Wake County Sees Big Uptick In Mental Health Crisis Services

Jul 6, 2018

Veteran Duke basketball fans will remember the name Marty Clark. He played for the Blue Devils in the early 1990s, including on the back-to-back championship teams of 1991 and 1992.

But after college, things turned for Clark.

"As it turns out, most of my adult life, I've struggled with alcoholism and bipolar disorder," said Clark during the ribbon cutting for Triangle Springs, a new mental and behavioral health hospital that opened in April in Brier Creek.

This year, Wake County is seeing one of the largest additions of inpatient psychiatric services in its history. In addition to Triangle Springs, more bed capacity is coming to Holly Hill Hospital in east Raleigh, and Strategic Behavioral Health in Garner.

At the ribbon cutting, Clark said he struggled with alcohol abuse and then a hip surgery opened his life to opiates, which made matters worse.

"I can stand here for a while and tell you the yelling, the lies, the manipulation, the broken promises, the financial ruin, crying children pulling your leg begging you to stay home. But it wouldn't be anything compared to the heartache and the verbal abuse that my wife experienced and the stories she could tell," he said, his voice choking back emotion at times. "An almost 20 year drinking career can be summarized in that it started out as fun. Then it became less fun. Then it became scary. Then it became necessary."

Clark's story has a good ending, though. His wife called his college coach, Mike Krzyzewski, who helped Clark seek out treatment. He now works at the Raleigh House of Hope, an addiction treatment center and sober living facility located in Denver, Colorado. He was on hand for the Triangle Springs ribbon cutting to encourage the staff as they prepared to welcome their first patients.

Former Duke University Blue Devil Marty Clark, left, with Duke basketball head coach Mike Krzyzewski, right, and Kim Guy, director of business development for Beckett Springs, a sister facility of Triangle Springs.
Credit Jason deBruyn / WUNC

Mental health and substance use disorder advocates generally agree there aren't enough services for those struggling with illness. But in Wake County, that's changed all in the span of a few months. This year, three hospitals added a combined 124 adult inpatient psychiatric beds. That's an increase of almost 50 percent in just one year.

To understand the significance of that bed capacity increase, consider that since these beds were approved in 2015, N.C. Department of Health and Human Services regulators have allotted just 122 new inpatient psychiatric beds for the entire state. Statewide, there are 2,009 such beds, including 292 in Wake County.

"And I still feel like with all of these beds, there's still going to be a gap between the number of beds that are available and the need," said Triangle Springs CEO Carla Hollis.

Health Care Services Tightly Regulated in North Carolina

Health care services, including those that serve mental health and substance use disorders, are tightly regulated in North Carolina. Providers must first prove to state regulators that a geographic area has a need for any proposed service expansions. For example, providers might present regulators with reams of data that show high rates of service utilization, or geographic areas that are underserved. Regulators review these applications, which can run to nearly 1,000 pages, and award a Certificate of Need, which validates the need for the proposed services by the applicant health care provider.

Mental health care differs from physical health care in North Carolina in that mental health services are broken up in catchment areas. These are governed by managed care organizations, which also allocate state funding for Medicaid.

The chart below highlights the adult inpatient psychiatric bed capacity in Wake County and North Carolina. The Wake County chart is broken out by hospital and the North Carolina chart divided by managed care organization. Wake County is within the Alliance Behavioral Healthcare MCO.

The addition of 124 adult inpatient beds in Wake County is notable for the high number over the span of a few months. Regulators approved the new bed capacity partly because of the county's rapid growth, and partly because of a dearth of inpatient beds left when Dorothea Dix hospital closed in 2010.

Regulatory Designations Vary By Patient Age, Type of Treamtment

DHHS has a separate regulatory designation for inpatient services for children, defined by the state as those younger than 18 years. There are 416 such beds across the state, including 92 in Wake County spread between Holly Hill and Strategic Behavioral Healthcare.

There is yet another designation for chemical dependency treatment beds. These are intended for less acute situations than the inpatient beds and are sometimes referred to as substance use disorder beds. There are 751 such beds in the state.

The new approvals in Wake County are for inpatient beds, intended for short stays of patients in crisis. Too often, patients in mental health crisis go to hospital emergency departments.

And while the opioid crisis hasn't made as many headlines in 2018 as it has in recent years, the strain on hospitals has worsened across the state. Through May, there were 2,210 opioid overdose emergency department visits in North Carolina. That was 4 percent more than for the same period in 2017, a year in which North Carolina shattered the record for most opioid overdose emergency department visits in one year.

Opioid emergency department stats for North Carolina.
Credit N.C. Department of Health and Human Services

Experts say these visits cause overcrowding in emergency rooms.

"It's become a terrific burden on EDs and it's a terrific expense as well," said Hollis, who worked for more than two decades at Duke Raleigh Hospital. "And at the end of the day, we're not doing the right thing for the patient."

The new Holly Hill campus will offer Electroconvulsive Therapy (ECT), a treatment recognized by the American Psychiatric Association as effective for treating severe mental illness. There are 12 sites in North Carolina that offer ECT, with Holly Hill's becoming the second in the Triangle.

At the Holly Hill Hospital ribbon cutting. From left: Kody Kinsley, Senior Director, North Carolina Department of Health and Human Services Division of Mental Health, Developmental Disabilities and Substance Abuse Services; Amanda A. Johanson, CEO and Managing Director, Holly Hill Hospital; Kevin Patton, and Gary Gilberti.
Credit c/o Holly Hill Hospital

"Our treatment model is to improve patient symptoms so that they may return to their communities as healthier individuals," said Kelly Millsap, Holly Hill director of nursing. "By and large, this is the case, however, there are times when treating severe or persistent mental illness requires more than medication and talk therapy. These patients are excellent candidates for ECT, which may reduce the likelihood for future hospitalizations."

Many behavioral health providers also hope to destigmatize mental health. Triangle Springs Medical Director Dr. Nadia Meyer points out that almost everyone is touched by mental health in some way.

"It really could be anyone, and that's why I think our facility is so important because we want to take away the stigma," she said. "As an internist it's really easy for me to walk in a room and a patient will identify with me and go, 'Oh that's my doctor.' If you’re a psychiatrist, that's different. So if I can feel that from the position of a provider, how much more so from the behavioral health patient?"

At the ribbon cutting, Clark, the former Blue Devil, talked about getting the help he needed, and how it has allowed him to take back his life. Krzyzewski also attended the ribbon cutting, and praised Clark.

"Marty was a member of two national championship teams," Krzyzewski said. "He hit a few clutch free throws to put us in a position to do that. But he's hitting a lot more shots right now. Shots that are going to help human life, not just make his coach look good and make his school look good."