WNC sheriffs convene mental health summit

The sheriffs of the seven western counties met with area mental health and medical professionals, hospital administrators, county officials and state and federal legislators Monday afternoon in an effort to improve what Sheriff Robert Holland called "the process" of receiving mental health services. Holland hosted the gathering, which took place at the Macon Bank corporate office.

"I think all of the sheriffs agree that the process a person goes through is a travesty," Holland said in his opening remarks. He noted that law enforcement deals with these issues on a daily basis.

The problems center on the difficulty of finding mental health beds for patients, and confusion over the responsibilities of the law enforcement officers who are charged with transporting them. The sheriffs and other officers in the meeting expressed growing frustration with the cumbersome system, the amount of time they must spend with patients and the high cost of providing transportation.

"Unfortunately, it seems to only be getting worse," Holland said.

He emphasized that the meeting was not going to be about pointing fingers, and that no single person or agency was to blame for the situation.

"The system we are a part of is letting us down," he said.

The meeting kicked off with a formal presentation on the laws dealing with transportation of involuntary mental health commitments. Presently, responsibility for transporting a person for evaluation falls to law enforcement.

Lisa Granberry Corbett, the N.C. assistant attorney general representing the Division of Mental Health, and Mark Botts, an attorney with the N.C. Institute of Government, discussed the process and the governing statutes.

They said the Mental Health Study Commission of 1983 recommended giving the counties the option to develop alternative transportation plans if they so desire, and the statute was amended to allow counties and cities to utilize individuals or agencies other than law enforcement.

Corbett said she had searched but failed to find any such plan in existence. She offered suggestions on how a plan could be developed.

As the meeting progressed, it became evident that considerable confusion exists about the statutes and different authorities have different interpretations of the law.

"If you subscribe to one interpretation, hang your hat on that at your peril," Botts said.

Press photo/Barbara McRae. Sen. John Snow (second from right) discusses possible solutions to transportation problems posed by involuntary commitments. N.C. Representative Roger West is at center; Cherokee County Sheriff Keith Lovin at far rigiht; Mike Neidig, a mental health provider in Macon County, is at left.

Botts pointed out that law enforcement, the hospital emergency departments and state hospitals operate under three different laws.

He told the crowd that he was "hopeful" and impressed by the willingness of so many people, in so many roles to come together in the same place to discuss the issues. Corbett agreed, saying the diversity of people in the room "says a lot about your commitment to solve the problem."

Holland said his office has worked out an agreement with the Angel Medical Center Emergency Department that, if they leave a patient at the E.D., officers will return immediately if called.

Corbett said the underlying difficulty with that solution is "Who has custody?"

Botts said he was comfortable with it, if a plan is worked out clearly transferring custody.

Following the formal presentation, Holland opened the floor to discussion.

Representatives of Smoky Mountain Mental Health, the Local Management Entity that provides services in the western counties, addressed how the Balsam center functions within the region. Balsam accepts about 30 percent of involuntary commitments in the region. But caring for the other 70 percent has become a headache because of a shortage of mental health beds in the state system.

Leza Wainwright, N.C. deputy director of the Division of Mental Health, and Michael Moseley, director of the division, addressed questions about the status of Broughton Hospital. The hospital has been decertified by Medicare and Medicaid, they said, but "that should not prevent people from getting admitted."

Wainwright said admissions to Broughton had to be decreased because of a shortage of psychiatrists, but the state is working on the problem.

"It is clear to me that we need clarification in terms of process," Moseley said of the sheriffs' transportation concerns. "But the biggest issue is bed availability. The delays relate to the fact that there are inadequate beds. We have to focus on how we're going to create across North Carolina more beds."

N.C. Senator John Snow and Representative Roger West brought information packets for the sheriffs, addressing the issues that concern them.

"There is no reason we can't work on the process," Snow said. "In July, 16 new beds will open in Haywood County that will solve a whole lot of problems."

Snow added that North Carolina needs to look at what other states are doing. He asked the sheriffs to provide him with information on current costs to help in developing a plan.

"Our mental health system has been in disarray, but things are getting better," Snow said.

"A stigma is involved in mental illness, and to have law enforcement involved doubles the stigma," he said. "We need to spend the money to get law enforcement out of it."

Macon County Commissioner Ronnie Beale said the county commission will appoint a mental health task force on Jan. 14, to include the sheriff's office, Angel Medical Center, the Department of Social Services and consumers.

"Mental illness is very devastating to families," said U.S. Representative Heath Shuler. He expressed an interest in seeking ways to help on a federal level.

"I'll talk to my colleagues and see how they are working with their constituents," he said. "More than anything, I commend our sheriffs." He said that having an open forum, such as this meeting, would help the community find solutions.

"I'd like some information on Broughton admissions," said state Representative Phil Haire. "This is not just unique to us. It's a state problem." He suggested getting the counties together, perhaps with the Southwest Commission, and perhaps come up with a pilot transportation system.

Doug Trantham, service management director for Smoky Mountain Center, said clarification was needed of the options available to officers and what they are required to do.

Trantham said a pilot program at the Balsam Center allows a Licensed Clinical Social Worker (LCSW) to do the initial evaluation of a patient.

"We release one in five of the involuntary commitments. If we can do that in a local hospital, we save you a lot of time," he said.

The center is going to bring that model to the local hospitals, 24/7, he said, with someone on-call to the smaller hospitals. This system should avoid some involuntary commitments.

The 16-bed unit that will open in July will also help the region. "We hope to divert 70 percent of commitments," Trantham said. The remaining 30 percent would still need state care.

Wainwright noted that North Carolina is unique in that short-term beds are operated by the state. "In most states, you don't get into a state bed until you've been in another facility for 14 days."

Moseley said the secretary of Health and Human Services is forming an advisory committee to advice him on where the gaps in service exist.

"Every citizen should have certain services available, no matter where he or she lives," he said.

Mike Neidig, a local provider of mental health services, asked, "Are we relying too much on hospitals? Are there enough crisis care services in the community?"

"There is a continuing shortage of providers in Macon County and other western counties," Tom McDevitt, area director for Smoky Mountain Center, said. "Our challenge is community provider development." He noted that providers might want to settle here but, "there is no workforce to employ."

"There's an urgency to this," Beale said. He referenced the recent Youth Risk Behavior Survey that was conducted in the Macon County schools and said he felt the needs of youth were not being served.

"It's not acceptable to us, either," said McDevitt. "There is a shortage of basic benefit providers. It's a rural dilemma that we constantly deal with."

Those in attendance at Monday's meeting included Sheriffs Jimmy Ashe of Jackson County, Tom Alexander of Haywood County, Keith Lovin of Cherokee County, Curtis Cochran of Swain County, Joe Shook of Clay County and Russell Moody of Graham County. Other area law enforcement also attended. From Macon County, Don Sandoval, CEO of Angel Medical Center, and personnel from the hospital E.D. participated, as well as commissioners Beale and Charles Leatherman, county manager Jack Horton and school superintendent Don Brigman.