When a patient comes to Novant Health New Hanover Behavioral Health Hospital seeking help for themselves or because a family member or guardian is seeking it for them – everyone’s upset or frightened.
“Scared would be an understatement – especially for children and adolescents,” said Mary Williams, market director for Novant Health’s Psychiatry & Mental Health Institute for the Coastal region. “These are patients who might have substance use disorders – from alcohol to opioid abuse – or mental health issues, including depression, anxiety, bipolar and schizophrenia.”
Several times a day, patients arrive at the hospital’s emergency room who require care beyond what New Hanover is licensed to provide. Those patients must be transported to a facility outside the system. And up until August, they were transported in law enforcement vehicles because there were no other services available.
But thanks to support from the Novant Health foundations, the New Hanover team partnered with a private vendor, Allied Universal Transportation, to offer a more dignified mode of transportation and help reduce the stigma of mental illness and substance misuse.
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The first year or so of the program is supported by a $463,000 grant from Novant Health regional foundations. Once that initial grant runs out, costs will be absorbed by the hospital’s Psychiatric & Mental Health Institute.
Dr. Bryan Durham, a New Hanover emergency department physician and local Foundation board member, has been deeply involved in advocating for and implementing the program. “Our goal is to ensure our behavioral health patients are as comfortable as possible while receiving psychiatric or substance use help,” he said.
The new program allows patients to ride in unmarked, but modified, passenger vehicles that provide maximum safety and standard comforts.
Reasons for transfer
There are several reasons a patient might require transfer. New Hanover’s behavioral hospital isn’t licensed to treat children and adolescents. If a patient has been to the ER multiple times and failed the treatment programs, they may be referred out. Likewise, if they show severe aggression toward team members.
“These patients had to be transported via sheriff in the back of a windowless van,” Williams said. For safety reasons “Deputies often had to shackle them, in handcuffs, and secure them to the floor of the van – even if the patient wasn’t violent or resistant.” They might transport up to three patients at a time.
Individuals living with mental health and substance use disorders aren’t typically violent, Williams said. “They’re at greater risk of being victims of violence than of being violent themselves.
“The sheriff’s department has done nothing wrong,” she continued. “We’re grateful they’ve provided this service. They do the best they can with the resources they have. But handcuffs criminalize that person and their illness. Even though our staff does a good job explaining to patients that they’ve done nothing wrong and they’re not being arrested, when you see handcuffs, we’re conditioned to believe something’s wrong.”
The N.C. Sheriffs’ Association has asked state lawmakers to discontinue their role in transferring patients who are involuntarily committed and says that the job should fall to mental health professionals.
Safe and compassionate
It’s not that Williams and other team members didn’t see a need for improvement. But as an independent regional hospital, New Hanover Regional Medical Center didn't have the financial means to make this improvement.
“But when Novant Health integrated with New Hanover, we brought this up again, and it gained traction,” Williams said. “Other Novant Health locations use Allied Universal. We felt it had been a big gap in patient care and made our case again.”
And so today, patients who have to be transported from New Hanover experience a much gentler method. Behavioral health patients now receive timely, safe, compassionate transportation while in Novant Health’s care.
“The drivers are trained in behavioral health interventions to de-escalate situations,” Williams said. “Partitions separate the driver from the patients – no more than two – in the back, and there are partitions between patients. The interiors have been altered so patients can't hurt themselves with anything around them. Patients also have a window they can see out of. It seems like such a small thing, but they didn’t have a window before. It makes such a difference.”
The vehicles are equipped with booster seats and car seats for the youngest patients, Williams said. “It’s heartbreaking to think about, but it’s the reality.”
Everyone involved appreciates the significant difference the change has made. “A teammate told me that one of the first transports using Allied was for a child,” said Williams. “She said it was much smoother, and the parents felt more secure and more in control than parents who’d experienced the old way.”