Psychiatric Nursing Care Plans

>> nancy fey-yensan: good evening and welcome to unc charlotte. we're so proud of our center city campusand are so pleased that you are all here to join us tonight. i'm nancy fey-yensan. i'm dean of the college of health and humanservices at the university and it is my extreme pleasure to welcome you to the charlotte observerand pnc bank community forum solving it together: mental health and crisis care. as north carolinaã­s urban research university,unc charlotte is committed and positioned to engage in our local and regional communitiesacross a range of critical societal issues,

not the least of which is health. research, training of our future health andhuman services workforce and outreach in the mental health arena is of supreme importanceto us. this thursday, the 21st, hereã­s my shamelessplug, here at the center city campus, a special art exhibit, the art of recovery will occur. this has been organized by our collegeã­sdepartment of social work, the chair of social work is here and many of our faculty, in collaborationwith unc center for excellence in community mental health, mental health association ofcentral carolinas, person centered partnerships bridges program and acasio incorporated.

this art exhibit seeks to reduce stigma thatã­srelated to mental illness. please visit our website, the universityã­swebsite to gather more information about this wonderful free event and i hope to see youthere thursday. throughout this eveningã­s discussion, wewill undoubtedly hear that the time has come for our nation to develop new, completelynew, approaches to mental health services. one tremendous opportunity area for new approachesis actually housed at the university of north carolina at charlotte in our big data andinformatics initiative. health informatics is a field filled withpromise and the ability to with improved fidelity position health and human service agenciesto be as effective as possible in responding

to those with mental health issues as wellas their families. and today, our college actually enjoyed avisit from one of your panel presenters today, the new mecklink director, phil endress. our faculty were the grateful recipients ofhis perspective and conformation of the direction for and needed investment in integrated mentalhealth services. we at unc charlotte look forward to beingthe active partners with phil and with mecklink. but now, itã­s my pleasure to introduce westonandress, the regional president of pnc bank covering charlotte and the western carolinamarket. weston, a long time charlottean, assumed hisrole with pnc just this past fall.

he and pnc have made charlotte one of thebanksã­ highest priority markets and we are all so appreciative of how they have alreadystepped up to make this eveningã­s important forum possible. so please join me in thanking and welcomingweston andress. >> weston andress, pnc bank regional vicepresident: thank you nancy, good evening i am delightedto welcome you in the second of the series of forums organized by the charlotte observerand pnc bank to explore issues that are important to our community. thank you for being here tonight, it is citizenslike you that make a difference.

also i want to thanks unc charlotte for holdingthe forum in the state of art facility and i want to welcome our distinquished panelists. pnc is celebrating our first anniversary inthe charlotte community and our year has been exceptional both in terms of our acceptanceand our growth here as well as our philanthropic work. while our major philanthropic work is focusedon one of todayã­s primary challenges, early childhood education we realize the need forour communities to identify challenges and tackle issues in a collaborative way thatis why we have joined the charlotte observer to present more forums in 2013 each examiningissues that confront our citizens and communities.

tonightã­s forum is especially important aswe grapple with the important issue of mental health service and how best to support thepeople in need. once again we appreciate your participationwe hope you can stay after the program and enjoy some refreshments. now for more on tonightã­s program and howit will work please join me in welcoming charlotte observer editor rick thames. rick thames, charlotte observer executiveeditor: thank you weston and good evening everyone. i am going to offer our sincere thanks topnc for actively supporting tonightã­s forum,

also dean fay-yensan we are greatful to unccharlotte and to the college of health and human services for hosting us tonight. you know the university opened this campusless than two years ago for the express purpose of collaborating with the community and tonightis just one more example of that as you can see unc charlotte is committed to doing this. as weston noted this is the second in a seriesin issue forums that we are calling simply solving it together. at the observer we believe that there is moreto news than just describing the problems. solutions that will help us solve our problemsare news too, big news in fact.

there is no better way than to identify possiblesolutions than to have a conversation in a room full of people who care, people who wantto help and that is what we have here tonight. drã­s, patients, police officers, parents,scholars, sisters and brothers our elected officials thank you all for taking the timeto talk about better care for our mentally ill especially in times of crisis. we also thank more than 20 special gueststhat we have with us tonight who are listed in your program as panelist and resource specialist,you will hear more about them later. many will also be available later in the lobbyat the reception and we hope that you will stay and take advantage of this opportunityto speak with them.

finally a special thank you to two peoplewho provided key advise as we planned for this forum, ellis fields with the mental healthassociation of central carolinas and melissa mashburn with mecklink. and now i would like to introduce tonightã­smoderator, observer editorial page editor, taylor batten. taylor is an award winning journalist withmore than 20 years of experience covering major issues in local and state government. he joined the observer in 1995 after writingfor the associated press he has also written for the new york times, the boston globe,the dallas morning news and the miami news.

taylor became the observers editorial pageeditor in 2008 and sense then the north carolinas press association has named the observerseditorial pages as the best in the state and in 2010 it named taylor batten as the statestop 10 editorial writer. taylor has poured over dozens of questionsthat many of you have sent in and he has prepared now to help our panel provide as many answersas possible. but please join me now in welcoming taylorbatten. >> taylor batten, charlotte observer editorialpage editor: thanks rick and thank you to all for beinghere and braving the rain and the cold weather. i thought this past weekend that we had turneda corner with the weather but i guess we are

going to have to wait another week or twobefore we fully have spring into spring. so, i do appreciate you all coming out asweston and rick both said this is the second community forum that the observer has hostedwith pnc the first one was on congressional gridlock and as we were talking about whatthe topic should be for our second forum mental health care really was at the top of the list. itã­s always been a big issue but now it becomeon the radar of people nation wide and it is such a deeply important topic in our communityand it has some problems that need to be talked about and worked out. it is gratifying to see all of you care sodeeply about it and i am looking to starting

a conversation that maybe will be a beginningof doing so in a lot more public fashion. i am hopeful that tonight will really advancethe discussion in meaningful ways and will lead to some movement and solutions and thereis a good chance that we will be having a very fruitful conversation tonight becausethere are so many people here from so many different components of the mental healthcare system. all of you, our panelists, some of our specialguests that are here in the front and all of you in the audience bring a different perspectivefrom different pieces of the issue and i think that is really going to help us have an informeddiscussion tonight. a few logistics to go over we do want to answeras many questions from you all as possible

tonight that is the whole idea. you all submitted more than 200 questionswhen you registered for this event we went through all 200+ of those and there are somereally good questions so we want to get to as many of those as we can. you can also give us more questions, if newquestions come to mind during the session you should have note cards. did you all get note cards as you came in? if you donã­t already have a note card jenrothacker and tracey curtis in the back will be handing those out.

you can write your question on the note cardplease include your name and pass it to the end of the isle and jen and tracey will pickthose up and bring them down and our folks will go through those and have as many ofthose questions answered by our panelists and special guests as well. some of you may have questions that are veryspecific to your case or the case of a family member and we ask you to save those if youcan until after the panel discussion there is going to be continued conversation afterwe are done in here there is a reception following the event. different organizations you probably saw setup outside and so we will be able to have

more one on one conversations after the paneldiscussion. there is also a list of resources on the backof your program i encourage you to look at those and contact those organizations to learnmore about what they do. i will introduce our panel in a moment andwe also have a number of local experts here tonight sitting down front representing anumber of different organizations, charlotte mecklenburg schools, mecklenburg county, mecklink,the va, the national alliance on mental illness, the mental health associations and a numberof other organizations so thank you all for being here as well. ok, i would like to introduce a panel andthen we will watch a short video that puts

the topic into some context. i will start with my immediate left dr. rogerray is executive vice president and chief medical officer for carolinas health caresystem which operates cmc, randolph the counties only psychiatric hospital all these bios arein your program so i am not going to read these to you, i will just give you the highlights. to his left is pat cotham, pat is the chairmanto the mecklenburg county commission serving her first term and the county is responsiblefor funding many of the counties health needs to her left is phil endress, he is the directorof mecklink. mecklink is the managed care organizationwho is now administering behavioral health

care in mecklenburg county to his left chiefrodney monroe he has been the chief of the charlotte mecklenburg police department since2008 and to his left is mebane rash, mebane is an attorney with the nc center for publicpolicy research and editor of its journal north carolina insight and has done a tremendousamount of research and writing about mental health care in north carolina. thank you all for being here. we have a video i believe that puts the topicinto context. (video playing) one thing i forgot to mention you can alsosubmit questions using twitter use #solvetogether

and we will be monitoring that, this is justanother way to submit questions. speaking of solve together we want this eveningto be solutions oriented but before we can dive into solutions we need to get a handleon what the problem is also the scope and the breath of that problem. as all of you know better than anyone thereis a stigma around mental illness that gets in the way of addressing it properly and ihope tonight can be one small step in starting to address that and eventually eliminate it. many of you in the audience asked about thiswhen you registered so i wanted to start there. the question for the panel is how do you allsee the stigma being a barrier to mental health

treatment and how can we eliminate it andone audience member specifically wanted to know what your organizations are doing todispel myths around mental illness and to educate the public? so if any of you can jump in dr.ray maybeyou can start us with that and what are you all able to do to educate the public? >> dr. roger ray:thanks i am happy to do that i want to add my thanks to others for the groups that cametogether to put this together. important conversation and important learningfor us i suspect and we appreciate the opportunity to be here and talk with other leaders andothers of you that are interested in the topic.

as it relates to stigma itã­s probably importantfor you to know that iã­m a neurologist by training. i practiced about fifteen years prior to becomingan executive physician. the stigma is real. i think thatã­s the first step to acknowledgeit is a reality for many of us who endeavor to improve behavioral health services andwe need to deal with it upfront. as a neurologist, i would tell you that, wegot a chance to treat many illnesses paralysis or any other conditions but as soon as thecondition began to affect behavior, it changed for everyone.

why is that do you suppose? i suppose as many have written that has todo with the fact that we channel so much through behavior and communication about what we thinkof others. but nonetheless, i think itã­s important toknow itã­s a human thing, a human reaction but in fact a human thing that we must finda way to rise above, to go beyond. an illness is an illness, itã­s chemistry,itã­s medical and therefore really no different than other medical illnesses and itã­s oursto understand that when it affects behavior we have the capacity to teach ourselves torise above that and look beyond it to work with individual better.

what are we at chs doing? we are doing a number of things. we have a whole set of initiatives aroundpatient centeredness, trying to change over time our constructive health care from beingabout a facility or a practice or a physician or a team and being more about the patientand the whole patient and therefore the patientã­s behavior and any stigma that might be attachedto the patient becomes our problem not the patientã­s problem. thatã­s the first thing. the second thing is, weã­re engaging withmany communities.

a number of you probably in the room becauseeducation discussion is really the center point of helping us all elevate our game soas to be able to rise above stigma and deal with patients where theyã­re coming from asthey deserve so much. >> taylor batten:ms. rash, how about you? youã­ve written a lot about it and you alsohave personal ties to it. when you hear talk about stigma what stoodout to you? >> mebane rash: so iã­m with the north carolina center forpublic policy research and weã­ve been studying mental health reform in north carolina forfive years and the first thing that we do

when we talk about stigma of mental illness,developmental disabilities, or substance abuse in north carolina is we try to define thescope of the problem. so the state estimates that there are 1.37million people across this state that either have mental illness, developmental disability,or substance abuse. thatã­s fourteen percent of our state population. 300,000 of those are children. and the reason itã­s important to talk aboutthe scope is it helps people realize that this issue touches all of our lives rich andpoor, all races, all ages, urban and rural, democrats and republicans and the next thingwe try to do is talk to people about the need

to tell stories around this and itã­s hardand i appreciate you being here tonight. itã­s hard for people to come and tell theirstories but itã­s also really important. this issue is personal and professional forme. i started in this work two decades ago workingfor carolina legal assistants which was a mental disability law project, but itã­s alsopersonal. i have an uncle who has autism and developmentaldisabilities. heã­s lived in a group home near roxboro almostall of his life, but i also have a son that struggles with anxiety and depression andis in mental health treatment. so the reason that itã­s important for youall to tell your stories is because you are

the public and public policy. and if i go to the general assembly and itestify about the numbers and how long the waits are in ers across the state and howlong people are waiting for a bed thatã­s important, but it is another thing to walkinto that building and tell the story of a twelve year old girl who waited for six anda half days in a hospital emergency room for treatment. her mother was ninety miles away, she didnã­thave a bathroom in her room, and she was on a gurney for six and a half days. there was no exercise, there was no schoolwork and so from boredom she begins to self-mutilate.

and she doesnã­t get a bed until she herselfpicks up the phone and calls 9-1-1 and says i need a ride to butner and those storieshelp policy makers understand this issue in a very different way than just looking atthe numbers and it helps them understand that the public and public policy is somethingtheyã­ve got to pay attention to. these are people that are constituents intheir districts. so thatã­s what we are trying to help peopledo to work on the stigma across the state in addressing this issue. >> taylor batten: chief monroe, is there any role for the policedepartment in this?

>> rodney monroe: well, i heard the doctor speak earlier aboutit being about the patient and i think that couldnã­t be more so the truth. unfortunately we deal with a lot of situations that it is about the personitã­s about the patient and for any other medical problem that a citizen may endure,you pick up the phone, you dial 9-1-1 and an ambulance will come and take that personto the hospital depending on their injury or illness or you can take that person tothe emergency room or to the doctor but a lot of the cases that we see and we respondto thereã­s a struggle in navigating that system of mental health issues and i agreethat we donã­t talk about it enough and i

think thatã­s part of the problem. itã­s behind a shield and itã­s hard to penetratethat shield and itã­s hard to come from behind that shield so that more people can understandand i believe the more people that can understand the issue the greater the opportunities areto help address that particular issue. so, for us, itã­s a lot about the secrecy the mystique about mental illnessthat challenges our officers each and every day. well, and

along those lines we heard a lot from youall saying that thereã­s not enough collaboration among the different agencies and people whoare involved in delivering care. one member of the audience asked this ã¬whatideas or plans do you have for insuring that all of the entities involved in a particularclients life and care are able to share information quickly and effectively so as to streamlineassessment and appropriate interventions?ã® we also heard a lot of stories about clientsgetting passed around from one case worker to the next. and another audience member asked ã¬is therea mental health clearing house in mecklenburg county?ã®

i think i know the answer to that but mr.endress maybe you can talk a little bit about that because youã­re going to be having toorganize a lot of i would think collaboration and will mecklink be a type of clearing house. >> phil endress: well thank you, and iã­d like to thank everyonefor coming tonight as well. i think this is a wonderful opportunity tonot only address the issue of stigma but also to really talk about the services that areavailable in this community. mecklink began operation eighteen days agowe are the mco for medicaid and behavioral health care down in mecklenburg county andas part of our operation we have currently

a 24/7 help desk help line for people to callto be able to access services in a timely manner so i guess thatã­s sort of a clearinghouse functionality. i hope we go much beyond that. we talk to the person and or the family memberwhoã­s calling and try to understand what the issues are that they are dealing withso that we can make an appropriate referral to a service provider. one of the issues, going back to the previousquestion about stigma, is that and chief monroe was right on when he said that it is verysecretive people hide and try to cover that up and to forums like this if we can talkabout the issues and whether itã­s an embarrassment

or not to us as an individual, itã­s somethingthat we can deal with early so that weã­re not having to involve the police or otheremergency workers in a crisis situation we want to be able to identify individuals thatare beginning to have a problem so that we can identify resources to deal with that effectivelyour strategies or our treatment strategies available through clinics through providersthrough a network of providers that we have in the county that can effectively assistand support somebody to deal with the issues of mental health and or substance abuse issuesso that it doesnã­t get to a point that weã­re involving law enforcement or the fire departmentand taking somebody to an emergency room and that being the only source or the first sourceof treatment services.

the more that we can identify the issues upfrontand be open and honest about them the more that we can divert people that level of treatmentand reduce the burden on law enforcement and emergency departments. so i think that the issue of stigma is thenumber one issue that we confront every day and it has its impact on all other servicesthat are delivered through the community. excuse me, taylor. i think thatã­s important when i speak aboutthe secrecy and the stigma associated with that. we also bear a large portion of that throughthe various organizations that we represent

whereby even the sharing of information amongstone another that can help the person as a whole versus just dealing with different piecesof that mental health issue whether itã­s just when you call the police or when someoneis visiting the emergency room i think that the coordination and i was talking earlierabout there are systems out there that allow organizations to share information. sometimes i think we hide behind the privacyissue to the point where we become either resistant or numb to be able to respond tocertain things. so thatã­s part of the secrecy that i wastalking about. thatã­s interesting because i heard a lotof that kind of thing and a lot of you were

frustrated from how hard it was to share thatinformation even to get thereã­d be somebody who qualifies for medicaid but they mightget turned away from an initial assessment because you donã­t know if they qualify formedicaid and thereã­s no easy database or getting that paperwork shared or thatã­s justone example but it seems to be something that can be done better. commissioner cotham the board of county commissionersultimately oversees mecklink what are your hearing and what are you learning along theselines about the need to smooth some of the communication and collaboration among thedifferent players. >> pat cotham:

well i think weã­ve been open for a few weeksat mecklink and i know that weã­ll have a great first month and i know it will be agreat asset to the community and so i think itã­s a little too early to do an evaluationof that but i can say that not only am i the new chair of the county commission but mentalhealth is something was a reason why i ran for office so also as i wear the hat of thecounty commissioner i also wear the hat of working for a non-profit where i helped peoplewho had a criminal background many of whom i saved forty or fifty percent of them hadmental health problems so as i listen to the conversations i think about just as mr. battenthinks about his dear son vincent, i think about bruce i think about demitri i thinkabout people that i spoke with and also how

they had the stigma and also think about thewhispers, the whispers of a woman saying my son is having problems but nobody knows butiã­m telling you iã­m sure youã­ve all had that as well my cousin, my husband or whatever,my mother i think about that too. the stigma thing is something that we as acommunity and as a nation need to address but mental health hits every different economicgroup. itã­s not just poor people, itã­s not justmen, itã­s not just women, itã­s children, itã­s adults so we really need to come togetherand i worked at the center for community transitions for three years and i would still be workingthere part-time but they lost some funding so i lost my job a few weeks ago so i hopethey get some funding back but i was on a

federal grant and i helped people find jobsbut i can tell you i remember the phone call from bruce who called me ms. pat i was goingto kill myself but i called you, you know, it makes you never want to not take a phonecall. the stigma, you know, he was embarrassed anda lot of the people are embarrassed and as soon as you say billingsly road they justgo oh i donã­t want to go there but you know they need to but thereã­s that stigma on poorpeople and i would really like it if we could and i learned that people by working withtheir criminal record many of them had mental health problems, they donã­t have coping skillsthey donã­t know how to cope so if you have a problem and you donã­t have transportationsomeplace you know how to think it through

what am i going to do? i need to call a friend to help me. they donã­t know how to do that. theyã­re either going to go hit somebody ortheyã­re going to take drugs. they donã­t have a lot of choices and theydonã­t know how to think things through and they also need to feel safe like where i workedthey felt safe they would come in and they felt safe because nobody was judging themand iã­ve often thought when i was working there that it would be a good idea if therewas a mental health assessor or someone to evaluate somebody at a non-profit where thereã­soffice space and where they feel safe and

where theyã­re more likely to go and talkand get the help because like the chief of police said they donã­t know how to navigatethe system they donã­t know how to do it and so they donã­t do it. but if they were in a safe place they couldbe more likely to do that and so i just often thought that this was one of the reasons whyi ran for office. i see two of my commissioner colleagues overthere commissioner leake and commissioner fuller and on the campaign trail we talkeda lot about mental health because the citizens talked to us about it. so this is something, a big reason why iã­mhere and why i ran for office and so i think

itã­s something that we have to address asa community and we have to listen to people and we have to listen to the whispers of thefamilies that are struggling and we have to listen to the people and know that a lot ofthem are not getting the help because they donã­t know how to do it and they donã­t feelsafe and if we can make them feel safer, i think that makes sense to, iã­m not an expertbut maybe the experts could think about that, i just think that the non-profits weã­re workingwith the same population and so thatã­s just something that i would like people to thinkabout. dr. ray. for the panels, weã­re going to start sharinga hand held mic because your lapel mics are

coming and going a little bit. >> roger ray: just a couple of comments. can you hear me? say something brilliant and weã­ll tell youif we can hear it i didnã­t have anything brilliant plannediã­m sorry. i think we have to own a little of that youknow. as i hear the conversation. as i walked in this evening i got a chanceto meet one of you who shared a story with

me about a family member or an acquaintancewho had recently been with us at cmc randolph and to paraphrase said when we needed it yougave us safety, when we needed it you gave us hope and support and it is a wonderfulstory now a time later looking back on it. we probably own that of the stories we tell,we donã­t tell those stories so often or so effectively so as to help pull patients towardthe help that is sometimes there waiting on them and help them get passed the whisperstage. the other question you asked about was collaborationand just quickly on that i think we are at moment where there is more possible maybethan at sometimes in the past with the emergence of mecklink and community care of north carolinaas many of you know is a statewide organization

that provides sponsor largely but not entirelywho works statewide on policy and medicaid issues and also performs care coordinationand lots of very needed services. they have a new collaboration of sorts withmecklink and i think it can really help us move ahead as it relates to coordinating thecare in that patient centered way. iã­ll just give you one data point, i wasmeeting with ccnc in the last couple of days. most of us in the room would say if i wentto the emergency room this year that would be a huge event for me and hopefully i onlywent once. if you look at patients who last year wentto the emergency room more than twenty times, imagine that more than twenty times and thereare many of them, eighty percent chance that

those patients will have a significant mentalhealth issue that is largely going unaddressed. so if weã­re ever going to reign in healthcare spending overall, if weã­re ever going to motivate health overall weã­ve got to seizethe moment and i do think mecklink, ccnc, the providers in the communities maybe havean opportunity for some collaboration that are better than we have seen in the past. i want to remind you all that you can fillout the notecards with questions and include your names and pass them down to the end ofthe row and we will look at those and rick has. >> rick thames:

are we on here, yeah. okay good. would the person who is a public defenderwho submitted a question raise their hand? okay weã­re going to go right up here. if you could work your way down the aislehere and ask your question. we are particularly interested in the secondquestion that you had posed here. >> stephanie adelman: my name is stephanie adelman and i am a publicdefender and i had two questions and the second one is i think most of us in here know thatthe jail has become a large mental health

hospital and i was hoping that the panel couldaddress how we as a community could address that, how we could stop treating the mentallyill as criminals and start treating them with the dignity and respect and really what theydeserve. chief monroe, do you want to take the firstcrack at that? well, i mean i think thatã­s a great questionand we in law enforcement struggle with that because thereã­s a fine line sometimes whenit comes to activity and behavior whether or not it falls along the criminal lines orsome other form and what weã­ve done over the years is weã­ve began training our officersboth our patrol officers as well as our school resource officers to help them to be betterable to recognize mental illness in a sense

and how it manifests itself into somethingelse that we see out on the street and being able to use different kinds of skill setsto try to deescalate some of those situations and hopefully be able to make the proper referralsor have the proper support systems immediately available in order to address crisis situationsbecause a lot of times i think itã­s easy to say that i recognize that there is a problemhere with an individual but if you stop and think what are the choices what are the opportunitiesat 2:30 in the morning in order to address that particular issue in that individual,the resources are limited. and with that the choices become limited. ultimately you want to err on the side ofprotecting that individual and the public

so a combination of increased opportunitiesand resources available 24 hours a day to address the real issue so that jail doesnã­tbecome the automatic and better training and more training of officers, not only patrolofficers, i know that thereã­s close to 300 officers within the jail system that havebeen trained in crisis intervention and weã­re approaching about 300 officers ourselves. we just applied for another grant to hopefullytrain another 500 officers over the next three or four years but again that training is onlyone option and if thereã­s not other options in which an officer has the ability to redirector divert an individual in to immediately then i think weã­re going to still strugglewith the issue about jail being an option

because when you look at the activity it couldgo either way. weã­re trying to lean more towards that optionbeing some other resource, family, mental health providers, even being able to readilybe able to reach out to a doctor to help assess a situation at two or three oã­clock in themorning whereby we can divert that person versus taking that person into custody. judge bell, i donã­t want to put you on thespot but with this question i would be really interested to hear your perspective of therole of the justice system and all of this. lisa bell, judge lisa bell is the chief districtcourt judge for mecklenburg county. would you be willing to speak to this?

>> judge lisa bell: thank you.i appreciate the question. one of the scenarios that came to my mindactually as the question was being asked and as the chief was responding was a situationthat i think highlights the way we could as a community address the issue and decriminalizemental illness. it was a scenario that came up several weeksago where a young man had taken a cab from tennessee to charlotte-douglas airport. can everyone hear judge bell? just hold it close.

okay the young man had taken a cab from tennesseeto the charlotte-douglas airport he engaged in some behavior that was unquestionably criminal,but he also exhibited behavior that was indicative of a pretty significant mental health issue. chief monroeã­s officer recognized that andrather than taking this young man to jail, he took him to the behavioral health centerwhere he was admitted through the emergency department and his treating psychiatrist recognizedthe need for a longer term treatment program for him. this was a scenario where the family had thebenefit of private health insurance and was able to travel here and arrange long-termcare for this young man and also arrange for

legal representation, but the attorney cameto me because there was a warrant outstanding and this young man was going to go to jailif he was released from the behavioral health center. and it just took communication with the sheriffã­soffice and the police department and the behavioral health center and the district attorneyã­soffice and the court in just communicating with each other to allow this young man tobe placed in a residential facility as opposed to going to jail and everyone was on boardwith that but that key initial decision point was with that officer who made his decisionbased on his training and personal experience to take this individual to the hospital andnot to jail.

we are working as a collaborative effort throughthe criminal justice advisory group, the county has been working for a number of months nowthrough funding called the justice reinvestment act and it is an effort to redirect moniesto spend them rather than on the back end of crime on hopefully the front end of crimewhich is the preventative measures. one of the things weã­re looking at is moreof a crisis center where individuals can be taken by law enforcement that gives them theopportunity to be assessed and have that intervention in some way that is not incarceration andthe police department cmpd has been a part of this, the sheriffã­s office, the county,the court systems, and that would be ideal because when thereã­s no place else to takethese people sometimes as chief said, sometimes

itã­s a choice between something bad and somethingworse. itã­s jail or leaving them on the street whereeither they could injure themselves or cause harm to another person. but that would be a new entity. a new entity, in fact we had a presentationseveral months ago from bexar county, texas. theyã­ve got such a crisis response facilitywhere individuals can go, itã­s open 24/7, law enforcement can take them there it accessesvarious mental health services as well as other services that a person may not needmental health, may be substance abuse, it may be simply a housing issue that they havenowhere to go that itã­s a residential issue.

but this facility, itã­s kind of that clearinghousephysically where those decisions can be made and the accessibility to those services canbe facilitated by those professionals. is that a county funded thing? it was partly county funded but it was partlyfederal funding i believe thatã­s available and private funding. it might be that michelle lancaster couldspeak to the funding issues around it but from the court perspective, it absolutelyis needed because once these individuals get in to court and what i spoke for in the videoabout the accessibility and affordability you recognize thereã­s a need but thereã­sno way to get these individuals who donã­t

need to be in jail who may not need to beon probation that may not be successful, what they need is mental health treatment, butwhen they are transient when itã­s difficult to stay in the communication, they need someonethere holding their hand, metaphorically, to help them access and navigate the system. thank you, judge bell. quick from commissioner cotham and then ithink rick has another question from the audience. i just wanted to add about my work with peoplewho have been in prison. i would really like to see a better coordinationwith the state prison system but now i think itã­s called the department of public safety.

so, i would often have people who had justgot out and then iã­d be talking to them and i could tell there was an issue and i wouldsay did you get any medication when you left two days ago or yesterday and sometimes theyã­dsay yeah i got this bag here with these pills in it and then theyã­d say well can you getme a job and just change the subject. but they donã­t seem to have coordinationwith how do you take those pills or whatã­s the next step or i would say did you connectwith anyone here in mecklenburg did they give you anyone to call, no. so thatã­s another problem that certainlyour jail does a much better job with this but i would like to see more coordinationwith the prison system when people are just

getting out and they have medication or theydonã­t or they need it, because if they donã­t get it they often get themselves in a problemand often they get rearrested. this man, several of them iã­m thinking of,that we were able to get them help and i was able to find them a job and then we wouldstay with them to help them with their medication, but if they hadnã­t found us, lord only knowswhere they would go. do you have another one? yes.leigh petticoat, raise your hand. yes. leigh has a question about mecklink.

>> leigh petticoat: iã­m curious as to who are going to be answeringthe phone calls at mecklink, what credentials they have and how many people are going tobe answering the phone calls for the high percentage of the population that hopefullywill be calling you? and the second part of my question was somethingthat officer monroe spoke to what systems are you talking about that allow sharing ofthis information? i donã­t know what youã­re talking about.either part. so in some of our work, weã­ve been lookingat other states. hold that closer.

weã­ve been looking at other states. one of the states that weã­ve been lookingat is south carolina. south carolina has an information technologysystem in place that allows their departments to share information so the education system,social services, law enforcement with the example that i was giving you was somebodywas arrested when they pulled up his record they could see is he getting services already,what services is he getting, who is he, who are his providers, is he in the educationsystem and the general assembly had somebody from south carolina come up and testify aboutthe system in the fall. and so it is something that our state is lookingat and i think that it would go a long way

towards communication and collaboration andwould keep people from having to pick up the phone and having to make those phone callsthemselves. mr. endress, i think you said you are alreadygetting 2,500 calls a week, is that right? and so that number is probably going to climband you must have a lot of people answering the phones. yes, we are receiving about 2,500 calls aweek at the call center the staffing is that we have staff in the call center. i believe we have 26 people answering thephones. we have clinical backup, trained clinicians,social workers, nurses, psychologists, licensed

professionals in the state of north carolinato be able to, i donã­t want to say itã­s a warm handoff, itã­s a hot handoff. thereã­s a connection so that if somebodycalls in and there is a crisis, the clinical person can come and take over that phone callright from the person who actually answered the telephone, immediately. itã­s not can i get back to you, can i haveyour name and number, thereã­s a real handoff immediately for that individual. we have done approximately, in the 18 daysthat weã­ve been operating, approximately 8,000 authorizations for services which ithink is quite remarkable and itã­s really

a system that weã­re growing into iã­m notgoing to make any promises that itã­s going to be absolutely perfect every it is somethingthat weã­re learning about we talk about it every day, we talk about our calls, we talkabout how we handle things, we talked about the authorizations, we talk about alternativesthat we could have taken in providing services to individuals and this is something thatwe talk about every day in our meetings and it is a 24/7 operation. during the evening hours, we have an on-callsystem that is staffed again by professionals and professional staff and those reports comeback to us every morning and i believe that itã­s seven oã­clock in the morning for thecalls that have come in overnight.

i want to go back for a minute to the questionabout prevention. a couple of you have touched on preventionand tonightã­s mostly about emergency care but obviously the two go hand in hand andwe had a lot of questions from you all about how we could have better early treatment andprevention and avoid and the crises and the er visits in the first place. one audience member said, as a professionalcounselor, i am aware that many have to wait for several months for non-emergency behavioralhealth appointments, which starts the crisis cycle over again. what can be done to address this?

and others pointed out that without that earlydiagnosis, the treatment and case management, you end up spending a lot more money on crisiscare. iã­ll take a shot at that one. i think that one of the things, mottos thatweã­re learning to operationalize at mecklink is what we refer to as the five rights. itã­s the right service to the right individualat the right time for the right outcome and the right cost. and this is something that is absolutely criticalthat we need to be able and to work with the broader community to be able to identify individualswho might be having a problem so that we can

do some outreach to them. we have services that do outreach in the community. pat has talked about services in the agencythat she has worked in that identified individuals that had stressors. we need to be able to talk to those individualsand to have them make that connection to us so that we can then begin to do outreach tothose individuals. chief monroe comes in contact and his officescome in contact with people every day, every shift that may not have a mental illness thatwarrants being taking to an emergency department, but they said we can give you a phone number,we can call we can make a referral for you

to be able to access services.and yes, mecklink is about medicaid managed care, we also respond to individuals who aremedically indigent that donã­t have any sort of health insurance and try to make thoseconnections so that they do not need to go to an emergency department or become involvedwith the court system and the judicial system to be able to access services. if somebody has health insurance we will beable to answer their questions but we will also then help facilitate a linkage back totheir health care provider to be able to provide more appropriate access to treatment servicesthat they may have in their network. so itã­s really a growing experience for usand a learning experience for us to be able

to manage the services within mecklenburgcounty and hopefully be able to assure more timely access to appropriate treatment andsupport services. i saw ellis. ellis fields is the executive director ofthe mental health association in charlotte. are you surprised that it might take somebodymonths and months to get a non-emergency appointment? what have you seen along those lines? >> ellis fields: honestly, not surprised just based on communityfeedback. we are constantly in contact with our friendsin the hospital system and we know what the

issues are. a lot of the barriers to solving those issuescome down to funding and we need to work with our state politicians and that would be myplea to the audience members is my organization is known for advocacy. weã­re looking at public policy around mentalhealth, primarily public mental health service delivery system and it takes everyone in thisroom to educate themselves about the issues about barriers, whatã­s needed to solve thoseproblems and be vocal. i know pat will love this but call pat. call her fellow commissioners that are inthe office, our state legislatures are particularly

important. so surprised? no. i know weã­re taking steps weã­re making progress,weã­ll have more beds here eventually when the new facility here in davidson opens butitã­s what i hear constantly. thank you. dr. ray? just a comment. lots of people know about the acute care environmentin cmc randolph a coming attraction for a facility that weã­re working hard on in thedavidson community but maybe not as well known

that there is a substantial clinic operationassociated with the campus cmc randolph last year i believe we saw about 50,000 visitsand that capacity is not enough and lots of stories that would indicate that i would getyou to help us do one thing and thatã­s expand our thinking a little bit about what screeningand early detection might be. for us, thatã­s going to be a move into ourprimary care environments everywhere we are and thatã­s hundreds of places through thecommunity that weã­re able to serve. our vision of it is that at some point beingscreened for a mental health condition would be as common as answering a question aboutblood pressure, diet or any other aspect of health in the primary care setting where itã­sway up stream of most of the problem which

we see and a lot of the crises are talkingabout and weã­ll keep talking about. so, weã­re trying to expand our horizons fromway upstream and early in condition so to try to identify who needs help early on. one in four of us in this room or on averagewill need the help of a mental health professional sometime in our life itã­s not somebody elseitã­s not a rare thing and we can do a lot better job of expanding our job of the healthcare providers of those who we have today of being better trained. well that is so essential you donã­t wantto wait to have a heart attack to have any kind of treatment or attention.

when we have high blood pressure we startworking on it right then. mrs. rash? so, that raises a question which is the statehas made a different choice than other states have and what the trend is nationally. north carolina continues to carve out mentalhealth care and have people served separate and apart from their normal health care needs. in most states weã­re seeing states move towardsintegrated health care and one of the reasons that you may not have routine non-emergentcare available is because of that decision. if anybody wants to comment on that, iã­dbe interested but thatã­s what my opinion

is. and we did invite state legislatures to joinus tonight, but theyã­re in a session tonight and were not able to be here. rick has another question from the audience. yes, weã­re getting a lot of questions fromthe audience tonight about care for adolescents. so for example tish schultz tweeted a questionfor adolescence that need a higher level of care what in county resources are becomingavailable level four for example. and then iã­d like to ask kristin jackson,would you raise your hand? kristin has a related question.

>> kristin jackson: hi, iã­m the paralegal at the public defenderã­soffice and my similarly related question and i donã­t know if there is anybody here fromcharlotte mecklenburg schools but i would kind of like to know this is also relatedto chief monroe, maybe he could address it if thereã­s no one here from cms but.. there is. we have someone from cms. what is cms and possibly in conjunction withthe charlotte-mecklenburg police department doing to try to divert our adolescents frompicking up charges out of a phrase or assaults

in school thatã­s happening at school andtry to divert them from the criminal justice system. it seems like recently at least whatã­s comingacross my desk in our office is an increased number of adolescents with charges that thesekids may be having mental health issues. well i beg to differ i think within the lastyear and a half weã­ve seen a tremendous decrease in the number of youth taken in to custodyand thatã­s primarily because we took the initiative and with partnership with the criminaljustice system to divert from that. i donã­t believe that we should use arrestas a form of discipline or punishment for what in many cases is childish behavior.

but we also have to recognize as a state,weã­re one of only two states in the country thatã­s still considers a juvenile at theage 16 as an adult and i think that there is a lot of work that has to be done in thatarea. but weã­ve met with all of our school resourceofficers over the last year and a half, taken them through a host of different trainingscenarios so that they can recognize and wade out different offenses and remove the majorityof those offenses into the non-criminal status in two ways. one, we divert them straight from schoolsinto various programs. number two, weã­ve met with the judges anddistrict attorney, whereby we will hold charges

in abeyance, not file that charge based onthat child taking other courses or other measures to correct that behavior where that chargewonã­t come to bear. so, thatã­s one of the things that weã­retrying to focus on to try to move more kids out of the criminal justice system as a wholenot just those that may experience mental health issues, but juveniles as a whole. >> rick thames: and i wondered if mr. endresswould address the other questions that was for adolescence that need a higher level ofcare what in county resources are becoming available? at this point, iã­m not aware of any new countyresources that are going to be made available

to address the highest level of care levelfor. i will say that one of the things that weneed to look at is how we can address and divert some of the kids that are currentlyin that level of care and provide service more appropriate services to those kids thoseyouth and their families in the community setting. once you remove a child from the communitysetting they begin to have more problems in school when they come back and the researchout there really does not support any sort of long term treatment interventions, long-termmeaning anything over three months. we need to develop a community that is willingand able and capable of addressing the needs

of our young people so that the young peoplethat really do need the most restrictive levels of care have access to it and theyã­re notsitting in detention or in other levels of care that are inappropriate to address theirneeds. did that answer your question? karen thomas is here from cms. karen is the executive director of supportservices for cms and weã­ve written recently yesterday about the number of school basedbehavioral health specialists has dropped and you all are really lacking resources rightnow in that area. can you talk a little about that?

>> karen thomas: thank you for the opportunity to address that. one of the words that i have heard repeatedlytonight that i think is a key to solving it together is collaboration and currently incms we are really understaffed with our support services folks that are in the schools. that includes our counselors, social workers,and psychologists. in 2009, when we all remember that severeeconomic downturn, we had many many cuts in our services and have not yet recovered fromthat. and so part of the collaborative work thatweã­re trying to put together now has involved

some conversations with michelle lancasterfrom the county and also some conversations with meckcares. we do have some intervention team specialiststhat started it as work from a grant with meckcares. so we recognize, and i appreciate mrs. rashã­sdata on the number of children that are experiencing mental health issues and we just know thatwe cannot address all of those issues from the school district, weã­ve got to have allof us working together to address this situation. but, i firmly believe we need more staff inthe schools to be those front line folks to help children with their mental health issues.

that sounds like to me purely a question ofknowledge and sense. >> karen thomas: it is a question of knowledgeand sense. commissioner cotham is there any money inthe budget for more? we certainly have talked about this as wellas the school nurse program and just like the security program for cms and so whereverwe have money we have to take it from someplace else so you know it is really difficult withthe budget right now and because of the security work that cms wanted.but i know we need to look at all of these things and i know as a board we will but theseare hard decisions and we need to make them as a community.

so please know that this is something veryimportant to the commissioners. youã­re right that you cannot do this on yourown and one of the things that i see in the data when we look at the kids in need, while56% of the kids needing mental illness services are served within the stateã­s public systemof care and while 21% of those with developmental disabilities are served within the stateã­spublic system of care, only 10% of those needing substance abuse service are served withinthe stateã­s public system of care. and that is a place where services have gotto expand. the other thing that we see as students transitionout of schools and into the adult system of care the lack of continuity of services fallsoff and thatã­s when we lose children and

so thatã­s another area of particular concernthat i think we have to pay attention to going forward. taylor batten: thereã­s not just a schoolissue, thereã­s obviously a lot of other venues where you can encounter the children and thereã­sa lack of inpatient beds for kids and teens as well. yes, chris winn, would you please raise yourhand? >> chris winn: thank you, thank you rick. iã­m honored to be here.

mebane i wanted to come to you on somethinghere. you know you just said that we canã­t do itseparately, weã­ve got to do it together, you know it seems to me that in north carolinaschools certainly weã­ve got somebody that stands up for health care, more traditionalhealth care weã­ve got somebody that stands up for tax reform, weã­ve got somebody thatstands up for education, economic development, but it seems to me that mental health doesnot have a chairman. that no one is willing to stand up, put astake in the ground and really carry this flag, iã­m using another metaphor. is that the case?

is there anyone out there that we donã­t knowabout? or does there need to be someone pulling fromthe front and not just the gang in this room that are pushing from the back? in our research we saw one of the, i think,sad things about mental health reform was that north carolina lost its mental healthstudy commission and the mental health study commission in north carolina had been a nationalmodel and i think it had been a national model for three reasons. one, it had independent staffing. it had independent staffing separate and apartfrom the division and the department.

separate and apart from the legislature andthey looked at these issues and they developed seven long-ranged plans that guided policymaking in this state on mental health reform and mental health issues and i think we aremissing that. the other thing that the mental health studycommission did was that consumers, it wasnã­t just token consumer representation, consumerswere an active part of the mental health study commission. they had voting rights and we need a policymaking form where that is the case where all of the people who are stakeholders in thissystem can come together and can do what youã­re talking about and thatã­s also how they developedlegislative champions on mental health issues

back in those days. in the meantime, i am hopeful that the managedcare organizations, the mcos, will step into that role in their communities. when we looked at piedmont behavioral healthcare which was kind of the pilot model for this, one of the things that they got fromthe waiver was the ability to become advocates for the people that they are serving and totry to identify providers that would provide the right mix of services for their communityso that may happen and weã­re hopeful that it will happen. iã­m not an expert on this issue but i justwant to comment on it.

i think youã­re absolutely correct and i comethrough a lot of different forms and a lot of different community meetings, but justlooking out in this audience and seeing the number of people that are here tonight thatcare about a single issue is probably the most powerful statement that you can maketo anyone whether itã­s law enforcement, whether itã­s the state or whoever if you have thatcare and that concern and that passion you can make a difference, but i think we allhave to be willing to, again, pull back the curtains and go through the door and makeit an issue that youã­re not afraid to talk about every day, because the stories and thecrises that are out there facing individuals with mental health issues.

itã­s scary, it really is. you know, what weã­ve experienced just inlaw enforcement this past weekend involving our young people but thereã­s a secret aroundit. no one wants to talk about the real issuesabout what was happening to our children. we find other ways of disguising it and makingit a tragic accident but itã­s more than that. these kids are suffering out there, the challengestheyã­re going through, the things that weã­re seeing them involved in, itã­s a crisis butwe speak about it in other terms so i believe that just the power that i see amongst thegroup here tonight can really help make a difference in bringing about real change.

iã­d like to echo that and i think as a newlme/mco that we need to listen to our consumers, our family members and you know we have amechanism in mecklenburg county to be able to do that and i believe that every lme/mcohas this as well and itã­s called the cfac, consumer family advisory council. and that has a tremendous input into how wethink about the delivery of services in our community and it should be driving that levelacross the state and when we begin to listen better and when the cfacs begin to have apolitical voice in raleigh i think then weã­ll have some real progress in the delivery ofservices across the state. as long, while weã­re talking about the stateand chris i thought that was a good question.

the state seems like theyã­re reforming themental health care system every few years but from what i can tell sometimes throwingthe baby out with the bath water and not keeping some of the good aspects of, mrs. rash iã­dbe interested in your take on some of the biggest aspects in recent years from the statelevel of what are the biggest mistakes theyã­ve made or do we have another couple hours oris there something that we need to do or do we need to let this one play out? so i think the biggest mistake is just thelack of instability in the system. when we look at mental health system acrossthe country and evaluate how well theyã­re working, states that have good systems haveidentified their mental health strategy, theyã­ve

implemented it, theyã­ve funded it and theyleave it in place long enough to evaluate it and make meaningful change. in this state it seems like there are majorchanges in policy, in funding and in leadership so frequently that often the stateã­s biggestproblem is its inability to stay the course. and so i hope as we move through with theconversion to manage care organizations, and the waiver that there will be patience forus to implement it and leave it in place long enough that we can really go in and make somemeaningful evaluation and have good positive changes come about from that. given that the question was kind of directedat me, iã­m new.

iã­ve been here seven months now, six anda half months, i guess so i really canã­t address it. but i think that one of the critical issuesis that behavioral health care reform is part of national health care reform and itã­s anevolutionary process and, you know, iã­m not familiar with all of the changes that havetaken place in north carolina over the past ten years but where we are now is not thatdissimilar to where other states are in terms of moving towards a managed care system. as it was pointed out earlier, some statesare doing it as a segregated system. other states and more states are doing itas an integrated care system.

but this is part of an evolutionary changethat north carolina is under taking and i suspect that in the next, as we learn aboutdelivery of services to individuals with mental health issues and substance abuse issues herein mecklenburg county weã­re going to do more and more about integrated care whether itã­sthrough our pro act model with the emergency departments or with ccnc and looking at thedata in a much more holistic integrated manner. this is part of the evolutionary learningand i think that iã­m willing to give the state some kudos for allowing this to happen. other states may not be there, but i thinkthat north carolina at this point is on the verge of moving in these directions and itã­sa very positive direction to move in to.

>> taylor batten: thank you. we have time for just a couple more questions,two or three more questions. something we havenã­t touched on much, sofar, is homelessness and housing and thatã­s a big piece of this you know. the vast majority of homeless people sufferfrom some kind of mental illness or behavioral problems and moore place has been a wonderfuladdition to this community serving the chronically homeless and i kind of feel like we need moreand more places. is john yaeger here? john is with urban ministrycenter and iã­d like you to talk a little bit about, you know, what needs to be donearound helping homeless individuals, specifically

through the mental health lense. and then i might ask the panelists what canbe done to provide more housing and supportive services to severely mentally ill individuals. >> john yaeger: well i think the housing works program throughthe urban ministry one of the things weã­ve done differently is we used the housing firstapproach. we donã­t say that youã­ve got to get cleanand sober first. we donã­t say you have to be on your medsand stable first. we say, come and get housing and weã­ll helpyou with that and weã­re showing that thatã­s

successful. we need more housing first. well first of all, we need more housing, butusing that housing first model, we can put people in to housing, once their basic needsare met, now they can focus on taking care of those other things, but itã­s really hardto think about going to get your meds or getting substance abuse treatment when you donã­tknow where youã­re going to sleep tonight, or if youã­re going to sleep, or if you haveshoes on. so, having that stable place to live is reallythe first step. so is that, i donã­t know if you all couldhear that, but housing first.

if you have a roof over your head and youknow where youã­re going to sleep, youã­re more likely to be able to deal with your otherthings that need to be dealt with. does that mean building another moore place,i mean there are a lot of different ways to provide that housing. john yaeger: well it could mean building anothermoore place. we also have a scattered site model wherewe place people in apartments throughout the community and work with landlords. we have case managers that go to peopleã­sapartments and thatã­s also very effective though it doesnã­t necessarily have to meanbuilding more buildings, but it does mean

having access to more apartments. taylor batten: well doesnã­t it mean thenproviding the supportive services that they need. i mean the roof wonã­t magically do it. you also have to provide a lot of supportivehelp. people arenã­t homeless just because theydonã­t have a home, thereã­s also typically other things that they need and so the supportservices have to be in place and they have to have people who know how to access thesystem or have mental substance abuse knowledge themselves and can work with the people andincrease their motivation to accept treatment

and then help them get into treatment andkeep them motivated and be there when crises do happen because just because someoneã­shomeless doesnã­t mean that there wonã­t be any more crises. someone has to be there when that happens. commissioner cotham, what can the county doto help the mentally ill individuals who are homeless? well there are probably a lot of things wecan do. certainly we need to help to educate peopleand i also really believe in working with the non-profits more can also be a big help.

homelessness, iã­ve worked with a lot of peoplewho were homeless and i was able to get a lot of them out of the shelter which was thebest thing in the world to get somebody out of the shelter. but one thing that weã­re not talking aboutthat i think is part of this, a lot of these people who have mental illness can still havea job, a lot of them can have a job and we havenã­t talked about that and same thingwith people with criminal records, but a lot of them i have found jobs for and they arestill very successful in their job. it may not be a job that you might want, butthey are very happy with it and that can also help them get out of the shelter so that mightbe another topic we might talk about sometime

is jobs, because that is a constant themewith this population as well as with the overlap of people with a criminal record and thereare a lot of places that, including the housing authority, that will not rent to someone whohas a record and itã­s a real problematic. and this is something that i went to visita, i helped a woman who just got out of prison last week and i helped her find a place tolive and went to see her on sunday and i was able to vouch for her because iã­ve knownher for a while, but if she didnã­t have me as someone to vouch for her she would reallybe in a problem and she has two college degrees, but she just got out of prison. but again we need to think about jobs andthere is a lot of discrimination and we havenã­t

talked about vocational rehab because thatã­sanother non-profit that helps a lot of people who have disabilities. rick has another one from the audience. >> rick thames: is zach gordon here? zach, yes. well youã­re right in the middle arenã­t you? iã­ll get right over here. zach raises a question that many other peoplehave raised and it is regarding hospitals. >> zach gordon:

to dr. ray. the question really is, it seems to me andour daughter had a situation very similar to the story earlier, overdose, went intothe emergency room and i hear the story about people twenty times a year, it seems likethe hospital is the place to have a facility so that there is a police officer or someoneelse a crisis could really go there. the question really is, how can the hospitalbe encouraged or maybe required to use a euphemism to provide that service because really, itã­s2:30 in the morning, thereã­s a problem, and what do you do? you donã­t really want to take them to thecounty jail, you donã­t want to bring them

to the emergency room, our daughter was therefor three or four days and then fortunately we were able to get a bed an hour and a halfaway and i think that it comes down to funding i know and it seems that naturally it wouldbe those hospitals that seem to be sprouting up in every community that would be a goodplace to take them. >> dr. roger ray: couple of comments, you know, it is a bonafidecrisis and access is not adequate and much like law enforcement, in a certain sense,becomes the last line of defense in a clinical sense, hospital emergency rooms that peoplecome to work to do the right thing and if that wasnã­t enough federal law has a lotto say about what we need to do in emergency

rooms to help stabilize those who are in emergentmedical condition our last line of defense. and the crisis is such that the shortagesare extreme and therefore the stories that emerge from that are at a minimum and frustratingand confusing and at maximum, tragic and theyã­re easy to find and thatã­s what brings us allhere today that we try to figure out i think. thereã­s no doubt that going forward we haveto both do more and do better. we, carolinaã­s health care system, is convincedwe need to do more and thatã­s why we have doubled down as it relates to capacity witha new behavioral health hospital in the davidson community at a time where the math does notsupport it, the finances do not support it. we even deal with some criticism to do it,but itã­s the right thing to do and we are

committed to trying to building the capacitythat even as the last line of defense, weã­ll be better suited to the need than what wehave today as we all recognize, thereã­s just not enough. the interesting discussion is once we havemore, how do we then do better? and thatã­s where the interesting discussions i thinkof potential partnerships and collaborations and changes in the model learning from ourselvesgiven more time for the model to work and also from other states as mebane was talkingabout may give us some tips of some things to try that have been either in a positionto or collaborative enough to be able to try. so, you know, iã­m proud to say that we arecommitted for hospitals and health systems

doing their part and i think weã­ve demonstratedwith some courage our willingness to do that, but it is our part and everybody in the roomand everybody represented on the panel and in the first three rows has a substantialrole to play that we canã­t or shouldnã­t as a community coming together to watch afteritã­s citizensã­ health needs together. and so we stand ready to work with others,to do their share, weã­ll do our share and i think thereã­s benefit for all of us inthat. >> taylor batten: dr. ray with carolinas healthcare, we also have a number of presbyterian hospital representatives today, dr. greg clary,who is the medical director for psychiatry at presbyterian, would you echo what dr. raysays?

>> dr. greg clary: to a certain extent, yes and to a certainextent, no. i mean the reality of things is, thereã­sno room in the inn and the question becomes with the lack of resources, with the lackof renovation, what can we do to help our patients to ease their suffering? and i think the key element in any of thisis a community, that there is room in that community and what that community can do. iã­ve been at presbyterian for a little over60 days and the last 60 days i have been swept into reality, but luckily, given the supportthat we have, iã­ve made contact with mecklink

and weã­ve discussed options in terms of bringthe acute crisis team into the emergency room at presbyterian to assist with disposition. actually in two days, iã­m meeting with thepsychiatrist at cmc randolph so that we can try and establish better communications onsimilar patients in a way that doesnã­t violate the governmental rules, but best helps thepatient and helps the system deliver the care thatã­s necessary. the child situation is, to be quite honest,a disaster. iã­ve got five children in the emergency roomwaiting for beds at our hospital with essentially no other disposition options that we contactother state facilities and iã­m not trying

to point fingers at them, again thereã­s noroom in the inn and weã­re doing the best we can given the circumstances that weã­vegot. i think presbyterian, i think cmc, i thinkthe county, everybody is making the best effort possible to make end roads to make thingswork, but the problem becomes, how do we as a community, as a city, as a state, as a nation,because this is nothing new. i mean deinstitutionalization was in the sixties. weã­ve been chasing our tail since then. how can we do things better? how can we recognize the problem better?

how do we not make this a competition andmake it better? that question there, i donã­t know what the answer is. presbyterian is trying theyã­re certainlygiving me plenty of rope to try and do thing in a better way to help the patients and tohelp the community, but i think things like this, integration of systems, iã­ve workedin a prison system, embarrassingly i was a resident at duke and i was the stateã­s psychiatristin two prisons in northern north carolina, thatã­s how pitiful things are, but the differencebetween the patients i saw there and the patients i saw in the hospital was where did the officerdecide to take them first. so i think we can all do better.

the question is, whatã­s the best step? >> taylor batten: well i donã­t know thatthatã­s an uplifting answer but itã­s a realistic one and itã­s probably a good place to leavethings this evening. itã­s really deeply challenging problems withno easy solutions and you all knew that coming in. but we wanted to start that conversation andi hope that this is a beginning and not an ending of talking about these issues. letã­s give a big thank you to our panelists. our panelists are going to stick around.

we have coffee and deserts outside at thereception. different agencies have booths set up thenational alliance of mental illness is here. so, please join us and keep the conversationgoing, thank you all for coming.