Telemedicine Initiative Could Deliver Mental Health Services More Effectively | Eastern North Carolina Now

   Publisher's note: The author of this fine report, Dan Way, is an associate editor of the Carolina Journal, John Hood Publisher.

Proposal outlined in House Bill 580 due for hearing Tuesday

    RALEIGH     North Carolina's mental health system is "very fragile," straining beneath the weight of psychiatrist shortages, emergency rooms overflowing with the mentally ill, and a Medicaid program whose structure too often fails to aid the behavioral disorder population in a timely, cost-efficient, and appropriate manner.

    State Health and Human Services Secretary Aldona Wos issued that sobering assessment at a recent town hall session in Greensboro to familiarize medical providers with the Partnership for a Healthy North Carolina. That is the new program the McCrory administration has created to replace the bulk of the state's present Medicaid delivery network.

    "Right now in North Carolina there are emergency rooms that literally have all 15 or 12 of their acute care beds filled with behavior disorderly patients, with a police officer or a sheriff right next to them for not a few hours but days, literally days in the emergency room ... where the staff is assaulted, when we're trying to protect the staff, and trying to care for the patient, and trying to figure out where to move the patients to," Wos said.

    "And there is no place to move them to. There are such enormous issues we have right now with this situation. We're trying to figure out how can we have community behavioral health expanded in our communities" to attack that dilemma, Wos said.

    "From the perspective of the provider community ... there are great hurdles for you" created by the state government, Wos said.

    The system is unsustainable in part because it compartmentalizes Medicaid patients' needs under several caregivers rather than consolidating them under one care manager for coordination of all physical, dental, and mental health services as Partnership for a Healthy North Carolina would do, she said.

    "If you are seeking medical care and if you also have to seek any form of mental health care or substance abuse [treatment] you have several hurdles," Wos said. "It's a pretty complicated system for the people who need the care."

    The Department of Health and Human Services operates its own facilities and psychiatric hospitals, but they are short staffed.

    "I have a 20 percent vacancy rate for doctors, and an 18 percent vacancy rate for nurses," Wos said.

    "I can tell you in reference to psychiatrists, for the state, we are desperately in need," she said. "Our mental health care system right now in North Carolina is very fragile."

    Efforts are under way "to figure out how to pump out more psychiatry residents," she said. "The training is years but it has to start some place."

    In the interim, officials are looking at ways to incentivize doctors to resettle "in our vulnerable zones," and especially to lure psychiatrists to locate in eastern and western North Carolina, which are "very vulnerable," Wos said.

    Her department is hoping to reduce some of the burden by launching a statewide telepsychiatry program based on the successful model created in 1992 by East Carolina University and now serving 13 counties of Eastern North Carolina.

    Officials at emergency rooms or jails would be able to connect with psychiatric professionals in real time via two-way video for assessments and care instructions. Such a system could reduce the time it takes for a patient to receive care, and free up emergency room and psychiatric hospital beds much faster, reducing costs.

    Sy Atezaz Saeed, John Diamond, and Richard M. Bloch, professors in the Department of Psychiatric Medicine of the Brody School of Medicine at ECU, long have recommended the expansion of the telemedicine project around the state.

    "Telepsychiatric services are comparable to those delivered face-to-face, and there are no data to suggest that these services are harmful to psychiatric patients, whether they are children or adults," they wrote in the June 2011 edition of the North Carolina Medical Journal.

    Telepsychiatry services "are acceptable and, sometimes, even preferable to individuals in both outpatient and facility-based settings. Telepsychiatry appears to be a viable option for providing psychiatric care to groups that are currently underserved," they wrote.

    The state House Committee on Health and Human Services is scheduled to debate House Bill 580 at 10 a.m. Tuesday. The measure would allocate $2 million in both 2013-14 and 2014-15 to establish and administer a statewide telepsychiatry program, purchase the necessary equipment, and contract with an outside vendor for management.

    The program would be modeled after one managed by the Albemarle Hospital Foundation, which partners with ECU's medical school and other organizations.

    "Institutional care is our highest cost," said Medicaid Director Carol Steckel. Often, in the absence of a psychiatrist's consultation, "the default crisis decision" is not the least expensive or best option. The telepsychiatry program should curtail that problem.

    Steckel said Medicaid and the Community Mental Health division will work together to prepare a new model of mental health and substance abuse services under Partnership for a Healthy North Carolina.

    The new program's "continuum of care in co-locating behavioral health and physical health together" will allow county mental health programs to tap into Medicaid to receive more money than they do now, even if it's not a full Medicaid benefit.

    The care continuum would help defuse the cycle of patients receiving county services, going to jail, being released, and receiving county services again, Steckel said.

    "If we can create a system that's more efficient, then the dollars that the counties, and the LMEs [local management entities], and the state is spending that is not Medicaid, [money] can go further and provide more services," she said.

    During the Greensboro town hall meeting, one man who identified himself only as a provider of Medicaid and Medicare services for dual-eligible patients said providers are skeptical about the new system.

    "Based on our experience as Medicaid providers we have seen this state destroy -- and I don't mean mess up -- destroy a functioning mental health system, and watched people die, commit suicide in the emergency room, die at home, die in their apartment," he said.

    "That is a very negative experience," he said. "We have seen people die as a result of state intervention. So I will tell you bad things happen. Very bad things."

    "It is a nightmare," Wos agreed.