Mental health pilot program proposed for NHRMC
Star-News - 4/11/2017
April 11--WILMINGTON -- Lisa Estep's family member was frantic. After two days in the emergency room at New Hanover Regional Medical Center (NHRMC) during a mental health crisis, an armed escort came to the woman's room, telling her she was being forced to move and giving her no explanation.
The woman is learning disabled and has a history of a mental health disorder, Estep said. Because the woman had inadvertently checked a box saying hospital staff couldn't share her medical treatment, Estep -- while being begged to help by the family member -- was frozen out of any information by hospital staff looking to maintain the woman's privacy.
"I was given no chance to know what was happening or understand why," Estep said. "They created hysteria."
Estep, a member of the New Hanover County School Board, finally reached a member of the hospital's board of directors, who helped her get permission to act on her family member's behalf.
That was the third time her family member had been at NHRMC's emergency room for a mental health issue. She'd had records taken before of her history.
"At no time ... did the records follow her," Estep said. "None of that (history) came through."
That led to more problems trying to navigate mental health services and insurance requirements following the difficult day at the emergency room, Estep said.
"It's impossible to put into words how distressing it was," she said.
The frustrating experience led Estep to share her story with a committee formed by N.C. Sen. Michael Lee, R-New Hanover, that resulted in legislation, Senate Bill 334, co-sponsored by Lee and Sen. Bill Rabon, R-Brunswick. The bill would set up NHRMC as a pilot program for an in-house, multi-pronged approach to handling such mental health issues. N.C. Rep. Holly Grange, R-New Hanover, has filed a companion bill in the House.
Breaking down silos
"The mental health issue is so difficult," Lee said. "The reason (taking steps to address mental health) is different now is because we've gotten all of the stakeholders engaged and included."
Lee said he wanted to take action this legislative session to address problems with delivering mental health services. But Lee, a real estate attorney, said he didn't know much about how to treat those suffering from mental illnesses.
"I really wanted to find a way to keep people out of crisis and improve outcomes," he said. "Improving outcomes is what it's all about. The efficiencies are just a byproduct of this collaboration."
What he was told by experts, Lee said, was that there were numerous individual agencies or services doing good work, but none of them were working together well.
"Everything is so siloed," he said. "They all weren't really rowing in the same direction."
"There was no concerted effort," Grange said. "The goal in this was to hopefully bring everybody together and help people get the services they need from whatever organization is able to provide that."
So Lee brokered a meeting of medical and mental health experts to come up with ways to work together and find solutions.
"It's about breaking down the silos," he said.
Legislative first step
The bill would provide $500,000 over two years to pay for three new positions through the hospital -- a peer counselor who has lived the experiences of those needing services; a clinician to conduct critical care assessments; and a "central navigator" dedicated to helping patients and families find appropriate help among the region's mental health services. The three-member team would operate out of the hospital and at Wellness City by Recovery Innovations, according to the bill.
It helps the idea's cause that Rabon is involved -- he was appointed chairman of the Senate Rules Committee, a powerful post that controls the flow of legislation in the Senate.
Rabon said he believed the hospital was ideal for the pilot program.
"They just seem to have the ability to do things right," he said.
Lee said he didn't view the legislation as an end point or a cure-all.
"There is still a lot of work to do," he said.
Scott Whisnant, community relations manager at New Hanover Regional, agreed.
"This won't solve our problem," he said. "This is a starting point."
Uncrowding the emergency room
Whisnant walked through the hospital's emergency room on Friday, when he said the emergency room was "not as busy" as usual.
He walked past several patients lying on gurneys in the hallways and gestured toward a row of about 20 blue clipboards at a nurses' station.
"Those are for patients waiting to be seen" for emergency room services, Whisnant said.
Increasing demand for mental health services has taxed the emergency room, with as many as 15 to 20 people at a time waiting for mental health treatment. And that is on top of the injuries and other physical trauma treated in the ER, he said.
"It's overwhelming our system," Whisnant said.
He said the navigator and peer support counselor would help the hospital "find out where our real gaps are" in delivering mental health services.
"We hope it will help get patients out of our emergency room who are awaiting mental health services," Whisnant said. "There's nobody in our emergency room (right now) who is going to be able to do that."
He said patients can often wait for days before finding an appropriate mental health service outside of the emergency room. Estep said her family member was in the ER for two days "and was seen by a physician assistant once for about 15 minutes."
"The emergency room is not a place you want to stay a long time if you can help it," Whisnant said.
He said wait times could also be reduced by having the clinician conduct a critical-care assessment, followed by the central navigator helping patients get where they need based on need and ability to pay -- whether through private means or insurance.
"We want to create somebody here who knows who's available, who's got a waiting list, who has immediate availability, what do they treat and what payer mix will they take," Whisnant said.
Removing the stigma
"With the community working together, it kind of breaks down the stigma a little bit," Grange said. "Because, let's face it, mental health services have a certain stigma."
And that's why Estep said she came forward with her experience.
"I'm tired of the stigma," she said.
Estep said she was in the room to remind officials of an important point of view.
"It's not just this clinical perspective," she said. "Those individual patients are people who are going through a mental health crisis."
Estep said she is fortunate that she has the kind of connections that result in having the personal phone numbers of state senators and hospital board members saved in her smartphone. But she said she still had a frustrating, aggravating experience that should be far easier.
And she said Lee's initiative to get the pilot program moving should result in people dedicated to helping patients and families navigate what is now a mental health maze.
"If I can't find it (even with) my status and my kind of tenacious nature, then I don't know how somebody with a mental health crisis can deal with it," Estep said. "There is nobody to fight for that person in the hospital. There's nobody there to care. There's nobody there to protect them."
Reporter Tim Buckland can be reached at 910-343-2217 or Tim.Buckland@StarNewsOnline.com.
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