beds in NC
When asked if there is more of a need for mental health services in the High Country than there are services available, Greer noted the many studies that show the “significant gaps” of inpatient psychiatric beds available across the state.
From 2000 to 2010, the number of psychiatric inpatient beds declined from 1,958 to 1,744, according to a report released last week by the N.C. Center for Public Policy Research.
“Compounding this trend,” the report read, “is the reduction in state psychiatric hospital bed capacity. Over an almost 20-year span between 1992 and 2011, the state psychiatric hospitals lost 1,879 beds, and between 2000 and 2011, they went from serving 16,789 people to serving just 5,754.
In the High Country, Cannon Memorial Hospital has 10 inpatient beds. The five-county region in and around the High Country (Ashe, Avery, Watauga, Alleghany and Wilkes) that Daymark represents that also coincides with Smoky Mountain, a local management entity, only has local outpatient clinics. Daymark has no inpatient beds located in the High Country.
Smoky Mountain Center’s 15-county coverage area does have 32 adult inpatient beds, but none of those are in the High Country. Dunagan said that Daymark patients are transported to a crisis recovery center in Statesville, and she also mentioned that several private providers exist that serve inpatient needs.
Dunagan of Daymark said that the while cuts in state funding cuts have caused enhanced services to be limited to the indigent population, “there is always help” for people of all age groups who experience mental health, substance abuse and/or developmental disability crises in the High Country through walk-in-clinics and mobile crisis services as well as those needing basic services.
‘Hitting the Reset Button’
Daymark CEO Billy West said mental health reform has been a failed effort from a statewide perspective.
“What you’ve seen over the past 10 years is the effort to privatize things,” Billy West said. “It’s gotten out of control financially, but now it’s being kind of corralled back in.”
But he added that the on-the-fly adaption to the waiver system for mental health services that was expanded to all of N.C. this summer has been a “tall order.”
In 2005, the N.C. Department of Health and Human Services established Piedmont Behavioral Healthcare, a LME, as the pilot vendor through the use of Medicaid waivers to serve individuals with mental health, developmental disabilities and substance abuse needs on a per-capita basis through a prepaid inpatient health plan.
“[The pilot program] got a great deal of success as for cost savings,” West said. “In theory, it was good for five counties. Piedmont had multiple years to get it right and more money in the system.”
“There is a much shorter time frame. It’s not multiple years, it is months and now weeks to get things right with a lot less money to do it with. There was more money in the system 10 years ago than today,” West said. “I think it’s a good plan with the waiver, but do we have enough time and money in the system to make it work? Right now, that’s where we are going.”
Aside from the new waiver system and less money overall for mental health services in the state, West said the dissolution of New River Behavioral HealthCare “really hurt.”
“Regardless of people’s opinion, were they good, bad, managed, mismanaged, Smoky’s fault, New River’s fault – that’s less relevant,” West said. “One thing important was they had stability until they became unstable.”
“When they left, we’ve had a year of picking up the pieces. The entire community, Daymark, Smoky, ARHS, DHHS – everybody’s been in the same boat here.”
But, he added, considering everything, it’s been a very good year.
“We are here a year later. We’ve treated a lot of people and the community has really been supportive,” West said. “Hitting the reset button has not been easy.”
As for the Sandy Hook tragedy and its impact felt around the country, Dunagan of Daymark said, “I think it certainly opened a lot of eyes, but I also think there won’t be any additional money for services.”
She said that the reprioritizing of funds could occur to focus on the highest needs. However, she said, if and when that happens those funds would likely be cut from something else, such as from another helpful program in the community.
Speaking on Thursday night, West said that he “received word” that more rate cuts from Medicaid for outpatient services will be announced soon. However, he wouldn’t have any details or know the extent of the impact those cuts may impose on outpatient services until after the New Year – after more number crunching takes place.
West said that policy makers agree that nobody wants to see citizens languish in emergency rooms with mental health and substance abuse problems and witness more of the seemingly frequent shootings that have occurred.
“But at some point this becomes a simple math equation where the expense of the service and all the non-value added paperwork surpasses the dollars left to pay for this health care,” West said. “If this trend continues and some money is not put back the providers and local management entities will be out of heroic efforts to keep the system afloat.”
“So no amount of state initiatives will really matter for no private company will be able to make the math work.”
Crisis Help is Available
West, Greer and Dunagan, all three, mentioned that help is available, especially for immediate crisis situations – whether it’s a trip to the emergency room that is open 24 hours or to an urgent walk-in clinic.
“Crisis Services are available for anyone through Daymark,” Dunagan said, encouraging folks who might need help or who may know someone who needs help to call for immediate needs, schedule an appointment or utilize a walk-in clinic. Mobile Crisis services are available around the clock, every day of the year”
Daymark Recovery Services is open from 8 a.m. to 5 p.m. It’s located at 132 Poplar Grove Connector # B in Boone. To reach, Daymark call 828-264-8759. To reach the after hours crisis line, call 828-264-4357.
Contact Appalachian Regional Healthcare Systems in Boone at 828-262-4100 and in Linville at 828-737-7000.
When To Seek Help
The Cannon Memorial Hospital’s website has a link on its Behavioral Health Services page that suggests when its time to seek help.
“Many people fail to seek help for mental health problems because of fear of stigma. Mental health is just as important as physical health to our general well-being and it is just as common to have emotional difficulties as it is to have physical difficulties
Do you or someone you know have any of the following symptoms? If so, please give us a call.”
Symptoms of Depression
- Crying Spells
- Prolonged feelings of grief/loss
- Sleep/Appetite problems
- Feelings of hopelessness/helplessness
- Loneliness, isolation and withdrawal
- Thoughts of suicide or self-harm
Symptoms of Thought Disorders
- False beliefs about reality (delusions
- Feeling, seeing or hearing things that are not real
Symptoms of Anxiety
- Excessive worrying and fear
- Difficulty concentrating
- Sleep disturbances
- Panic Attacks
Symptoms of Mood Disorders
- Feelings of euphoria followed by periods of depression
- Excessive Spending
- Impaired Judgement
Symptoms of Personality Disorders
- Persistent difficulties in personal relationships
- Persistent problems in professional relationships
- Difficulty understanding the emotions of others