Why you should care
Because the best help often comes from someone who’s gone through the same thing.
This story is part of a series between OZY and Well Being Trust called Mental States of the Nation, where we explore ways that different states across the U.S. are enforcing and facilitating mental health parity.
Most emergency rooms are designed to treat physical traumas. But many are also poorly adapted to treat mental health traumas and crises — two issues that are on the rise in Tennessee.
“ER doctors are about blood, guts, heart attacks and babies. ERs were not designed to handle the mentally ill,” says Mike Dietrich, vice president of Member Services for the Tennessee Hospital Association, a healthcare advocacy and educational group. He argues that the mental health crisis is partly the state’s own fault. “We spent thirty years underfunding or de-funding the mental health system,” Dietrich says. “The opioid crisis has exacerbated this in a major way.”
Indeed, Tennessee consistently ranks in the top five U.S. states when it comes to substance abuse. And according to the National Survey on Drug Use and Health:
It is estimated that 16 percent of Tennesseans ages 18 and up have a mental health or substance use problem, compared to 9 percent for the entire U.S.
However, Tennessee has worked hard to create a collaborative, multi-pronged crisis response system. First developed in 1991, and funded through Medicaid waiver funds and state general funds, the crisis response system includes: a statewide toll-free crisis line, 13 mobile crisis response teams (four for children), eight crisis stabilization units (CSUs), eight walk-in centers (WICs), eight 23-hour observation units, five emergency respite programs, and seven medically-monitored withdrawal management units.
In addition to the crisis response system, Tennesseans who are uninsured or at the federal poverty limit are covered by the Behavioral Health Safety Net — a program from the Department of Mental Health and Substance Abuse Services that gives proper care to those with serious mental health illnesses. “Tennessee serves all who need help, regardless of their insurance status,” says Morenike Murphy, director of crisis services and suicide prevention with the Tennessee State Department of Mental Health.
Additionally, in 2017, the state put $15 million toward pre-arrest diversion programs that aim to help people with mental health or substance abuse issues before incarcerating them. These programs aim to keep “low level offenders” out of the ERs and jails. “We’re trying not to criminalize mental health and create new entrances to the system that aren’t an ER or jail,” says Dietrich.
We need to get back to encouraging states to look at mental health services as a fundamental human right.
Clayton Chau, regional executive medical director for Providence St. Joseph Health
Mental health and substance abuse issues are often ineffectively siloed from one another. “The prevalence of mental health co-occurring with addiction is huge, so we definitely need treatment offerings that address both simultaneously,” says Marshall Moncrief, regional executive director of the Institute for Mental Health for Providence St. Joseph Health. Due to the complicated nature of the mental health crisis and the rapidly growing need for all kinds of services, the state is trying something new to tackle the opioid problem — the Tennessee Recovery Navigators.
This group of ”navigators” are people hired across the state who themselves are in long-term recovery and can serve as an access point to treatment and recovery resources for those struggling with addiction. “We’re excited about new work to embed peer recovery specialists in the crisis services continuum,” Murphy says. “We fully believe that peers can use their lived experience to help people in a time of crisis.”
And while these various crisis management systems may not be perfect, they’re definitely a step in the right direction for Tennessee. “These programs are no silver bullets,” Dietrich admits. “But the state has the right connected framework laid out, they just need to do more of it.”
Clayton Chau, regional executive medical director for Providence St. Joseph Health, adds that, at the very least, states need to make sure that the basic services for in-patient and out-patient care are in place. “We need to get back to encouraging states to look at mental health services as a fundamental human right.”