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Treating mental health with sustainable solutions

Our nation’s mental health crisis continues to grow, directly affecting more and more individuals and their families every year. And when they need help, they frequently turn to emergency departments. 

That’s not a sustainable solution. It’s also not an effective one. Often, emergency departments can provide stop-gap solutions but not much in the way of follow-up care, and sometimes the experience of sitting for long periods of time in the frenzied hospital environment can make matters worse for some patients, according a study by Frontiers in Psychiatry. And, adding insult to injury, the end result of waiting in this environment is often an expensive inpatient admission.

North Carolina’s hospitals have felt this strain intensely. According to data from Mental Health America, North Carolina ranks near the bottom nationally in access to mental health care. The state has a few brick-and-mortar urgent care clinics dedicated to treating mental health issues, but these only serve a few select areas. As a result, North Carolinians often resort to hospitals. Based on an article in North Carolina Health News, Atrium Health reported a 65% increase during the pandemic in patients seeking mental health care in its emergency departments.  

If North Carolinians can get care at the right time and at the right place, there’s less of a chance they’ll need to turn to emergency departments as a first – or as a last – resort. Two Blue Cross and Blue Shield of North Carolina (Blue Cross NC) programs – our Behavioral Health Care Navigation service and Behavioral Health On Demand – demonstrate what can be done to connect members quickly to a continuum of cost-effective care options that lead to better outcomes than what emergency rooms can deliver in most scenarios. 

Supporting the first steps to care

When someone acknowledges that they need mental health support for the first time, it’s important that their first steps toward care are easy steps, and that they head in the right direction. Our Behavioral Health Care Navigation service offers quick, personalized support that helps members understand what resources are available to them and how to navigate the terrain ahead.

The easiest way to find connect with this service is to call the Care Navigation line at 800-755-0798. Response time is rapid – usually within a couple of days following an initial inquiry. 

Simplifying the process of finding support is important, and speed isn’t the only priority. Our team also takes preferences into consideration and works to match each member with a provider who will meet their needs. The initial round of support typically delivers several options for treatment.

Support doesn’t stop there, either. We engage the member in follow-up conversation to make sure the initial referral was a success. Not every match will be a success. If a member doesn’t respond positively to the first visit, the Care Navigator can help find a different provider who’s a better fit. In especially complex situations, they can refer members to our case management team for help coordinating multiple layers of care.

Whenever someone waits weeks or months for a first-time appointment, that leaves more time for their condition to grow worse. Worse still, they might simply give up on finding help altogether.

The end result is more potential for a trip to the emergency department, either because an unmet mental health need has escalated to a crisis situation or simply because emergency care appears to be the only viable option for support. According to data from the Centers for Disease Control and Prevention (PDF), mental health issues account for more than 10% of all emergency department visits made by adults. The pandemic drove significant increases in the number of adolescents seeking mental health care and substance abuse services in emergency departments, based on a report in JAMA Psychiatry

By connecting members to care quickly and without hassle, Behavioral Health Care Navigation provides a better alternative: Members get on track toward personalized, long-term support, which is effective, more affordable, and more sustainable.

Responding to urgent mental health needs

Urgent mental health needs can quickly and unnecessarily escalate into a crisis situation. When someone is experiencing an urgent event – 1 that doesn’t present an immediate threat of self-harm – they need a different level of care, they need it fast, and emergency departments should not be the resource people turn to first.

Blue Cross NC launched our Behavioral Health On Demand program to give eligible access to meaningful  care within hours. This is significant because until now, for most people, the only place to receive immediate care in North Carolina was the emergency department. 

Emergency departments are set up to address trauma to the body, but they’re not always equipped to help someone who is experiencing a mental health crisis or facing immediate need for substance abuse services. It’s estimated that only 25% of emergency medicine residencies include formal training on handling patients with acute psychiatric needs, based on a study by AEM Education and Training

According to research from Cureus, patients in emergency departments seeking mental health care often find themselves waiting for hours – sometimes for days, reports US News & World Report – to move to the front of the line in a triage situation. And while they wait, they sit in a public, high-stress, frantic environment. This is hardly an ideal situation for any person experiencing intense psychiatric need.

Our Behavioral Health On Demand offers clinical intervention that’s both rapid and meaningfully designed to address urgent need. And, because it’s virtual, this care is available anywhere in North Carolina.

A member can self-refer to see a behavioral health provider through 1 of the following routes:  

Our customer service representatives and care managers are also prepared to transfer members in need directly to Behavioral Health On Demand.

When a member engages the service, the response will be timely and effective: They’ll be assessed and connected with a mental health specialist to address their immediate need. Before the appointment concludes, the member will be scheduled and connected with a provider who will continue treatment, aiding in the members’ path to well-being. 

Easing the burden on emergency departments helps everyone

Taken together, our Care Navigation service and our Behavioral Health On Demand program create clear, efficient pathways to specialized clinical support along a continuum of care. They demonstrate the broader Blue Cross NC commitment to supporting members through their whole care journey, getting North Carolinians access the right level of mental health care at the right time and at the right place.

Helping people get access to care in a time of acute need is the most important goal, but it’s worth noting that all North Carolinians will benefit indirectly in the long run from the work. Reliance on emergency departments stretches their resources thin and drives up health care costs.

Studies show that, in many situations, emergency-department care related to mental health or substance-abuse related issues could have been handled just as effectively – if not more so – elsewhere. Redirecting patients toward alternative, more effective treatment options could save Americans billions in health care costs, according to an article in AJMC. It will also free up beds and precious staff capacity in overcrowded facilities, reports Fierce Healthcare

To be clear, in a crisis situation, patients and their families should seek out help quickly. If an emergency department is the only option, then it is absolutely the best option. But Blue Cross NC understands that hospitals should be a last resort, not a first resort. More pathways to care will help North Carolinians know where to turn for specialized support when they need it.

Getting members the right care, delivered in an appropriate setting, and giving them options to get short-term and long-term mental health and substance use treatment leads to better outcomes and lower costs. Most importantly, it improves the lives of our members.  

Emergency departments are an indispensable safety net. But by offering a variety of care options that are more immediate and more responsive to unique needs, we hope to ease the pressure on our state’s emergency departments and improve outcomes for our members. 

authors photo

Ellyn Saren

Ellyn Saren

VP, Behavioral Health

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