Taylor Kopf is a reporter for North Carolina Health News, from which this article is republished.
The 10 behavioral health beds at Cannon Memorial Hospital near the western edge of North Carolina are almost always full. Meanwhile, more patients struggling with mental health issues end up waiting in the hospital’s emergency department to be admitted or sent somewhere else for psychiatric care.
The small psychiatric unit at the Avery County, North Carolina, hospital has received more than 5,000 patient referrals from across the state each year, but could only admit about 11% of those patients. (Avery County is on the Tennessee border on the spine of the Blue Ridge Mountains. It has a population of about 18,000. Ed.)
This is not an uncommon story, as emergency departments across North Carolina and the country have become increasingly filled with behavioral health patients seeking help. The added stressors due to the Covid-19 pandemic have driven even more people experiencing mental health crises to the ER.
While mental health patients lined up for care at Cannon Memorial Hospital, more than half of the hospital’s 25 acute care beds — which are designated for patients with injuries or other illnesses — sat empty most days.
Now, leaders at Cannon Memorial Hospital have decided to flip the model and convert unused inpatient acute care beds into behavioral health beds, said Carmen Lacey, president and chief nursing officer of the hospital.
On November 15, the doors of the new Appalachian Regional Behavioral Health Hospital officially opened to the public. The new 27-bed adult behavioral health hospital is under the same roof as Cannon Memorial but has a separate entrance.
Renovating and Hiring
Leaders of Cannon Memorial Hospital, which is part of the Appalachian Regional Healthcare System, renovated an old medical unit to increase the size of the behavioral health unit from 10 to 27 beds. The acute care side of the hospital has been reduced to eight beds.
The hospital received a grant from the N.C. Department of Health and Human Services for the conversion project which came out of the pot of money from the sale of the property that used to be the Dorothea Dix psychiatric hospital in Raleigh.
Lacey said her hospital received a special exemption from the federal Centers for Medicaid and Medicare to expand the behavioral health unit beyond 10 beds. Usually, the upper limit for a behavioral health hospital is 16 beds unless the facility gets its primary funding from the state.
“We received an exemption from CMS for that particular regulation as long as we had two separate hospitals under the same roof,” Lacey told the North Carolina Health Care Association in a video interview.
“We are the first in the country to be given the exemption by CMS,” she said. “We will be a role model for future facilities. Critical access hospitals around our state are looking at us to see if we can make this model work and we are committed to making it work.”
Recruiting medical staff to a rural area can be challenging, and the new behavioral health hospital is in the process of hiring for about 50 new positions.
“We haven’t had an employment opportunity that large in this community in a long time,” Lacey said.
The hospital will open in phases to ensure all staff positions are covered, with a goal to be fully operational by the end of December.
“We’re excited to be able to care for more patients,” Lacey said. “We can take patients from ERs on a much more frequent basis.”
Less Traumatic Admissions?
While the new Appalachian Regional Behavioral Health Hospital can accept referrals from emergency departments across the state, the hospital will also accept walk-in patients.
“Patients can walk in and request an assessment to access care on their own,” said Stephanie Greer, behavioral health services director Appalachian Regional Health, in a video tour of the hospital produced by the North Carolina Health Care Association.
“We know that in the state of North Carolina, the traditional way — almost the only way — to access inpatient mental health services is via an emergency department,” Greer said. “That creates a significant strain on our emergency departments but more importantly, it is not the experience we want for our patients.”
Emergency departments do not always have a mental health specialist on-site, and patients are often left waiting to go somewhere more appropriate for care, she said.
“And in a rural setting like ours, patients are often incredibly hesitant to go through an emergency department. Our communities are small and everyone knows each other,” Greer explained. “And you don’t want to tell your story four times, and you don’t want someone your kid goes to school with or who you go to church with to know what you’re dealing with.”
Inside the new hospital, there is space for staff to assess up to five patients simultaneously. The goal is that no one is forced to wait, she said.
Another unique feature of the new behavioral health hospital is a designated visitation space for visitors under the age of 12. In the past, small children were not allowed to visit psychiatric patients at Cannon Memorial for safety reasons, Greer said.
“We recognized last year when we had several postpartum mothers dealing with severe depression and because of these constraints, we couldn’t allow them to see their babies. That didn’t work for them to continue treatment in the way they needed to,” she explained.
Greer said that there needs to be room for exceptions to those rules and a safe place for adult patients to see younger visitors.
The hospital is also set up to accommodate the increasing number of patients who are admitted under involuntary commitment, a court order which mandates treatment when a patient is considered a risk of harm to themselves or others.
Greer said that 50% of patients in the past were admitted under involuntary commitment, which typically means they are brought to the facility by law enforcement officers. The new psychiatric hospital includes a separate entrance and waiting area for patients brought in by law enforcement under this type of court order.
The hospital also has a courtroom inside, where the judge and other legal representatives can meet with the patient and their doctors — both in person or virtually — to determine the next steps of treatment for a patient under an involuntary commitment.