‘A Safe Place to Go’: New Alamance crisis hub provides free mental health services that keep people out of jails, ERs
By Taylor Knopf
It’s been a little less than a year since Alamance Behavioral Health Center opened its doors to the public to offer an array of mental health services ranging from a walk-in, urgent care setting for those in distress, to follow-up outpatient appointments for children and adults.
This month, the final piece — a 16-bed inpatient facility — will begin accepting patients who can stay up to a week. The publicly funded behavioral health center is designed to be a one-stop shop for anyone struggling with mental health issues, and it’s free for people in North Carolina.
The Alamance crisis center, at 963 Kirkpatrick Road in Burlington, also has a pharmacy on site, a mobile crisis team based out of the facility, and monthly support meetings for families. For people reluctant to engage in traditional mental health services, such as counseling or medications, there’s a peer living room where anyone can come and just hang out with peer support specialists and others who may share similar struggles with their mental health.
Historically, mental health crisis services were fragmented — different pieces operated by different providers around the county — and people looking for help weren’t always able to find what they needed. Those experiencing mental health crises often end up at a hospital emergency department or in a jail cell.
But since the center opened last year, an increasing number of people are coming each month, from 720 in October to 980 in January. Data collected at the Alamance center shows that 90 percent of people who have come to the crisis center would have otherwise ended up in a jail or the emergency room.
“An individual in crisis [shouldn’t have] to look all around your community to figure out what they need. We know that when you’re in crisis, you just can’t do that,” said Donald Reuss, with Vaya Health, the regional group that manages public dollars for behavioral health services in 32 of North Carolina’s 100 counties. The new center is managed by Vaya and operated by RHA Health Services, a mental health service provider.
Much of the upfront costs for establishing this crisis center — and others opening across the state — come through the state Department of Health and Human Services. These centers have been made possible through a $835 million investment for behavioral health services that was included in the 2023 state budget. The money was part of a $1.4 billion sign-on bonus delivered by President Joe Biden’s administration after North Carolina expanded Medicaid.
Because these centers are publicly funded, state health leaders are actively working on plans for long-term sustainability. Right now, the centers are only able to bill Medicaid for the crisis services it provides, as private insurance companies have been slower to adapt to nontraditional mental health service models. Meanwhile, threats to Medicaid funding loom as the U.S. Congress has been directed by President Donald Trump’s administration to find hundreds of billions in savings.
Long-term sustainability sought
As the state Department of Health of Human Services test marketed the array of mental health crisis services expanding throughout the state, they found that many people resonated with the phrase “a safe place to go.” That’s what these crisis centers aim to be, said Kelly Crosbie, director of the state health department’s Division of Mental Health, Developmental Disabilities and Substance Use Services.
“Every community wants one of these, but we have been judicious about where we have set them up — using a formula that looked at population density to get a sustainable billing group. These places also enjoy good state and local support,” Crosbie said. “Every county would want one, but they are not sustainable everywhere. If everyone was pitching in, these could be sustainable.
“We need other insurers pitching in their fair share.”
Anyone — regardless of their insurance status — can receive mental health crisis services in North Carolina, but Medicaid is the only insurance plan that actually covers the services. If someone with private insurance shows up at the behavioral health urgent care, with Blue Cross Blue Shield or Cigna for example, they are considered “under-insured,” Crosbie explained.
The urgent care, which offers walk-in evaluations and support for up to 23 hours, may reach out to the patient’s private insurance to try to get parts of their care covered. Private insurers may cover a psychiatric evaluation, but they will not cover a full stay at the urgent care, Crosbie said. “What will often happen is they’ll hear, ‘we don’t see that covered in our benefits package. What is it?’”
Crosbie and her team continue to meet with private insurers to educate them about the continuum of mental health crisis services with varied responses. She said they’ve made a lot of progress in their conversations with Blue Cross Blue Shield of North Carolina, adding that their leadership understands that their clients are better off receiving community-based crisis services than going to the emergency room.
However, another insurance company told Crosbie it wouldn’t cover the crisis centers because they’re a public commodity. “What makes you think this is a public commodity?,” she recalled asking. “There’s no public tax for it. There’s no public funding source for it. Medicaid covers it. It’s a Medicaid coverage benefit. We really need all insurers to cover it as a benefit.”
“We also use state dollars, and the critical thing about the state dollars we get every year from the General Assembly is it’s for the uninsured and under-insured,” Crosbie said. “It’s really critical that we continue to keep Medicaid well-funded and keep the expansion population, because Medicaid does cover a lot of this.”
Meanwhile in Washington, D.C., the federal insurance program that covers more than 70 million Americans, including low-income adults, children and people with disabilities, could be reduced as Republicans in Congress look to cut federal spending. Some Republicans have said they would oppose any proposal that takes away their constituents’ Medicaid benefits; but Democrats have questioned how GOP leaders plan to cut a targeted goal of $880 billion without touching Medicaid. Lobbyists for hospitals and insurance companies have joined together asking lawmakers to preserve Medicaid.
North Carolina advocates for those with disabilities are already very worried about what would happen to their loved ones if Medicaid is cut. Republicans at the state legislature have expressed varying levels of concern from doubting whether the cuts will actually happen to wanting to prepare for possible changes.
Community support and impact
The Alamance County Sheriff’s Office has been very supportive of the new crisis center because it gives officers a designated place to take someone to get the help they need without taking officers off their patrols for extended periods of time. The behavioral health urgent care receives approximately 75 drop offs from law enforcement each month.
Craig Stephens, head of investigations with the Alamance sheriff’s department, said law enforcement officers used to take someone in mental distress to the emergency department, and that officer would often spend four to five hours there for security reasons. Now, an officer can drop someone off at the behavioral health urgent care and be back out on the street in about 30 minutes, he said. Also, two deputies work out of the center every day as part of a co-responder model where officers and social workers respond to some situations together.
“Law enforcement is on the front lines of seeing a lot of members in the community, and a lot of times they may be [crisis intervention trained], but they need additional support, and so this gives them the ability to be able to pick some up, bring somebody here,” said Reuss with Vaya Health.
It also means that sheriff’s deputies don’t have to start the process to have someone involuntarily committed to a psychiatric facility.
“They don’t have to pull those rights away,” Reuss said. “Once they get into the urgent care center here, they can actually triage them and decide what they need. They may set them up with an appointment to see the psychiatrist.”
People can also be sent home from the urgent care center with a mobile team that helps address mental health crises and ongoing mental health support.
“The mobile crisis team now comes out of this building,” Reuss said. “It’s kind of like having your ambulances actually at your hospital.”
If someone arrives at the crisis center who needs medical attention, the Alamance center is across the parking lot from Cone Health Alamance Regional, a medical hospital. The local construction company, CHADCO Builders, that built the new facility also secured the prime location — next to the hospital right off of the highway I-40 — for a discounted cost, believing in the mission of the center, according to Vaya’s CEO Tracy Hayes.
There is also a steady flow of visitors at the peer living room, which has its own entrance at the crisis center. It’s a bright space with a community table, couch, TV and kitchenette with snacks and drinks. The informal setting is staffed by peer support specialists, people with their own experiences of mental illness, substance use, homelessness, incarceration or some combination of these. This “peer living room” provides support for people who may not want to interact with the mental health system in a clinical setting.
“I think the peer living room brings value to these programs that no one’s going to be able to measure,” said Sandy Feutz with RHA Health Services.
She explained that when someone accesses mental health services, there are steps that must take place and paperwork to be filled out, such as an assessment, a qualifying diagnosis for services and an official treatment plan.
“But with a peer living room, you simply show up — no appointment or paperwork required,” she said. “Maybe you end up talking to someone who has accessed other services at the hub, or you talk to the peer support specialists. Maybe some of the stigma around treatment falls away, or maybe you just get the support you need by being in a place where others understand a little about what’s going on in your life.
“Often we’ll find that people in our more intensive services go over to the peer living room,” she said. “They start talking to others about what they like. Sometimes people do come and get enrolled through that process, and at least it was on their terms.
“I think peer living rooms are crucial for a fully functioning comprehensive care center.”
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