Easing the Psychiatric Burden

By Scott Nicholson

The following is the conclusion of The Mountain Times’ eight-part series, Breakdown.

A pilot program to put in-patient psychiatric beds at Cannon Memorial Hospital in Linville could address several problems that have been plaguing public health and law-enforcement sectors.

Cannon is pursuing certification for the beds and expects to have a 10-bed unit open by October 1. The hospital was part of a $1.2 million program grant awarded to Smoky Mountain Center to undertake a regional approach to mental health services. The grant also includes a 15-bed unit in Haywood County and several non-hospital outlets, such as psychiatric beds in nursing homes.

Tom McDevitt, SMC area director, said the units would be for adult mental health or substance-abuse patients. He said the 10 beds were expected to meet demand based on analysis over the last 18 months in a five-county area.

The goal is to alleviate staff and resource strains when patients with mental health issues arrive at hospital emergency rooms. Often such arrivals require a case worker from New River Behavioral Health and a law enforcement officer. If the patient has to be sent to the nearest state psychiatric hospital, Broughton in Morganton, McDevitt said the intake process lasts from 12 to 24 hours, meaning the staff time for those accompanying the patient increases the cost.

“This will ease the load at Broughton,” McDevitt said. “It will also serve the community, and the real impact is on people and families who will have more compassionate care. That waiting time is reduced to five or six hours, so they get the care they need in a timely manner.”

The additions of beds at the two hospitals were part of a pilot program designed to ease the burden on state hospitals. Only four local management entities received the grants, and McDevitt said it could serve as a useful model for other parts of the state and also hopes to add some psychiatric units at a third hospital, possibly in Wilkes County.”The involvement of SMC as management entity to handle indigent patients was critical in making the idea workable.

Chuck Mantooth, CEO of Cannon Memorial Hospital, said Cannon closed its psychiatric unit in 2005 due to variety of reasons such as financial viability and changes in certification involving the hospital’s reimbursement method from Medicare.

The involvement of SMC makes the psychiatric unit fiscally viable again, and it’s likely SMC will have a role in admissions to Cannon’s unit to streamline the reimbursements.

“This will meet the community needs for behavioral health services,” Mantooth said. “The pilot project provides a way of funding care that wasn’t available before.”

The 30-to-40 percent of patients who don’t have private insurance, Medicaid or Medicare are traditionally difficult to collect from, straining financial projections. “Hopefully this is part of a long-term solution for in-hospital behavioral health,” Mantooth said. “If mental health patients present in the ER (emergency room), emergency room folks aren’t specifically trained in that field, and through our relationship with New River Behavioral Health, we’ll provide good crisis management to direct the patient’s care to the most appropriate place.”

The unit is expected to serve Ashe, Alleghany, Avery, Watauga and Wilkes counties. Mantooth said the majority of admissions would be suffering from depression, anxiety, or substance or alcohol abuse. The average length of stay for each patient is expected to be approximately seven days, with would allow assessment time to determine whether patients need longer care or follow up through the most appropriate outpatient service. Having the unit in the hospital would also help those with mental health issues who are also suffering secondary medical problems.

“We want to get them (units) up and running and see if they can be financially successful,” McDevitt said. “If the model is successful, it could move more funding out of Broughton and into community hospitals.”

Other benefits include easier access for families, shorter drives and more community and local agency support available for patients. “This is a major solution to a lot of the reform challenges,” McDevitt said. “There is extreme pressure on sheriffs’ departments. There will be a much better continuum of care, better discharge planning. There are a lot of compelling reasons why the state has put forth this pilot program.”

Mantooth added, “We see this as an opportunity and really want to be a leader in western North Carolina. We do that through providing services and through our partnerships with local agencies.”