A Place to Go for Prompt Help with Behavioral Health Problems

February 1, 2017 | by Thomas Goldsmith

The young woman knew she needed help, she said, after she bit her husband’s thumb to the bone, then jumped out of a car traveling 45 miles per hour.

Melissa Leonard, 21, of Lincoln County, admitted herself in late January to Cleveland Crisis and Recovery Center, a 16-bed behavioral-health urgent care center where she’d gotten help before. Located a few blocks off the square in Shelby, the Cleveland County center maintains a commitment to starting physical and mental health workups of clients within 30 minutes of their arrival and completing assessments within two hours and 15 minutes.

The center recently won a state award for its treatment of clients and its efforts to solve one of North Carolina hospitals’ most vexing problems. That’s the pileup of thousands of people in emergency departments statewide — for hours or even days — when they need mental health treatment.

People in Shelby can avoid that – this center is open 24 hours a day, 365 days a year.

Leonard, a married mother of one, spoke willingly about her difficult life experiences. She said she had experienced sexual abuse as a child and had recently abused prescription opioids. She listed diagnoses for herself including depression, paranoia, obsessive-compulsive disorder and bipolar disorder.

During this admission, Leonard said she would have lost control had she faced a wait of six or eight hours before receiving treatment or transfer in a regular hospital emergency department.

However, during the 2016 fiscal year, the average wait time in a North Carolina ED was at 119 hours, a number that’s scarcely changed over the past few years.

“If I had had to have waited, I probably would have flipped out,” she said in a staffer’s office at the crisis center. “I start cussing, hitting people, throwing things.

“I’ve come a long way since I came in here.”

Partners in care

Opened in July 2011, Cleveland Crisis and Recovery Center exists through the collaboration among a mental health provider, Partners Behavioral Health Management; a hospital, Carolinas Medical Center, Cleveland; law enforcement, the City of Shelby Police Department; and a behavioral health company, Phoenix Counseling Center.

“We’ve really seen a dramatic reduction in people going to the emergency department for primary behavioral health care,” said Barbara Hallisey, associate clinical services director for Partners Behavioral Health Management, the LME-MCO serving eight North Carolina counties in the western Piedmont.

Talk and medication therapy during a weeklong stay at the Cleveland center had put her on the road to recovery, she said, but she will continue with therapy and undergo regular drug counseling after discharge.

“When I get out of there, I see my path getting better — just doing a lot better and not flipping out like I used to,” she said.

Some patients, like Leonard, admit themselves to the crisis and recovery center. Others are brought by law enforcement officers specially trained for dealing with behavioral-health clients.

Admission to the center can, but doesn’t have to, involve involuntary commitment papers signed by a magistrate.

“In the past … extremely cumbersome”

In addition, clients can be left in the care of center staff, instead of being accompanied by officers during indefinite waits for assessment, even if they are brought in by a law enforcement officer.

“In the past, the mental health process was extremely cumbersome on our staff, not only from a manpower standpoint but a service level,” Shelby Police Chief Jeff Ledford said in press material.

Sgt. Craig Earwood of Shelby City Police and Jake Zaludek, a detective from the Cleveland County sheriff’s office, were staffing the urgent care entrance during a reporter’s recent visit. About 900 clients came through the doorway during a survey period between February and December 2016, said Cheryl Billings, the Cleveland clinical manager for Phoenix Counseling Center.

“Not everybody who comes in here is admitted,” Billings said. “They may have to go to the ER or to a higher level of behavioral health care,” such as the state-run Broughton Hospital.

Behavioral health admissions to Cleveland County emergency departments decreased by about a third between the fiscal years 2012 and 2015, according to the state Division of Public Health. By comparison, similar admissions went down by only 5 percent during the same period in Wake County, where WakeBrook Recovery Center offers similar facility-based crisis functions.

Urgent-care model gets support

“One of the things that we like about the urgent care model is that it can become a regular resource for people with severe and persistent mental illness,” said Jack Register, state NAMI executive director.

Register and other advocates for people with mental illness refer to the long waits in hospital ED units as “psychiatric boarding” and consider it a form of torture.

“We are really excited by the growth of the urgent care center model,” he said. “We would like to see it expand.”

Leonard was preparing to return to her home in Vale after a seven-day stay in the residential treatment area of the center. She felt ready to be with her husband and five-year-old daughter again.

“She likes to go outside and play, play X-Box, and we do learning games,” Leonard said. “And she likes to help Mommy cook.”