The combination of mental health beds, crisis services and a psychiatric emergency room in one region of South Carolina could create a model for the entire state, health officials said.
The Department of Health and Human Services is leading 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 at the end of August and will meet again at the end of September, with monthly meetings to follow.
The initial focus is on creating a behavioral health care system in the Pee Dee area that includes new mental health hospital beds. The state averages one such bed per 2,600 people, but in Pee Dee it’s close to one per 7,000, HHS Director Robbie Kerr said.
The department has $65 million in funding from the state legislature for the effort, but could also spend other one-time funds it has, in partnership with MUSC and McLeod Health.
“This is one of the most underfunded areas for inpatient beds in the state,” Kerr said. “So we’re going to address that and MUSC is working very closely with us to put in place proposals that we hope to fund…very quickly to get that in place.”
Where he will go in the region is still being determined. MUSC and McLeod envision several sites in and around Florence.
The goal is to have a plan by January that could be presented to the governor and the legislature, he said.
“I’d like to start in January by saying, ‘You’ve spent your money well with us in the sense that we’re bringing plans to you for the legislature to see,'” Kerr said.
Model of mental health care
Planning and building inpatient beds will take the longest time, but a host of other details about the model are still being worked out, said Dr. Patrick J. Cawley, CEO of MUSC Health System.
“Not everyone needs hospitalization (treatment),” he said. “Some people will be fine in a crisis stabilization center. Some people will be fine with a quick stop in a psychiatric emergency room.”
The state has already identified a lack of Crisis Stabilization Units, centers where patients can go for a short, intensive treatment stay, as a real need for South Carolina; the only such unit is in Charleston and it is currently operating at half capacity. SC’s mental health department has been working to establish more across the state, with talks in Columbia, Greenville and Anderson at various stages.
The Pee Dee model will also look to create new units, but with an eye on connection, Kerr said.
“We would like to build them and network them” with other mental health resources, like mobile crisis teams, he said.
The idea of a dedicated psychiatric emergency room is also a new concept that needs to be considered, Kerr said.
“Do we have dedicated mental health emergency rooms and how do they handle referrals?” he said. “That’s going to be the big focus of the committee initially.”
It’s a problem MUSC faces “every day,” Cawley said. “I speak every day, there are 20 to 30 patients boarding our emergency room (waiting for a room), just in Charleston, the majority of those patients (having) biobehavioral issues.”
It’s happening all over South Carolina, he said.
“It happens in every emergency room in the state to one degree or another,” Cawley said. These hospitals are looking for solutions, and the goal of Project Pee Dee is to try to put together something that will work for them, Kerr said.
“We kind of use the Pee Dee as an incubator for that,” he said. “Although the network that we’re hoping will be statewide, we’re going to be testing things in the Pee Dee, using that as a model, with a desire to roll things out hopefully very quickly across the country. ‘State.”
This includes consideration of important issues, such as whether the psychiatric emergency should be next to the regular emergency, where crisis stabilization is located, and where outpatient clinics are located in relation to beds. of hospitalization, Cawley said.
Connection is key to the model and providing the right care at the right time, said Dr. David J. Cole, president of MUSC.
“It’s about access and continuity of care. Those are the first steps,” he said. It’s one thing to have a stabilization of the crisis, but “it’s not okay, if you’re in crisis mode, to have an appointment to follow you in four months,” Cole said. “It just doesn’t work.”
It also means addressing the opioid crisis and ensuring mental health services don’t exclude drug and alcohol treatment, Kerr said. Some estimate that around half of all mental health patients also have a substance abuse problem and vice versa, he said. But because of the way these services are currently structured, “we isolate and silo these treatments,” Kerr said. “We have to figure out how to bring these services together in a (common) framework. This is a challenge that we will be looking at very closely.”
It’s a real problem for mental health care providers right now, Cawley said.
“We come across this all the time,” he said. “We have a patient, we refer him to a provider and he’ll say, ‘I don’t treat anyone with alcohol or drug addiction (problems). Or vice versa.”
Even as they seek to revamp the system, Palmetto State faces a severe shortage of providers. As of Sept. 9, the state’s Community Mental Health Services Division had 515 vacancies, mostly clinical positions, in part due to a lack of competitive salaries, said Deborah Blalock, deputy director of the division. While there’s no quick and easy solution to this labor problem, there are better ways to use the state’s existing resources, Cole said.
“We’re being creative in terms of changing the model” of care, he said. “We have huge strengths in terms of telehealth, which has a huge impact on the delivery of behavioral health care and leverages our providers. I think it’s more of a long-term commitment to train more providers, but changing the model of care is provided will help the workforce meet the need over time.”
Heads of state recognize this and were ready to support it when asked to help fund workforce development last year, said Mark Sweatman, head of government affairs for MUSC.
“Legislatively, I’ve never seen an issue receive so much support, from the Governor, Director Kerr, the legislative leadership, the House and the Senate, they’re all on the same page” , did he declare. “They granted that in the blink of an eye.”
From a hospital perspective, there is great value in having a new model to address the current lack of crisis services, Cawley said.
“I don’t see it as a MUSC thing at all,” he said. “Other hospital systems are getting involved. There’s a lot of interest. I’m hearing it through the hospital association.”
Nor can it be the job of the state to run and fund it, Kerr said.
“If we try to handle this as a public initiative, it will fail,” he said. “This must be an initiative at all levels, for all suppliers.”
Doing nothing is no longer an option for anyone now, Cole said.
“In my opinion, we are on the cusp of a behavioral health crisis, a tsunami, whatever term you want to use,” he said. “We need to address this. It affects our society on so many levels.”
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