Integrating and Extending Crisis Mental Health Care

Many people entering hospital emergency departments are in need of specialized mental health care.To improve crisis mental health services in the Carolinas, The Duke Endowment has awarded more than $11.7 million since 2007 to build telepsychiatry networks for hospitals in North Carolina and South Carolina.

Challenge

Hospitals in North Carolina and South Carolina continue to see increasing numbers of people with undiagnosed or untreated mental illnesses. When these patients arrive at the emergency department, there often is no psychiatrist present or available on call, meaning patients may wait many hours or days to receive a psychiatric evaluation.  

Gaps in Access to Crisis Mental Health Care

Many of those suffering from mental illnesses have less than adequate access to the services they need. Both North Carolina and South Carolina are experiencing shortages of psychiatrists, especially in rural and remote communities. As a result, those experiencing mental health crises end up in hospital emergency departments, where emergency care providers are left to diagnose and treat behavioral health needs, despite a lack of training.

With typical emergency room costs for a mental illness at nearly $3,000 per day, crisis mental health situations can be frustrating and costly for both the patient and the hospital. Costs can also add up for local law enforcement, as officers frequently must stay with involuntarily committed psychiatric patients until an evaluation occurs. 

Response

To improve mental health services in the Carolinas, The Duke Endowment funded the creation of four telepsychiatry networks: one statewide in South Carolina, and three regional networks in North Carolina.

A Statewide Telepsychiatry Network for South Carolina

The South Carolina Department of Mental Health and the South Carolina Hospital Association received funds from the Endowment to develop a statewide telepsychiatry network, the first of its kind in the United States. The network enables patients, emergency department physicians and psychiatrists to interact through video screens, cameras and wireless communication, giving patients in emergency departments greater access to mental health specialists. When a patient presents symptoms of mental illness, the emergency department physician can request a psychiatric consultation through the network. A psychiatrist then interviews the patient (and, if needed, family members) to provide an evaluation and recommend a course of treatment.

The network is staffed 16 hours a day, seven days a week, by a team of psychiatrists at the South Carolina Department of Mental Health.

Since 2007, The Duke Endowment has awarded nearly $8 million in grants to establish and expand the program. Participating hospitals are equipped with:

  • 26-inch, high-definition screen capable of capturing subtle symptoms crucial to accurate diagnosis
  • mounted camera which can pan, tilt and zoom at the physician's will
  • two-way sound for communication between the physician and patient
  • wireless capabilities and independent power supply
  • access to electronic medical records
  • connection to database  of patients with mental, behavioral, or substance abuse history      

Hospitals and psychiatrists also can use the system to access a patient’s electronic medical record (EMR) to obtain important mental health information that can aid in evaluation and treatment. Consulting psychiatrists can add their notes and recommendations into the EMR in real time.

A Regional Telepsychiatry Network for North Carolina

Since 2010, The Duke Endowment has provided $1.2 million to develop regional telepsychiatry networks in North Carolina. The Vidant Health network includes 21 hospitals in the eastern part of the state. The First Health network serves the south-central part of North Carolina with six hospitals. The Novant Health network includes 22 hospitals in the central and western part of the state.  The WakeMed network includes eight hospitals in the Triangle region.

Leaders in the North Carolina effort based their network design and implementation on the knowledge and successes in South Carolina. The eastern North Carolina network connects hospitals to the psychiatric staff at Coastal Carolina Neuropsychiatric Center in Jacksonville, North Carolina.  The hospitals in the central portion of the state have arrangements with psychiatric providers within their hospital systems or local communities to provide care.

Pediatric Care in North Carolina

A recent grant from The Duke Endowment to Carolinas HealthCare System will give pediatric patients access to behavioral health services through privacy-protected virtual care. By integrating primary care and behavioral health care, the goal is to offer seamless – and critical – services to children.

The Endowment’s grant is supporting design and implementation. Project leaders say it’s an opportunity to improve how behavioral health care is delivered in the region and establish a model for others.

Participating Sites

North Carolina

  • 57 hospitals with emergency departments
  • Brody School of Medicine at East Carolina University, Greenville
  • Coastal Carolina Neuropsychiatric Center, Jacksonville
  • Carolinas HealthCare System, Charlotte

South Carolina

  • Department of Mental Health, Columbia
  • South Carolina Hospital Association, Columbia
  • 21 hospitals with emergency departments

Details

Area of Work

  • Access to health care

Program Area

  • Health Care

Grantmaking Status

Areas of Work

  • Prevention and early intervention for at-risk children

    To equip children and families with skills to ensure that children reach developmental milestones to lead successful lives.

  • Out-of-home care for youth

    To drive child welfare systems toward greater accountability for child well-being.

  • Quality and safety of health care

    Improving the quality and safety of health care delivery

  • Access to health care

    Improving health by increasing access to comprehensive care

  • Prevention

    Expanding programs to promote health and prevent disease

  • Academic excellence

    Enhancing academic excellence through program and campus development

  • Educational access and success

    Increasing educational access and supporting a learning environment that promotes achievement

  • Campus and community engagement

    Promoting a culture of service, collaboration and engagement among schools and communities

  • Rural church development

    Building the infrastructure and capacity of United Methodist churches to enhance ministry and mission

  • Clergy leadership

    Strengthening United Methodist churches by improving the quality and effectiveness of church leadership

  • Congregational outreach

    Engaging United Methodist congregations in programs that serve their communities