New Crisis Network, Mental Health Coverage Model May Come Out of SC Task Force | Health

Combining mental health beds, emergency services and a psychiatric emergency room in the South Carolina region could create a model for the entire state, health leaders say.

The Department of Health and Human Services is forming a task force that includes the Medical University of South Carolina and other health care systems and state agencies. The group held its first meeting in late August and will meet again in late September following monthly meetings.

The first focus is on creating a behavioral health care system that includes new mental health hospital beds in the PE region. The state averages about one of those beds for every 2,600 people, but it’s closer to one for every 7,000 in Pee Dee, HHS Director Robbie Kerr said.

The department received $65 million in funding for the effort from the state Legislature, but could use other one-time funds in partnership with MUSC and McLeod Health.

“It’s one of the areas in the state that is under-resourced for inpatient beds,” Kerr said. “So we’re going to fix that, and MUSC is working very closely with us on developing ideas that we’re going to fund … to get that up and running.”

It is still being investigated where he will go in the area. MUSC and McLeod are considering several sites in and around Florence.

The goal is to come up with a plan that can be presented to the governor and the legislature in January, he said.

“I want to go into January saying you’ve spent your money wisely with us in the sense that we’re bringing plans to the Legislature,” Kerr said.

A model for mental health care

Planning and building patient beds will take a long time, but many other details on the model are still being studied, said Dr. Patrick J. Cawley, CEO of the MUSC Health System.

“Not every patient needs (treatment),” he said. “Some people will be fine in a crisis center. Some people will be fine in a quick psychiatric emergency room.”

The state has already identified a shortage of crisis stabilization units, centers where patients can go for short-term intensive care, as a real need in South Carolina; The only such unit is in Charleston and is currently operating at half capacity. The SC Department of Mental Health is working to establish others across the state, with talks at various levels in Columbia, Greenville and Anderson.

The PED model looks at creating new units but also at relationships, Kerr said.

“We want to build those and connect them,” he said, along with other mental health resources like mobile crisis teams.

The idea of ​​a dedicated psychiatric emergency room is also a new concept to consider, Kerr said.

“Do we have emergency rooms for mental health and how do they handle referrals?” he said. This will be the primary focus of the committee.

It’s a problem MUSC deals with “every day,” Cowley said. “I’m talking about 20-30 patients a day in our emergency room[waiting room]just like in Charleston, most patients (with biobehavioral problems).”

It’s happening all over South Carolina, he said.

“This is happening to one degree or another in every emergency room in the state,” Cowley said. Those hospitals are looking for solutions, and the goal of the PED project is to try and put together something that works for them, Kerr said.

“We’re using the PD as our incubator for this,” he said. “Although we’re hoping the network will be statewide, we’ll be testing things in PE as a model with the desire to get things moving quickly across the state.”

That includes looking at important questions, such as whether the psychiatric ER should be next to the regular ER, where crisis stabilization should be, and what outpatient care clinics should have in terms of inpatient beds, Cowley said.

Treat addiction

Communication is key to the model and providing the right care at the right time, said MUSC President Dr. David J. Cole.

“It’s about access and continuity of care. These are the first steps,” he said. It’s one thing to calm a crisis, but “if you’re in a crisis, it’s not acceptable to make an appointment to follow up with you in four months,” he said. “It just doesn’t work.”

It’s also about tackling the opioid crisis and making sure mental health services don’t include drug and alcohol treatment, Kerr said. Some say that roughly half of all mental health patients also have substance abuse problems, and vice versa. But because of the way those services are currently structured, “we’re going to isolate those treatments,” Kerr said. “We need to figure out how to bring those services together in one (joint) context. That’s one challenge we’re looking at closely.”

That’s a real problem for mental health providers right now, Cowley said.

“We run all this time,” he said. “We have a patient, we refer them to a provider and say, ‘I’ve never had anyone with alcohol or drug abuse (cases).’ Or vice versa.”

Filling the gaps

While they are looking to improve the system, the Palmetto State is facing a severe shortage of providers. As of Sept. 9, the state’s Department of Community Mental Health Services had 515 vacancies, mostly clinical positions, due in part to a lack of competitive salaries, said Deborah Blake, the department’s deputy director. While there may not be a quick and easy solution to that workforce issue, there are better ways to use the state’s existing resources, Cole said.

“We are innovative in changing the model” for care. “We have great strengths in telehealth, which is having a huge impact on behavioral health delivery and leveraging the providers we have. It’s more of a long-term commitment to train more providers, but it’s about changing the model of how care is delivered. The workforce that’s provided will match what’s needed over time.” It helps to adapt.

State leaders understand that and were ready to support last year when they were asked to help fund workforce development, said Mark Sweatman, MUSC’s chief of government affairs.

“I’ve never seen an issue have so much support from a legislative perspective, with the governor, Director Kerr, legislative leadership, the House and Senate all on the same page,” he said. “They gave that in a heartbeat.”

From the hospital perspective, there is a great need for a new model to respond to the current crisis of underserved care, Cowley said.

“I don’t see this as a MUSC thing at all.” “Other hospital systems are getting involved. There’s a lot of interest. I’m hearing from the hospital association.”

It can’t fall on the state to run it and fund it, Kerr said.

“If we try this as a public initiative, it will not succeed,” he said. “It should be an initiative for all providers across the board.”

Doing nothing is not an option for anyone now, Cole said.

“In my opinion, we’re on the leading edge of a behavioral health crisis, a tsunami, whatever term you want to use,” he said. “We need to address it. It affects our community on so many levels.”