Two weeks ago today, Mickey Coffino and her family re-entered the maze of Charlotte-Mecklenburgs emergency mental health care.
For the third time in a year, Coffinos teenage daughter tried to kill herself, overdosing on the medication she takes for her mood disorder. Police found the girl in her high school parking lot, and medics rushed her to Carolinas Medical Center.
What followed, Coffino says, was a crisis experience that left her stunned by the lack of resources and coordinated care for Charlotte-Mecklenburg residents coping with a mental illness emergency.
Theres a real disconnect here that I wouldnt wish on anyone, Coffino said in her home near uptown. Mental illness is seriously underfinanced, understaffed, underinsured and misunderstood.
Mental health advocates and patients recognize the breakdown of care she describes. As North Carolinas state mental health system undergoes its third major overhaul since 2001, emergency rooms and police are left with a growing role in crisis care. Chronic shortages of psychiatrists and hospital beds exacerbate the problems of providing care to the estimated 14 percent of residents who need behavioral help.
The nations conversation about caring for the mentally ill took on more urgency in December after a gunman with lifelong behavioral problems killed 20 schoolchildren and six adults in Newtown, Conn. Since then, state after state has examined its safety net and found already strained systems weakened from recession-driven spending cuts.
You stop somebody on the street, and somewhere in their family is someone with a form of mental illness, says Mecklenburg Sheriff Chipp Bailey. Its not somebody elses issue. It touches everybody, and we really need to do a better job in this state trying to get these people help.
Change and shortages
North Carolinas chronic revamping of its mental health system means thousands of people who need care dont know how to find it, experts say.
Struggling to meet round after round of new state requirements, many providers have merged, changed names or closed. That drives more people to the familiarity of the emergency room. Or they stop seeking treatment altogether, which means police intervention becomes more likely.
A statewide study of emergency departments shows that mental health visits are increasing far faster than the overall traffic. The average length of stay has also jumped sharply. Longer waits in a chaotic ER atmosphere raise the likelihood that a mental health crisis will worsen. The threat of injury to patients and hospital staff also grows.
Since 2000, the number of psychiatric beds in Mecklenburg County has declined because two private hospitals closed. The 66 beds in CMC-Randolph on Billingsley Road are chronically filled, meaning many families must drive hundreds of miles or even leave the state to find long-term care.
More practicing psychiatrists have opted to leave public and private insurance networks rather than accept shrinking reimbursements, deepening a shortage of psychiatrists.
Duke Universitys Marvin Swartz, an expert in community psychiatry, says many behavioral patients cant afford to pay full price for psychiatric care, which adds to the pressure on emergency rooms. The doctor shortage often leads to longer emergency room stays as hospitals scramble to find consulting psychiatrists.
Often, patients are stuck in emergency rooms because theres nowhere else to send them. One mentally ill man has waited for almost a month at Presbyterian Hospital.
We cant find him any place to go, said Dr. Greg Clary, who was recently named head of Presbyterians psychiatric unit. For whatever reason, resources in this state make finding this guy a decent place to get help next to impossible.
Tension in front lines
Police and emergency rooms have long made up the first-wave of crisis mental health care, even if their training, budgets and staffing limit what they can provide. They handle thousands of cases peacefully, but behavioral situations can turn volatile.
Two men with histories of mental illness were shot and killed during standoffs with Charlotte-Mecklenburg police in the past six months. Both times, family members had called for help as their loved ones lost control.
Emergency rooms, like police, must make quick judgments. In a 2010 case that defined the risks, Kenny Chapman twice told clinicians at CMC-Randolph, which has the states only psychiatric emergency room, that he wanted to harm or kill his wife. On both occasions, he was sent home with medication after he said he wouldnt act on his threats. After the second time, he killed his wife and two of his children, and then, during a police confrontation two weeks later, himself.
With more people in need, and such a high price for failure, the strain on police and emergency rooms has generated tension between them.
The hospitals say they provide good crisis care and are working to expand capacity; police suggest hospitals could do more.
Too often, the hospitals attitude is to get them on their meds and get them out the door, says Charlotte-Mecklenburg Assistant Police Chief Eddie Levins. You drop them off on Billingsley Road (at CMC-Randolph), its a crapshoot. You dont know whats going to happen.
Bailey, Mecklenburgs sheriff, says the delays with psychiatric crisis care mean deputies sit for hours in emergency rooms while jail inmates wait for help. Were not going to babysit folks because the hospital cant get to them in a certain period of time, Bailey says. This is not unique to Mecklenburg County. This is a problem all over the state.
Carolinas Healthcare System, which is responsible for public care and thus draws more criticism, plans to add a new psychiatric hospital near Davidson in 2014. In a prepared statement, the hospital system said it is committed to continuing its substantial efforts in providing care to these patients who need it so desperately.
Clary of Presbyterian says the staff there is under the same pressure as all medical providers to help patients as efficiently and expediently as we can.
But at no time in his career has anyone told him not to take someone or to get somebody out, he says. I wouldnt have come here if I didnt believe there was a commitment to psychiatric care.
Better support needed
When Mickey Coffino found her family in a mental health crisis, she called the police and wound up in the nearest emergency room.
After the ambulance delivered her daughter to CMCs emergency room, which is Mecklenburgs major trauma center, Coffino learned there was no psychiatrist on weekend duty.
She and her daughter spent six hours waiting while hospital staffers sought a psychiatrist. They tried and failed to use Skype, a video phone call, to consult with the doctor, Coffino said. In the end, her daughter didnt see a psychiatrist until Monday afternoon.
She remained hospitalized for most of the next week while her mother searched for longer-term care. CMC-Randolph had no open beds, and no residential-treatment facilities in North Carolina accepted her ex-husbands insurance. One treatment center wanted $50,000 a year.
She ended up finding a place near Knoxville, Tenn., 250 miles from Charlotte. Insurance will pay for the first 30 days. She doesnt know what will happen after that.
Mickey Coffino believes she needs a better support system for her daughters care. For now, she believes, she has to build it herself.
Staff Writer Jim Morrill contributed.
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