Emergency Management Director Warren Cabe told county commissioners he hoped the program would help reduce health care costs and his department’s costs by taking a more proactive approach with mental health patients in the comfort of their own homes.
“We understand that if we can keep these folks out of the back of our ambulances it frees up resources for people who may really need us,” Cabe said. “It will also keep them out of the long-term beds at the hospital.”
Macon EMS implemented the Community Care Paramedic program a year ago in which high-risk re-admission patients — mostly those with chronic but manageable disease — were identified and monitored on a regular basis by EMS staff. Paramedics are currently performing in-home visits three days a week for 28 patients in the program.
Cabe said this kind of integrated health care model came out of the Affordable Care Act and helps to fill the gap between hospital care and home heath care.
“We tried to identify patients we know have minor problems that may become major problems if they’re not addressed,” he said.
Now EMS wants to apply the same concept to helping mental health patients in the county — if the Evergreen Foundation awards the county $34,500 as requested. According to Cabe’s grant application, Appalachian Community Services evaluated 7,627 new mental health patients in Western North Carolina between April 2013 and February 2016. During that same time period, mental health patients spent an average of about 29 hours in an emergency room.
Mental health patients can cost law enforcement and health care providers a lot of time and money. When magistrate judges issue an involuntary commitment order, a law enforcement officer from that county is required by law to transport the patient to a hospital for evaluation, but the shortage of available beds for mental health patients is making the process burdensome. Officers have had to drive hours to find a bed for a patient, which can eat up a lot of patrol hours and fuel. In 2014 alone, Macon County Sheriff’s Office spent 8,299 hours and $253,625 on involuntary commitments.
With a limited number of beds available for mental health patients and the increase in involuntary commitments, patients have to wait longer and travel farther for treatment. It’s a statewide problem — one that health care providers are trying to address.
Cabe said he met with the Evergreen Foundation, which is a nonprofit arm of Smoky Mountain Mental Health, about what Macon County EMS could do to help residents with mental health issues. After analyzing some local data, Cabe said he quickly realized many issues mental health patients were having revolved around problems with their medications.
“With this program, we will help people understand their medication and take it correctly,” he said.
If Evergreen approves the $35,000 grant, Macon EMS will spend the money to fund an additional eight hours a week for a current full-time employee and another eight hours a week for a part-time employee. Funding will also be used to partner with the community college to develop and provide specialized crisis intervention training for all paramedics and supervisors. Originally Cabe thought the community college would have to put together an all-new program to be able to provide that type of training, but Smoky Mountain Mental Health offered to provide the crisis intervention training — cutting down on the cost to pilot the mental health program.
“This grant request will allow us to do two days week to see these patients,” Cabe said. “We may already be seeing some of these same people through the other program.”
Similar programs have been successful in Nash and Vance counties where the number of involuntary committals has been cut by as much as 80 percent. The program implemented at Grady EMS in Atlanta, Georgia, prevented the ambulance service from transporting 175 mental health patients, which saved the EMS department about $13,000 and saved local emergency rooms $140,000.
If the program is successful in Macon, Cabe said he would request additional funding from Evergreen Foundation in the future as well as ask community health care providers to contribute since they would be reaping the financial benefits.
Commissioner Ronnie Beale, who has been heavily involved in mental health issues through the North Carolina Association of County Commissioners, said the program could make a big difference in the lives of people in Macon County.
“The bottom line is to cut down on involuntary commitments,” he said. “This program is very innovative. It’s a real game changer for these folks.”