Taken from the Charlotte Observer which is located HERE.
Two weeks ago today, Mickey Coffino and her family re-entered the maze of Charlotte-Mecklenburg’s emergency mental health care.
For the third time in a year, Coffino’s 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.
“There’s a real disconnect here that I wouldn’t 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 Carolina’s 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 nation’s 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. “It’s not somebody else’s 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 Carolina’s chronic revamping of its mental health system means thousands of people who need care don’t 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 University’s Marvin Swartz, an expert in community psychiatry, says many behavioral patients can’t 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 there’s nowhere else to send them. One mentally ill man has waited for almost a month at Presbyterian Hospital.
“We can’t find him any place to go,” said Dr. Greg Clary, who was recently named head of Presbyterian’s 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 state’s 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 wouldn’t 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), it’s a crapshoot. You don’t know what’s going to happen.”
Bailey, Mecklenburg’s sheriff, says the delays with psychiatric crisis care mean deputies sit for hours in emergency rooms while jail inmates wait for help. “We’re not going to babysit folks because the hospital can’t 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 wouldn’t have come here if I didn’t 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 CMC’s emergency room, which is Mecklenburg’s 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 didn’t 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-husband’s 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 doesn’t know what will happen after that.
Mickey Coffino believes she needs a better support system for her daughter’s care. For now, she believes, she has to build it herself.
Filed under: Christian Counseling, Christianity, Mental Illness
Where does one begin when commenting on such as this? It breaks my heart to read this article. First of all, it is not just a problem in North Carolina. It is everywhere. Personally, I know of two people here in Florida who died from suicide because they were released from the hospital on their word alone that they would take their meds. I truly believe that if a study would take place on the anti-depressants, etc…that is would reveal much. Many people die by their own hands while ON the medications that come with a warning that one of the risks is SUICIDE. (They also die by withdrawal from these same drugs.) The packaging insert has a warning that releases the drug company from any culpability. They have their backs covered while the doctors are trying out the drugs on their desperate and trusting patients. In my heart, I believe that the reason there are so many more suicides than ever before…is the “cure” and not the disease. The disease has always been around but not the new drugs that these companies keep designing. Sadly, “What came first, the chicken or the egg?”….what killed this victim?….their depression or the medications FOR depression? Will we ever know?
“Caring” is not a word that I would use in conjunction with the mental health system. It is a terrible mess. No wonder people who have any kind of mental or emotional disorder do not come forth to get help. There are so many reasons to stay in the shadows; the stigma attached to those who suffer from a disease that affects behavior and thinking is archaic, there truly is no real help out there unless you are wealthy, after all, the higher income bracket can well afford the over priced insurance, also, in my opinion, the medications that are being offered should be carefully monitored for each patient while meds are being titrated to each individual need and what place is going to house those who need monitoring for any length of time because the system seems saturated by mental health cases? AND the insurance companies have the convenience to deny coverage…just because they can!!! There is just too, too, much that must be done for this dilemma to ever be corrected.
I, personally, am in deep grief over the loss of my youngest child to suicide and my middle child who has a mental illness. I have seen this poorly structured system fail my middle child while my youngest suffered in silence, never going to a dr. for his mood swings, only to self-medicate with his wife’s zoloft. The outcome has devastated our family forever. There is no way to rebound except to die and go to heaven.
Reblogged this on Follow Me Films.
lensgirl, When someone is suffering with depression (not the blues) it’s important they receive some type of treatment. That treatment could be talk therapy with a professional, speaking with a counselor at church, speaking with a close friend, and when necessary through medication.
There is much controversy concerning medication and the side effects that come with them. If someone is to need medication then they need to be closely monitored to make sure they are responding well.
Sadly there are some doctors who will write out a prescription within ten minutes of you walking in the door when medication may not even be necessary.
With cuts in funding taking place stories like the one above will possibly become more common and we all end up losing. More people will end up in jails or on the streets instead of receiving much needed treatment.
There are so many organizations that are working hard to educate the public concerning mental illness and that includes dismantling the stigma that surrounds it.
I am saddened that your family has been impacted so terribly because of mental illness and pray that you and your daughter might find strength from our God. God bless you Dale.
i am really shocked by this blog. As a Canadian, looking at the American medical system from a distance, I know there are many serious issues facing medical care. But this goes well beyond my understanding. Particularly after there was so much thinking that mental illness is to blame for gun violence in the USA, I would have thought decent care would be a priority. What good is a mental health check on those who want to purchase a gun is there isn’t proper care for people declared mentally unfit.
I am very thankful to live in Canada. Things aren’t perfect but the level of care seems to be much better. I deeply hope that some real thinking about health care for those with a mental issues improves the situation in America.
I wrote about this issue in my own blog. if anyone is interested – http://bipolarcircus.wordpress.com/
Thank you for your comment. God bless you.
Terry, Thanks for dropping by. Sadly, there have been cuts in the mental health field as our nation is in a financial mess. The reality is our nation for the most part doesn’t understand mental illness and many hold to stereotypes that advance stigma.
As a result the mentally ill end up quite often in the jail system or living on the streets instead of receiving the help they desperately need.
Sadly, there are times when a mentally ill person who is untreated or goes off their meds becomes violent. Yet the truth is that the mentally ill are far more often the victims of violence.
There are many organizations in this nation who are doing all they can for the mentally ill. Many are becoming educated as a result and lives are being changed for the good.
Again, thanks for dropping by.
Dale, You’re welcome. God bless you and yours.
This post still is on my mind. However, I found this article that offers understanding, help and even hope.
http://blogs.psychcentral.com/depression/2013/03/god-bless-the-mental-health-care-community-with-cash/
Terry, Thanks for linking to the article. There are those who are ‘in the trenches’ that society is pretty much unaware of. They are doing what they do because they care and want to help others who are left with no other options.
Thanks for reminding us we can’t lose hope, that there are people doing things for the right reasons, and that they deserve our support.
Despite how difficult it is to imagine there is a God who sees, cares, and understands. This is a difficult truth for many to accept but the major reason I do this blog is to let people know that God cares and is our hope, no matter how difficult the circumstances. God bless you Terry.
You are noble in cause, in action, in bravery and in soul.The world would be much more compassionate and caring, a kinder place in which to live with more like you. In my own blog, even in some of the darker posts, I try to show people that they are not alone and that hope must never be lost, be cherished. I look forward to coming to know you in the future. Take very good care.
Thank you Terry.