Over the past decade, the number of patients seeking behavioral health care in North Carolina’s emergency departments, and the length of time they wait for treatment, has increased four-fold. Roughly half of NC hospital emergency department beds are consistently filled with patients with behavioral health needs, many of whom are involuntarily committed to treatment. Many NC hospitals, and especially the small and rural facilities, struggle with inadequate staffing and physical space to support individuals experiencing a behavioral health crisis. Extended emergency department boarding carries serious consequences for both the individual and the state’s safety net resources, as mental health conditions are likely to rapidly deteriorate in non-therapeutic settings.
Despite the odds, NC hospitals are developing innovative and promising solutions, including: creatively repurposing the role of the sitter to initiate therapy in the emergency department, constructing divided child and adult waiting areas using age- and disability-appropriate supportive equipment, and applying the patient-centered behavioral health urgent care model in the ED. NCHA is working to identify, standardize and disseminate these and other evidence-driven practice changes, while concurrently designing policy solutions to support implementation. Our work falls into the three broad objectives of 1) preventing unnecessary emergency department visits 2) improving the flow and care of patients after ED arrival and 3) promoting strong transitions into community-based care. Ultimately, reforms are intended to drive behavioral health in NC toward a true comprehensive system, where care is timely and appropriate, delivered by skilled practitioners, coordinated from prevention to treatment, and funded on par with medical services.
We have added a Behavioral Health section to our website, designed to serve as a summary of resources to support your work. As always, please share your ideas as we continue to build the site and our broader agenda of reforms for a more compassionate system of care.
– Julia Wacker, MSW, MSPH, Vice President, Community & Behavioral Health, NCHA