In a monumental move that will completely transform the nature of mental health care and substance abuse treatment Guilford County, Cone Health and the Sandhills Center, with the support of the State of North Carolina, are entirely reconstructing the way in which mental health care and substance abuse treatment are delivered in Guilford County.
Guilford County, Cone and Sandhills, along with the NC Department of Health and Human Services, have been in private talks for two years working out the details of the massive deal that will result in the construction of two new mental health centers in Greensboro, a total transfer of the county’s mental health care to Cone Health, the opening of the county’s first adolescent crisis care facility and the establishment of a new 24-hour crisis center for mental health patients – staffed with psychiatrists and other specialists equipped to handle such cases.
There are many other changes coming in what will be an essentially new world order of mental health care in Guilford County and is expected to improve overcrowding in emergency rooms and create a single portal of entry for mental health and substance abuse cases.
The new system is meant to be a fully-integrated, best-practices, state of the art model that will address all aspects of a mental health patient’s needs – both physical and mental. The system is designed to have the partners working together as a whole with a united focus on getting the patient well.
It will be the polar opposite of the highly criticized “siloed” pockets of mental health care that have been the rule in Guilford County and the state of North Carolina in the past.
Guilford County Commissioner Jeff Phillips, a primary architect of the plan that will now be realized, said it’s wonderful the way in which all of the partners have come together to create what’s expected to be one of the best mental health care delivery systems in the country.
The nationwide need for communities to address mental health issues in a new and innovative way has been highlighted in recent years by the breadth of the opioid addiction problem and the high-profile mass shootings by those with mental health problems. Mental health and substance abuse issues are also, on many other levels as well, highly destructive of communities, families and individuals.
“This new facility will actually begin to address some of the front-end needs around the opioid crisis like I don’t think we have in existence today,” Phillips said.
Phillips said state officials were impressed by how much time, effort and thought that the county, Cone and Sandhills had put into the new mental health care initiative. He said the reception of Mandy Cohen, the secretary of the NC Department of Health and Human Services, was particularly energetic.
“Nobody’s doing what we’re going to do and I didn’t really know this at the time but integrated health is pretty much the focal point of Human Services under Mandy Cohen’s watch, so, when we came in and made the presentation – it was largely by [Guilford County Emergency Services Director] Jim Albright – It got their attention. They were pretty much blown away by our integration of physical and mental health care under one roof along with the local collaboration that had been underway to get us to that point. We had done our homework and had been working together. It was a powerful combination.”
Phillips said Cohen made a comment to the effect that if she could just get folks in every county to work together like this, it would dramatically improve the situation across North Carolina.
State officials hope the project will be a model that can be emulated in other parts of the state.
The final product is one that snowballed from an effort Phillips began in early 2017 when he was chairman of the Board of Commissioners. At that time, he made a comment at a county commissioners retreat that got a lot of attention about the extent to which the existing mental health care system in the county was failing.
One of the most exciting aspects of the plan is that Guilford County will get its first ever Adolescent Crisis Center, which will administer care to children and adolescents with mental health and substance abuse issues.
Phillips said it became clear early on in the process that, due to security concerns and other issues, there would need to be a standalone center for adolescent services. That center, to be located near the coming new crisis center for adults, will be built and operated by Sandhills Center.
Debbie Cunningham, the Senior Vice President of Behavioral Health Services for Cone Health, said that the new paradigm will allow mental health patients to get the help they need and simultaneously free up emergency rooms in the Cone Health system.
She said that, years ago, the state radically changed the way mental health services were delivered.
“Over the years we realized that didn’t work,” she said, adding that it wasn’t creating the needed “continuum of health” for patients.
She said the talks with the county were the first step.
“We all started pulling together,” she said. “The county had the same shared vision.”
Cunningham added that Sandhills Center was an important partner. Sandhills is the management entity that oversees mental health administration for Guilford County.
“We knew we had to have their buy-in,” Cunningham said.
She said that, years ago, after the state shifted the way mental health care was handled, the problems grew.
“Patients got confused,” she added. “They didn’t know where to go – so they went to the emergency room.”
According to Cunningham, every day emergency rooms in the system see 50 or 60 patients that are there due to mental health issues. She said they can be disruptive and added that treating them in the emergency room can hamper efforts to handle medical emergencies. She said the new facilities will be better equipped to treat mental health issues.
Guilford County Emergency Services Director Jim Albright said this change is something that has been needed for years.
“This is a completely new service model,” he said. “It is a fully integrated model – a more holistic and integrated approach, and there will be a clearly defined portal of entry.”
Albright said it’s impossible to separate mental and physical health as the current model does to a large extent. The new model will address that.
“Physical issues may be causing the mental issues,” he said.
Albright said that for years and years everyone had been talking about a “no wrong door policy,” and he added that the new policy will be just that.
Phillips said that many people played a role in the new project. He said former Guilford County Commissioner Ray Trapp was in on the talks while he was a commissioner and added Commissioner Kay Cashion had also been integral since she had extensive knowledge of the Sandhills system through her work on that board. Cashion also has an intense interest in mental health care and substance abuse treatment.
“The awesome thing about the process is that it never went sideways,” Phillips said. “It’s an emotional topic. I found that everybody wanted the same thing. Everybody agreed that these services were not being provided nearly as well as we could and that everyone wanted to do something about it. Nobody knew exactly where we were headed or where it would go.”
Perhaps the most amazing thing was that the three groups were able to meet discuss, take a trip to Asheville to view elements of the practice there, and participate in meetings in Raleigh – without word ever getting out until everything was in place.
“It’s hard to have serious conversation in a public setting so we had to hold the talks a little bit strategically,” Philips explained. “It took longer to get to this point because with so many stakeholders and sensitive issues in the mix it made it difficult to have a lot of public discussion on the topic.”
Sandhills Center CEO Victoria Whitt stated that the new system is the result of a great deal of thought and deliberation among all the players.
“We have worked with Guilford County officials and other local partners for some time now to review the current behavioral health services in Guilford County and consider what changes may more effectively meet the needs of the community,” she wrote in an email. “We took that planning work to the NC Department of Health and Human Services for their guidance on how the project could be designed to fit within the regulatory requirements of State and Federal funding.”
She wrote that the new buildings will now provide a clear point of entry.
“We are excited that the project resulting from that work and from that partnership will bring Facility Based Crisis services to Guilford County,” Whitt wrote, “both for adults and for adolescents and children. While two separate facilities are needed, one for adults and the other for children and adolescents, we are pleased that both services will be available in Guilford County.”
Whitt added, “Facility Based Crisis offers a non-medical unit that serves as an alternative to hospitalization for individuals experiencing behavioral health crises. In addition, the facilities will each have a 23-hour assessment unit. This unit offers time for individuals in crisis to receive a thorough assessment and have their care needs assessed for up to 23 hours. Following that time, if a person is unable to go home, they may be transitioned to one of the planned Facility Based Crisis centers, transferred to a higher level of care, or connected with a community provider to receive continued services.”
Whitt concluded, “We are excited about the work that has gone into planning these facilities and look forward to continuing the partnership to bring them to a reality.”
Phillips said he and others involved are really looking forward to the new era in mental health in the county.
“We are ecstatic about the future of integrated physical and behavioral health services for the citizens of the Guilford County. In a word, ‘transformative.’”