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Ever since Sandy Hook, one of the standard responses from Second Amendment absolutists has been that the way to solve the problem of gun violence is to fix our mental health system.  As tone-deaf as that argument is, a front-page article in today's Charlotte Observer shows proof positive that there really has to be a comprehensive solution.  North Carolina has revamped its mental health system three times in the last decade.  As a result, whenever someone has a mental-health crisis in North Carolina, the burden increasingly falls on police and hospital ERs.

North Carolina’s chronic revamping of its mental health system means thousands of people who need care don’t know how to find it, experts say.

Struggling to meet round after round of new state requirements, many providers have merged, changed names or closed. That drives more people to the familiarity of the emergency room. Or they stop seeking treatment altogether, which means police intervention becomes more likely.

A statewide study of emergency departments shows that mental health visits are increasing far faster than the overall traffic. The average length of stay has also jumped sharply. Longer waits in a chaotic ER atmosphere raise the likelihood that a mental health crisis will worsen. The threat of injury to patients and hospital staff also grows.

How serious is this?  Due to several psychiatric hospitals closing in recent years, North Carolina has only one psychiatric ER in the entire state--a branch of Carolinas Medical Center here in Charlotte.  This despite being home to 10 million people and three very large metropolitan areas (Charlotte, the Triangle and the Triad).  There are only 66 beds in that facility's psychiatric ward.  Many psychiatrists have pulled out of insurance networks, forcing many patients to stay in ERs for weeks on end because there's no way to find help.  One man has spent almost a month at Presbyterian Hospital here in Charlotte because they can't find anywhere for him to go.

One Charlotte woman found this out the hard way recently.  Mickey Coffino of Charlotte has a daughter with mood disorder.  Two weeks ago, she overdosed and tried to kill herself in the parking lot of her high school.  Police took her to CMC's emergency room, only to discover there was no psychiatrist on weekend duty.  She wasn't able to talk to a psychiatrist until the following Monday, and was then stuck in the hospital for another week while her mother tried and failed to find long-term treatment.  Unfortunately, CMC-Randolph didn't have any available beds, and no residential facilities would take her insurance.  Coffino was eventually forced to send her daughter to a facility in Knoxville, 250 miles away.

As it turns out, Coffino actually fared better than some patients.  Sometimes, ER doctors determine that a mentally disturbed person poses no threat, only to have it backfire disastrously later on.  For instance, in 2010 Kenny Chapman told doctors at CMC two times that he wanted to harm his wife.  Despite this, he was released with medication after saying he wouldn't actually go through with it.  After the second release, he killed both his wife and children, and killed himself in a confrontation with police two weeks later.  This and other less-serious incidents have area police tied up in knots.

With more people in need, and such a high price for failure, the strain on police and emergency rooms has generated tension between them.

The hospitals say they provide good crisis care and are working to expand capacity; police suggest hospitals could do more.

Too often, the hospitals’ attitude “is to get them on their meds and get them out the door,” says Charlotte-Mecklenburg Assistant Police Chief Eddie Levins. “You drop them off on Billingsley Road (at CMC-Randolph), it’s a crapshoot. You don’t know what’s going to happen.”

Whether the hospitals are just struggling with limited resources or not doing enough, one thing is for certain--the status quo is unacceptable.  Period.

Originally posted to Southern Action on Sun Mar 10, 2013 at 12:15 PM PDT.

Also republished by Mental Health Awareness.

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