Increased partnerships and the delivery of nontraditional mental health care methods were cited as ways to improve the treatment of behavioral health issues during a community forum on Dec. 14.
At the Orangeburg Area Mental Health Center-sponsored forum, South Carolina Department of Mental Health Director John Magill noted the agency's improved financial picture has led to the expansion of services within individual communities.
“We are a state agency that doesn’t receive all of its funding through general state appropriations. We actually have to earn about 50 percent of our expenditure budget. So it’s about $225 million we have to earn through clinical services that we provide. The more money I can put into this system for clinical work, then the more it can earn from clinical work. With those two things put together, you are able to expand your services,” Magill said.
Reaching out to philanthropic organizations like the Duke Endowment has also helped the agency’s bottom line, he said.
The Duke Endowment is the primary funder of the agency’s emergency room telepsychiatry program that has been expanded in more than 20 hospital ERs statewide.
“It was so successful that we decided to do the community telepsychiatry program, which is a different set of psychiatrists that back up the entire community mental health system like they do here in Orangeburg. Your department of mental health has one of the largest, if not the largest, telepsychiatry programs in the United States. You’re doing a good job here and, hopefully, we’ll have even more of that up here in the future,” Magill said.
OAMHC Executive Director Willie Priester said the center has also had a liaison in the ER at the Regional Medical Center in Orangeburg since 2015. OAMHC employee Rickey James is the on-site liaison, he said.
“This has provided an opportunity for persons who are in the ER to be transitioned either from the hospital to another inpatient psychiatric unit or back in the community” and possibly avoid long wait times in the ER, Priester said.
Crisis intervention; psychiatric and medical assessments; therapy for individuals, families and groups; peer support and nursing services are also provided by the center, he said.
The agency served 1,731 adults and 1,027 children in fiscal year 2017, Priester said.
The agency’s Homeshare program, where individuals provide care in their homes for the mentally ill, and an ACT-Like program, which helps improve outcomes for mentally ill adults who are most vulnerable to homelessness and hospitalization, are among the center’s specialized services. ACT is an acronym for Assertive Community Treatment.
The OAMHC’s school-based mental health program provides the placement of mental health counselors in Orangeburg Consolidated School Districts 3, 4 and 5.
“We serve 42 schools with 21 mental health professionals and have provided over 4,000 services to the students,” with the agency having expanded those services at the Bamberg Job Corps site for the first time this year as well as at Claflin University, Priester said.
Magill said the SCDMH’s school-based mental health program operates in 641 public schools statewide, adding that the OAMHC is doing "a very nice job" with it.
Orangeburg County Sheriff Leroy Ravenell; Orangeburg County Probate Judge Pandora Jones-Glover; Freddie Bowan, director of the S.C. Vocational Rehabilitation Orangeburg Area Office and Family Solutions of the Low Country Director Virginia Berry White were panelists at the community forum.
Ravenell said he was thankful for the partnerships that have developed between local agencies to serve the mentally ill, particularly since “we used to have to ride around the majority of the night with a mental person in the car because nobody wanted to take them and we didn’t know where to take them.”
“Last year, I think the sheriff’s office responded to approximately 97,000 calls, and I can’t tell you how many of those involved mental health issues … . What I’m trying to do every day is educate our officers how to deal with people when they respond to these certain calls,” he said.
Magill said he would contact the National Alliance of the Mentally Ill, which administers Crisis Intervention Training, to see if the training could be provided to officers in the county.
Jones-Glover talked about her job in presiding over civil commitment hearings through which an an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is court-ordered into treatment in a psychiatric hospital or in the community.
She said the development of a mental health court would benefit Orangeburg in regard to the mentally ill who "find themselves in trouble with the law."
Magill said a Duke Endowment grant was given to the SCDMH this year to expand some mental health courts.
"If we can provide the efficacy of them, which I’m sure we will, I think you’ll see within a year or two a much bigger grant that will allow us to help incentivize communities. I will make sure Orangeburg’s on that list," he said.
Berry White, whose agency includes Low Country Healthy Start among is service programs, said more work needs to be done to combat stigma and provide “nontraditional ways" that families can receive mental health services.
LCHS works to reduce infant mortality in Barnwell, Allendale, Bamberg, Hampton and Orangeburg counties.
“We want to make sure that we can find some different ways to be able to meet the needs of the women and families that we’re serving,” Berry White said.
Magill said, “Stigma does prevent people from getting care. Another initiative that you may see a little more forward moving within the next couple of years statewide and perhaps here in Orangeburg is bi-directional integration,” which involves putting onsite psychiatric medical staff not just in mental health centers, but general medical practices and perhaps some federally qualified health centers.
James said there is “much benefit” in RMC having its own Behavioral Health Center, a 15-bed psychiatric unit serving adults who voluntarily seek help for crisis intervention and require short-stay inpatient treatment for stabilization and safety. However, he said he has encountered problems finding placement for other patients who may require psychiatric care.
“Usually the length of stay in the ER before I can get them back into the community or a facility where they can get the treatment that they need ranges anywhere from two hours to two or three days. The longest one I’ve had over there was probably about a week or two,” James said.
Dr. Jack Colker, the RMC’s medical director for emergency services, said the emergency department sees approximately 10 to 15 mental health patients a day.
“Sometimes we hold up to 10 mental health patients while we’re waiting to get some level of placement. In a department that has 30 beds if you stretch it, we lose a third of our capacity to actually do our mission of emergency and urgent care,” Colker said.
“RMC believes that we really do need to have a crisis intervention system and possibly some type of transitional service facility for the weekends and evenings … . This is one of those areas I really think that you have to get community people and shareholders involved to come up with a unique way to help take care of these people," he said.
Magill said RMC would do well to reconsider resurrecting its ER telepsychiatry program, which was “not a cure all but a tool in the tool box that you could have.”
He said the establishment of additional crisis stabilization centers across the state will also help.
“It’s a community effort, community partnership ... but, again, if this community is interested, then I’m willing to send people down here to try to help craft (it),” Magill said.
Sadie Jarvis, director of counseling at Claflin University, said a community-wide resource manual to provide a listing of mental health and other health services would also serve the community well.
He added that the RMC had received a $500,000 USDA grant to create a community telehealth system.
“We’re in the discussions now about how we’ll implement it. We literally just got this grant so the details are being worked out,” Colker said, noting the he welcomed collaboration on making that system work.
Magill said the number of people with behavioral health, psychiatric and addiction disorders has been “grossly underestimated” for many years, noting that his agency is working on prevention efforts by preparing to apply for a federal suicide prevention grant for adults.
“And I’ve created a statewide coalition on suicide prevention. Our efforts right now are very much directed at schools in doing some prevention work, but we’re also going to develop some protocols so that a lot of agencies that deal with suicide recognition will have some training of symptoms,” he said.