Need for mental health help seen in Caldwell ER

June 12--A visitor to Caldwell Memorial Hospital last Tuesday would have found that the waiting room in the emergency room was packed.

The ER that day was a prime example of one of the strains on the health care system: There was "a particularly high volume" of mental health patients, taking up five of the 14 beds in the emergency department that day, said Rebecca Smith, chief operation officer and chief nursing officer at Caldwell UNC Health Care.

"This challenge that all of the hospitals have across the state with mental health is and continues to be a serious issue for us, because it takes up our beds in our ED (Emergency Department)," Smith said. "Every day, we have mental health patients. It's more the norm than an exception."

The mental health cases that wind up in emergency rooms often are involuntary commitments, in which a person is ordered to get a medical evaluation to determine whether he is a danger to himself or others.

The volume of such cases has both law enforcement and emergency room staff looking forward to the 24-hour mental health and addiction urgent care and crisis center that is expected to open in late 2016. The center, now under construction alongside RHA Behavioral Health Services on Morganton Boulevard, will provide a place for mental health patients to be held as they are evaluated, rather than in the emergency room.

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HEALTH

Caldwell County Sheriff's Office deputies spent a combined 763 days, 2 hours, and 25 minutes in the emergency room on mental health calls, most of which were involuntary commitments, from March 2014 through January 2016, Capt. B.J. Fore said. In 2014, there were 283 involuntary commitments, and in 2015 there were 249.

"A lot of times we get called out ... to provide security for EMS" for what began as a medical emergency call, Fore said. If the patient displays behavior that could make him a danger to himself or to others, officers can go to a magistrate and ask for an emergency commitment order. If the patient is nonviolent but having mental health issues, deputies can call RHA Behavioral Health Services and request a crisis team to come evaluate that patient, and an involuntary commitment may not be necessary.

If the order is issued, deputies not only escort patients to the hospital but also must wait there for the evaluation.

"A short stay at the hospital (for a deputy) is six hours. The average is probably about 12," Fore said.

If the evaluation determines the patient is not in immediate danger, deputies can leave the hospital and check in on the patient every two to four hours. But for those thought to be a danger, a deputy must remain at the hospital.

Then, if it's determined if the patient needs to be placed in a mental health unit of a hospital, deputies must take the patient to that facility.

"That process sounds simple, but it's not," Fore said.

The nearest inpatient mental health units are at Frye Regional Medical Center in and Broughton Hospital in Morganton, he said.

"If we have a child, we have to go to Jacksonville," where there is one that accepts children, Fore said. It's about a six-hour drive each way, so two deputies must go.

In addition, once someone who has been committed to a mental health facility completes treatment and is discharged, if the patient has no one who can come get him, then a deputy must do it and take him home.

"We do a lot of return trips," Fore said.

Other law enforcement agencies in Caldwell County field fewer mental health calls than the sheriff's office, but they also feel the burden.

The Lenoir Police Department handled 111 involuntary commitments in 2014 and 104 in 2015, Capt. Brent Phelps said.

Lt. Chris Jenkins of the Granite Falls Police Department said that while Granite Falls had 13 in 2014 and just 12 involuntary commitment cases in 2015, "I don't think these numbers really tell how much we deal with mental health patients."

"We spent over 2,100 hours last year on calls ... dealing with mental health," he said.

In Hudson, there were 11 involuntary commitments in 2014 and 18 in 2015.

When the new mental health crisis center opens, patients will be able to be brought in 24 hours a day, said Rachel E. Leonard-Spencer, marketing and communications coordinator for Smoky Mountain MCO, the health care management organization that contracts with RHA. It will have 12 beds for people who need to stay at the center while receiving treatment for a mental health crisis or who need to detox from alcohol or drugs.

The center will save money that the county might have spent transporting patients or paying deputies to stay with them. The center will "have security on site, and that will be part of the operational cost of the building," Spencer said. "Sheriff's deputies (and others) should see themselves spending less time transporting people who are under an involuntary commitment order and also less time waiting with people in emergency departments."

"It's truly a community project that will benefit all of Caldwell County and help local residents get quality treatment without having to drive far distances," she said.

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