March 18, 2021
The Joint Appropriations Committee on Health and Human Services met today to receive an update on the NC Statewide Telepsychiatry Program.
The NC Statewide Telepsychiatry Program (NC-STeP) was established in 2013 to serve individuals with an acute behavioral health crisis who present at a hospital emergency department with timely, specialized psychiatric assessment via video conferencing technology. NC-STeP was created by providers at East Carolina University and Vidant Medical Center, but serves patients all across the state and includes a statewide coalition of behavioral health providers. 31 out of 100 counties in North Carolina do not have a psychiatrist, and 13 counties have no active behavioral health providers. Also, according to federal guidance, 90 counties in North Carolina qualify as Health Professional Shortage Areas. For these reasons, many people suffering with behavioral health needs go to an emergency department to receive care. Telepsychiatry offers a solution to these issues by increasing access to services, reducing geographic health disparities, increasing consumer convenience, improving professional isolation and recruitment of behavioral health professionals in underserved areas, and improving coordination of care.
The COVID-19 pandemic has exacerbated many pre-existing behavioral health needs across the state. Behavioral health conditions are increasing, but only 45.3% of adults with mental illness in North Carolina receive a form of treatment from the public health system or through providers. NC-STeP currently partners with 41 hospitals across the state, and continues to serve more patients every year. To date, NC-STeP has conducted over 45,000 assessments of patients and has overturned 6,688 involuntary commitments over the years, preventing unnecessary hospitalizations. There are NC-STeP hubs located all over the state, and the idea is for a patient to be served by a psychiatrist who is close in geographical location. NC-STeP serves in many communities where Duke LifePoint Hospitals are located, such as Vance, Franklin, and Haywood Counties.
In 2018, NC-STeP was given additional funding to build community-based sites across the state, providing a collaborative care program to coordinate behavioral health services with primary care providers. There are now 13 primary care partnership sites, with 6,039 patient visits since 2018. Of those visits, 809 patients saw a psychiatrist and 5,230 saw a mid-level provider, such as a licensed clinical social worker. NC-STeP is well positioned to build community capacity by taking care of patients in primary care settings by embedding psychiatric providers in community-based settings, such as health department clinics, primary care clinics, and rural and federally qualified health centers, to meet a tremendous demand for their services. Primary care providers and behavioral health providers s are linked, via telepsychiatry, to a clinical psychiatrist for case consultation and care planning. Before the program, waiting time for patients could be days. Now, providers can see a patient via telehealth within three hours.
The program serves many uninsured patients, which is where the legislature’s investment comes in to offset these costs. NC-STeP is requesting additional state funding this session to expand the program to up to ten additional sites across the state to meet the urgent mental health care needs of North Carolinians. State support will be needed for recruitment of psychiatrists and clinical social workers, equipment, a web portal, credentialing, workflow design, data management, training, and costs associated with administrative functions in order to grow the program. Two bills have been filed this session to support these needs.