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Mental health moves from regional to
local
By Scott Nicholson
Editor’s Note: The state’s mental health care
system has drawn criticism from both legislators and mental-health
advocates as overly bureaucratic and non-responsive to the changing
needs of the community. In a six-part series, The Mountain Times
will examine various aspects of the system as it affects local
residents as well as looking at some solutions. The series is
based on interviews with mental-health profesionals, lawmakers,
advocates and local residents caught between the need for care
and an ever-changing state system.
N.C. Rep. Cullie Tarleton
(D-93) |
The public role in mental health can be confusing and the avenues
myriad, especially with regulatory changes and reorganization
of mental and behavioral health agencies that often can be confusing
to clients.
Watauga County is part of a regional area overseen by The Smoky
Mountain Center, with New River Local Management Entity merging
early last year. As part of state reorganization of the mental
health system administration, management of services have increasingly
moved away from the county level and toward regional control.
Under the current arrangement, New River will continue to provide
the original five-county region with client services, as well
as emergency response, intervention and treatment programs. Smoky
Mountain Center handles screening, referrals, billing and payments,
as well as developing relationships with other agencies in the
region.
Cindy Henshaw, director of the emergency department at Watauga
Medical Center, said the hospital is only qualified to treat physical
ailments, though it accepts any patient with a developmental,
behavioral, or emotional disorder. “We don’t turn anybody
away,” Henshaw said. “If someone needs care or a medical
screening, we do that in consultation with New River Behavioral
Healthcare. Usually, the patient the patient has already been
referred and New River does its screening there.”
Henshaw said the hospital treats the medical situation or problem,
but has no psychiatric wing. Patients with substance abuse may
get medical treatment in Watauga County and then be shipped to
Wilkesboro for addressing the problem. Patients with behavioral
or mental disorders may be transferred out of the county to psychiatric
units, typically Broughton Hospital in Morganton.
Cannon Hospital in Linville, part of the Appalachian Regional
Healthcare System along with WMC, no longer has a psychiatric
unit, though Henshaw said Cannon is currently pursuing certification.
Henshaw said decisions on patient care are made on a case-by-case
basis in consultation with qualified personnel in the behavioral
health fields. When a patient is transferred, it often comes down
to “Whoever has the first available bed,” Henshaw said,
adding WMC keeps a list of psychiatric units in the state.
“We make sure that patients with behavior health issues are
treated appropriately,” Henshaw said, noting state regulations
require such policies. “Our first concern is to address any
medical needs. Sometimes they are treated in the emergency room.
Sometimes they are admitted to the hospital and then transferred.”
Bonnie Perkins, program director for High Country First in Families,
said help is available for families dealing with developmental
disorders or traumatic brain injuries. While First in Families
doesn’t address any medical or behavioral concerns, it is
a resource that can often make an immediate difference.
The non-profit agency covers a five-county region and helps families
in a short-term crisis or with one-time needs, trying to fill
the gaps that might not be met by other agencies or available
through the mental health care system.
The agency can provide funds for fuel assistance, a rent or house
payment, or other one-time expenditures such as an important trip.
“We try to help improve the quality of life and enable them
to participate in the community,” Perkins said.
First in Families tries to use its limited appropriations from
the General Assembly to partner with community agencies to meet
their clients’ needs. For example, Perkins cited a woman
in Ashe County whose home has a buckled floor. While the agency
can provide money for materials, it is seeking a church group
or civic group that can volunteer time and labor. Perkins said
such collaborations also create better community connections as
well as serving clients.
Last year, First in Families served 135 families and Perkins is
actively seeking business and community partners to help with
projects. Those seeking services or making a request for one-time
financial assistance must fill out an application. Perkins said
the agency only allows one request for fuel or housing assistance
per client because it wants to focus on a wider variety of services.
Rep. Cullie Tarleton (D-93) said he was learning more about the
issue but believes the state is not doing an adequate job of addressing
the needs of the mentally ill. He said a legislative action established
parity in insurance for the mentally ill, though alcohol and drug
abuse were exempted from the bill.
Tarleton also said it’s a complex and often hidden issue.
“Unless you’ve been involved in a family situation and
see it up close, people don’t think about it,” Tarleton
said. “Unfortunately, they often expect people to just ‘snap
out of it.’”
Tarleton said those suffering depression can be severely disabled,
and many mental disorders and emotional disorders are linked to
chemical imbalances in the brain. He suggested that the state
hadn’t addressed the issue adequately because it was so complicated
and that different types of disorders require different approaches.
In a recent column, Sen. Steve Goss (D-45) also acknowledged the
complexity of the issue. He said there weren’t enough practitioners
to adequately serve the client base and a lack of incentive and
support discouraged potential practitioners from entering the
field. Problems combining physical and mental health care, long
waiting lists, and lack of oversight and accountability have contributed
to problems.
He also said the current system depended on adequate funding and
less bureaucracy. “It is time, however, to compare the cost
of incarceration and broken families to the cost of providing
adequate resources for our relatives and neighbors who need adequate
and effective treatment of mental illness,” he said. “Local
providers need the state to make the process seamless to the point
that they and, most importantly, the patient will not drown in
a sea of bureaucracy.”
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