The number of people visiting emergency rooms in Wake County for mental health and substance-use treatment has risen over 40% in the last five years.

And those people span all age, gender and racial demographics, according to a 101-page report presented to the Wake County Board of Commissioners on Monday.

“I think this report sets us up to be even more thoughtful and deliberate about where we as a county want to put our resources and how we want to make sure that we hold on to what’s been strong and make it better,” said Assistant County Manager Denise Foreman.

In 2017, UNC Health Rex opened a behavioral health holding area for patients seeking treatment in the emergency department to “improve the care, support and healing of patients, and the safety of all visitors and staff,” according to the hospital.

“But there’s certainly a lack of resources for behavioral health patients in our area,” UNC Health spokesperson Alan Wolf said Monday. “These patients can be very challenging to place into a behavioral health or specialized psychiatric facility, so they end up staying in our emergency department for days or weeks.”

Need for more crisis services

The new report included interviews with over 70 people, including four in-person interviews with people who have used the county’s crisis services. It also relied on data from Alliance Health; WakeBrook, which is operated by UNC Health; hospital emergency departments; and a review of national best practices.

“In the spring of 2022, we were seeing increasing trends in the need for more crisis services, more requests for county resources and a number of upcoming changes in the behavioral health system,” Foreman said.

When the system is working it can help people earlier and “reduce avoidable law enforcement interactions, incarcerations, emergency room utilization and inpatient admissions,” she said.

She pointed to WakeMed’s new behavioral health hospital and the possible expansion of Medicaid in North Carolina as two ways to serve more people in Wake County.

UNC Health is also opening a youth behavioral health hospital in Butner later this year to “help treat children and adolescents, and ease some of the strain on local hospitals,” Wolf said.

Where the gaps are

In the same five years mental health and substance-use ER visits rose over 40%, other visits to emergency rooms increased just 1%.

There were 17,117 visits by 13,155 individuals for mental health or substance use at Wake County emergency rooms in 2022.

Wake County may be “considered resource rich” compared to other communities, but the report also points to gaps in the current system, “particularly around early intervention.”

Those gaps include:

  • An over-reliance on calling 911 for mental health

  • No transportation options beyond police and EMS

  • No 24-hour emergency shelter for adults

  • A lack of system-wide capacity to serve children and youth “with complex needs.”

The county’s Health and Human Services Committee will get a fuller breakdown of the report on June 5 with a work session planned for June 12.

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