Armed with significant funding from the Legislature, South Carolina health leaders aim to address the lack of emergency mental health treatment and create easier access for families to get the care they need.
Now is a great time to move forward on these issues with the debut of the new 988 hotline for people to call for mental health aid, said Bill Lindsey, executive director of the National Alliance on Mental Illness South Carolina.
“I think 988 is a game-changer for mental health around the country,” he said. “It is putting emphasis on an issue that has been long neglected.”
The S.C. Department of Health and Human Services, armed with the $64 million from the Legislature but with the ability to spend from its reserves as well, is convening a working group starting next month to look at how to strengthen emergency mental health treatment and access to coverage in the Palmetto State. While the initial focus of the Master Plan Advisory Committee will be creating a system in the Pee Dee region, the aim is to create something scalable that could work for the rest of South Carolina as well, director Robbie Kerr said.
The first step is a sober assessment of the system and what isn’t working, which is why the General Assembly authorized “significant” funding for the effort, he said.
“I think they recognize and we certainly agree that it’s an extremely fragmented system right now,” Kerr said.
The working group includes the Department of Mental Health, the Department of Alcohol and Other Drug Abuse Services, the South Carolina Hospital Association, psychiatrists at Medical University of South Carolina and Prisma Health, as well as Clemson and Francis Marion universities, among others.
They will “help make sure we identify the appropriate gaps in those mental health services around the state,” Kerr said, and “help us identify what’s the best way to look at the services we have and don’t have and integrate them.”
Legislative leaders have expressed frustration at the lack of crisis stabilization units in the state — the one in Charleston is the only true center and it is currently at half capacity — even as needs have increased during the isolation and worry brought on by the pandemic.
Researchers at Boston College found the rate of anxiety among adults jumped 50 percent during the first months of dealing with COVID-19 and depression increased 44 percent. It was even higher among young adults ages 18-29, with anxiety up 65 percent and depression increased 61 percent, according to the study in Translational Behavioral Medicine.
Yet accessing care for that can be difficult and the Medicaid program gets that feedback often, Kerr said.
“We hear from family members a lot: ‘We just don’t know where to go; we don’t know how to access the system,'” Kerr said. And it makes sense to him.
“I think if you are diagnosed with mental health (issues), from what I see it’s a daunting challenge to navigate the system,” he said. “I’m not sure where I would start and I am probably a little more educated user simply because of the job I have. And I’m not sure how you would start with our system.”
Connecting people who call for help to crisis stabilization, a temporary stay of three to four days in a center that can provide intensive treatment, is a major need for the state and a focus for the working group, Kerr said.
“How we get individuals stabilized to ensure we are getting them the appropriate treatment is of extreme interest to us right now,” he said.
Efforts to create those crisis units in communities across the state, from Greenville to Columbia to Florence, have been going on for years and those efforts will continue, said Deborah Blalock, deputy director of the Department of Mental Health Community Mental Health Services. That and the work of the committee will continue in parallel as the committee looks at perhaps larger, overarching systems, she said.
“The boots on the ground work is continuing to happen,” Blalock said. “It doesn’t get in the way of what this Advisory Committee is looking at.”
Networks for crisis stabilization are already in places in states around South Carolina, such as Tennessee and Florida, Kerr said.
“When I look around the Southeast, crisis stabilization has been operational in most states for some time,” he said. “I’m confused why we don’t have essentially any Crisis Stabilization network or units going. We want to rapidly put that in place.”
It could also include more jail diversion programs, which Medicaid programs in states from North Carolina to Michigan to Texas already operate.
“I think we’d be very remiss to start to talk about crisis treatment and not look at the judiciary side of things,” Kerr said. “We don’t want patients languishing in jail when they have mental health problems that we can alleviate.”
Mental health courts, which can divert people to treatment for minor offenses, already do a great job of this in the state, particularly in Richland and Charleston counties, Lindsey said. But more could be added, he said.
Crisis treatment centers and other physical places for treatment will likely need to be added or augmented, Kerr said. But there may also be a virtual component, and there have been discussions with MUSC about tapping into their robust telehealth network, he said.
“Let’s see what we can do to augment that for behavioral health purposes where we have a client who can be stabilized virtually because that is certainly possible,” Kerr said.
The point is to start creating the networks, filling in those areas where people fall through the cracks for mental health treatment, and adding crisis stabilization units around the state.
“We’re going to put some effort into making sure we stand them up,” Kerr said. “We need to figure how to bring the networks together, to make sure we know how to escalate and get the right care at the right time.”