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Background

North Carolina's management and delivery of mental health, substance abuse, and developmental disability services (MH/SAS/DD) has undergone many changes since the 2001 Mental Health Reform System Act. As of December 2013, the McCrory administration announced that the state's eleven current LME-MCOs will be further condensed down to four regions.

Analysis

State-created and funded, with boards appointed by county commissioners, LMEs direct patients to appropriate care, build networks of providers, and ensure patients receive care from one of those providers. LMEs contract with Managed Care Organizations (MCOs) to deliver authorized services to MH/SAS/DD patients.

County commissioners cannot control mental health funding, but they can utilize the Crisis Solution Initiative. Its goal is for localities to establish programs to anticipate crisis episodes among the mentally ill rather than resorting to unnecessary, costly ER visits or incarceration. Many seriously mentally ill patients end up in jail for public nuisance, sometimes violent, crimes.

Localities should work with their LMEs, law enforcement, and community leaders to utilize their MH/SAS/DD funds to efficiently direct the severely mentally ill to proper care. This early intervention will help the mentally ill become productive members of society.

Crisis solution initiative principles

Wake and Durham counties have implemented Crisis Intervention Teams (CITs), and the state chapter of the National Alliance on Mental Illness (NAMI NC) has co-hosted statewide seminars on the program.

Walk-in crisis centers are often good alternatives to emergency departments in crisis cases. They decrease ER visits and allow access to short-term residential beds for those who need a few days of crisis intervention for stabilization of mental health or detox. Alliance and Assessment Centers are located across the state.

A goal of the Crisis Solution Initiative is for localities to reduce ER visits, wait times, and readmissions. This provides better care for patients, saves money, and reduces the burden on law enforcement and hospitals.

Key facts

• Nationally, 17 percent of inmates have a mental illness.
• In 2013, 150,000 emergency admissions resulted from primary MH/SAS/DD diagnosis.
• In 2013, the average wait time in an emergency department for state hospital admission was 3.52 days.
• In 2012, 13% of mentally ill Medicaid patients revisited the emergency department within 30 days.

The entire 2014 City & County Issue Guide, is available for download as a 3.6MB Adobe Acrobat file.
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