County hopes to institute its own drop-in clinic by mid-January

This building is being considering by the mental health task force as a viable option for a walk-in mental health clinic.

The opening of walk-in centers and the establishment of mobile crisis units to serve the seven western counties will offset the closing of the Balsam Center’s crisis management and Adult Recovery Unit.

Doug Trantham, operations director for the Smoky Mountain Center, announced last week that the Adult Recovery Unit at the Balsam Center suspended admissions as of Dec. 12, effectively shutting down crisis mental health stabilization care for the western region. The decision also means that emergency services must move out of the Balsam Center.

“It is not safe for emergency staff to provide care without the presence of other support staff in the building,” Trantham wrote in an email.

The center is expecting authorization by the end of December, he said, to open three mobile crisis management teams and six walk-in clinics across the seven-county southern region of Macon, Clay, Cherokee, Jackson Swain, Graham and Haywood counties.

“The Balsam Center is needed more today than ever before, particularly for detox and dual diagnosis treatment,” Trantham said. “It is our intention to reopen the crisis center next year, but really, we do not know when and under what conditions we can re-open the system.”

Establishing a walk-in mental health clinic at this site, located just off Highlands Road in Franklin, could serve a dual purpose of relieving sheriff’s deputies from long hours spent transporting involuntary commitals to the distant Balsam Center.

The county owns some buildings behind Jim Brown Chrysler, on Thomas Heights Road, where the county health department used to be located. This would provide office space for a drop-in clinic if needed. Getting credentialed professionals to staff the center would be the next step.

“At least this would be a start to get people the help they need and get them to where they need to go,” Beale said. He said this is the time that Macon County needs to evaluate the services needed here.

The fact that this is coming to a head during the holidays and at a time of economic distress is a further concern of Beale’s.

“During tough economic times and during the holidays, that is when mental health is needed more than ever. It is just a tough time for people,” he said.

Macon County Sheriff Robbie Holland said the closing of the center comes as a mixed blessing. The sheriff’s department is required to serve as mental health transport, and the burden has fallen on sheriff’s deputies to take involuntary committals to the Balsam Center for evaluation.

This involves a deputy and the patient sitting in a small, enclosed room while waiting for that evaluation and then an eventual relocation – a process that in the past has taken up to three days. Deputies would have to take shifts driving out to the Sylvabased clinic to provide watch through the patient’s evaluation.

“If you have someone suffering from mental illness, by the end of 20 hours stuck in a room with a deputy, you know the situation has not brought any relief to that patient,” he said.

A local-based evaluation process either through a mobile crisis unit, emergency services at the hospital, or a drop-in service could shorten the process.

“They have been talking for a long time about having counselors available at hospitals. If that comes to fruition, you have the resources available when they are needed,” Holland said.

“The problem with the system is that it is a very complicated issue. The state has made it a mess, and things within the mental health system change on a weekly basis. It is hard to know where to focus,” said task force member Kathy McGaha.

As a result of the state’s overburdened system, new legislation allowed local management entities to work in public/private partnerships.

Smoky Mountain Center was one of the first state LMEs to take advantage of this system, working with Haywood Regional Medical Center to open a Behavioral Health Unit.

The inpatient facility was designed to take referrals screened by the Smoky Mountain Center’s Emergency Services. The Adult Recovery Unit’s closing will allow the inpatient clinic at Haywood to increase from six to nine beds.

Smoky Mountain Center said it was just not able to staff both units, and despite recruiting efforts, the crisis and inpatient center remained understaffed.

Southern Region Emergency Director Molly Richardson worked to move emergency services out of the Balsam Center last week and is working with regional hospitals to implement a new plan.

Marty Wadewitz, chief operations officer with Angel Medical Center and mental health task force member, said that The Balsam Center has acted as a clearinghouse for moving patients through the mental health system.

Angel Medical Center will have to look at what its emergency room can provide in terms of resources.

“A bigger standpoint is the lack of facilities in the state. There is a certain amount that can be done in the communities,” Wadewitz said. “But unless the state can get some changes into effect, it just creates a ripple effect back to the communities.”

The healthcare reform that went into effect several years ago was intended to get mental health patients out of state hospitals and into more longterm community-based follow-up treatment.

Announcements from across the state came this weekend regarding the state’s continually troubled mental health service system. The overburdened state system has resulted in a bevy of reports regarding abuse and neglect of patients.

Problems continue to plague state psychiatric hospitals in North Carolina. Four hospitals serve the entire state, Broughton Hospital, Morganton; Central Regional Hospital, Raleigh; Central Regional Hospital, Butner; and Cherry Hospital in Goldsboro.

Cherry Hospital has been the subject of much public scrutiny this month. The North Carolina Board of Nursing began an investigation of at least four nurses when a patient died after being left in a chair without food, water or adequate medical attention for almost 24 hours.

The patient’s death resulted in the hospital losing its federal insurance reimbursements, costing the state nearly $800,000 in funding. According to The Charlotte News and Observer, this comes on the tail of more than 10 employees in the last year facing charges for neglect or abuse of patients.

Earlier this month, Cherry’s director, Jack St. Clair, said he would be stepping down at the end of this year.

Central Regional in Butner was cleared this weekend after it, too, was threatened with loss of federal funding. The hospital, which opened this past July, was also under scrutiny for poor patient care.

Governor-elect Bev Perdue announced earlier this month that she is “looking aggressively” for a new Health and Human Services secretary.

Macon County has taken a strong lead in addressing mental health care issues. Cherokee County followed in Macon’s footseps this month by establishing a mental health task force of its own designed to address similar issues and evaluate the needs in its county.

And if Macon’s mental health task force can meet its Jan. 11 deadline, Macon may continue its trend in leadership to be among the first to establish a walk-in clinic. But that is yet to be determined.