Brittney Burns – Staff Writer

For the western part of the state, issues addressing mental health span across nearly every field from the sheriff’s office, which has to allocate a large portion of its annual budget to serve those who suffer from mental health issues and who find themselves incarcerated. Add to that mix  the county commissioners who have made it a priority to address the lack of services to treat issues not just in WNC, but in all of North Carolina.

The issue of emergency services funding behavioral health patients has been so prevalent in the state, last week the North Carolina Association of County Commissioners (NCACC) passed a specific legislative goal to address the issue, something Macon County Board of Commission Vice Chair Ronnie Beale thinks is significant for Macon County. The goal is for the NCACC to support and work for increased state funding for behavioral health services and facilities at the state and local level, including dedicating resources for community paramedicine projects. While the association is pushing for community paramedicine programs across the state, in Macon County, such a program is not only in operation and has been for two years, but last week, eight members of Macon County Emergency Medical Services (EMS) became the first paramedics west of Asheville to be trained in Crisis Intervention.

“We had eight paramedics complete this training last week,” said Joey Gibson, Community Care Paramedic Coordinator. “It was completed by all of our supervisors and our Community  Care Paramedics.”

Macon County’s Emergency Management Department has been taking a proactive approach to address the increasing number of involuntary commitments in the community by expanding the county’s Community Care Paramedic (CCP) Program to care for patients with mental illnesses.

“During several meetings with local community leaders and other healthcare providers over the last several months, an area was identified where we felt that EMS could help support an underserved population,” said Todd Doster, Macon County EMS Coordinator. “Patients with a history of Mental Health, substance abuse, and intellectual and developmental disability issues make up a significant percentage of our EMS call volume. The curriculum for traditional Paramedic training programs spends very little time on these topics, not fully providing Paramedics with a comprehensive knowledge of these conditions. The Crisis Intervention Team training fills this void.”

The county’s CCP program was started in the Spring of 2015 and on average serves 20-30 patients who are dealing with chronic illnesses. Paramedics provide home care for patients, can draw blood, check blood pressure, and other care options for patients in order to prevent them from needing to visit the hospital. The program works with patients who have recently been discharged from the hospital to reduce the number of re-admitted patients within a 30-day period.

“Through our 9-1-1 responses, we encounter anywhere from three to five patients a week with mental health issues. This can involve substance abuse, attempted suicide, or depression,” said Gibson.

As of Monday, the CCP currently had 25 active patients in the program. This number is ever changing as some patients start doing better and no longer need the services and new patients are always being referred to the program.

“We currently focus on high risk patients with chronic illness, high fall risk patients, and medication compliance,” said Gibson. “But with the new certifications and training, mental/behavioral health is just being added to our program.”

Macon County’s EMS became the first department west of Asheville to complete the Crisis Intervention Team training, which allows the county’s community care program to better serve its patients.

The Crisis Intervention Team (CIT) program is a community partnership of law enforcement, mental health and addiction professionals, individuals who live with mental illness and/or addiction disorders, their families and other advocates. It is an innovative first-responder model of police-based crisis intervention training to help persons with mental disorders and/or addictions access medical treatment rather than place them in the criminal justice system due to illness related behaviors.  It also promotes officer safety and the safety of the individual in crisis.

“Instructors for the 32 hour training were all well versed in their respective area of expertise,” said Doster. “We heard from Mental Health professionals with Vaya Health, Appalachain Community Services, Meridian Health Services, and representatives from Macon County Department of Social Services and Macon County Veteran Services. We also participated in a site visit to a local facility where we visited with their clients who were participating in an actual class as part of their treatment. All of these lectures and activities provided us with invaluable information such as how to better communicate with these individuals and how to direct them to available resources to better manage their conditions. To ensure that we would be able to provide this assistance at any time, we had each of our Community Care Paramedics as well as all supervisory staff in the training. While all of our EMS staff are fully capable of taking care of emergencies involving this demographic of patients, we now have individuals with specialized training to provide the next level of care and support for these folks.”

The Crisis Intervention Team program teaches first responders practical skills to help them interact safely and effectively with persons with mental health, substance use, or intellectual and developmental disability needs. The curriculum includes information about common signs and symptoms of behavioral health concerns, information about community resources, opportunities to hear from individuals and family members, and training in de-escalation and crisis intervention. The goals of CIT are to promote the safe resolution of crises, to divert individuals from jail and the emergency department, and to offer community members access to care and opportunities for service engagement.

“Integrated healthcare is the future of healthcare and this particular training program is just one step of many our organization and profession will undertake in the years to come as we adapt and grow to meet the needs of our patients,” said Warren Cabe, director of Macon County’s Emergency Management.

Gibson believes those trained will be able to better serve a population of the county that currently lack resources, not just in Macon County, but across North Carolina.

“This training has provided us a great working knowledge of many illness/issues that a mental/behavioral health patient may be dealing with,” said Gibson. “Through this training we learned how to approach these patients and how to interact with them.  With this training we were able to learn of several resources in our county that can serve these patients which may in turn keep these patients out of the emergency department.”