Why aren’t residents utilizing outpatient services for long-term management instead of the ED for acute crisis management?

Data was obtained using the South Carolina Revenue and Fiscal Affairs Office Emergency Department Reports Database. Analysis included total charges, average charge, and admissions to inpatient care via ED for all visits coded for mental, behavioral, and neurodevelopmental disorders. Diagnoses included schizophrenia spectrum and other psychotic disorders, depressive disorders, bipolar and related disorders, other specified and unspecified mood disorders, anxiety and fear-related disorders, obsessive-compulsive and related disorders, disruptive/impulse-control and conduct disorders, personality disorders, feeding and eating disorders, somatic disorders, suicidal ideation/attempt/intentional self-harm, miscellaneous mental and behavioral disorders, neurodevelopmental disorders, alcohol-related disorders, opioid-related disorders, cannabis-related disorders, sedative-related disorders, stimulant-related disorders, hallucinogen-related disorders, inhalant-related disorders, tobacco-related disorders, and mental and substance use disorders in remission. 

Additional References:

1. South Carolina Revenue and Fiscal Affairs Office Emergency Department Reports Database
2. County Rankings and Roadmaps 

Are things getting better? Are things getting worse? Are things staying the same?

An analysis of all ED visits for Behavioral Health/Psychiatric Episodes demonstrates a steady increase from 1,097 visits in 2016 to 1,209 in 2018. There is slight increase from 1,209 visits in 2018 to 1,220 visits in 2019 before steadily decreasing to 1,059 visits in 2021. In 2021, the total charges for ED visits for mental, behavioral, and neurodevelopmental disorders were $4,214,388 [1]. In 2021, the average charge for an ED visit for mental, behavioral, and neurodevelopmental disorders was $3,509 [1].

Source: South Carolina Revenue and Fiscal Affairs Office 

Source: South Carolina Revenue and Fiscal Affairs Office

What are different groups experiencing?

Looking at ED utilization for Behavioral Health/Psychiatric Episodes disaggregated by race the number of ED visits for White residents increases from 757 visits in 2016 to 765 visits in 2021 compared to non-White residents which increases from 340 visits in 2016 to 388 visits in 2021 [1]. Looking at the same data disaggregated by sex, the number of ED visits for female residents increases from 542 visits in 2016 to 584 visits in 2021 compared to male residents which increases from 555 visits in 2016 to 569 visits in 2021 [1]. In 2021, ED utilization was highest amongst White male residents with 383 visits, followed by White female residents with 382 visits, then non-White female residents with 202 visits, and then non-White male residents with 186 visits [1]. ED utilization in 2021 was highest amongst residents ages 26-35 with 266 visits followed closely by residents ages 36-45 with 225 visits and ages 11-18 with 182 visits [1].

Source: South Carolina Revenue and Fiscal Affairs Office

Source: South Carolina Revenue and Fiscal Affairs Office

Source: South Carolina Revenue and Fiscal Affairs Office

Engaging in the “Story Behind the Curve” process encourages us to better understand the supporting and contextual data associated with the specific result we are working to achieve as well as the related indicators. This analysis allows us to identify both positive and negative factors that influence the established baseline trend, identify partners to engage with, and develop strategies that would help us to “Turn the Curve,” in the direction that helps us achieve the desired results identified by each workgroup with the goal to improve the overall well-being of Kershaw County residents.

What factors are pushing up on the data?

The Mental Health Workgroup identified a number of factors that are negatively influencing the data. Some of these factors include:

• Stigma 

• Lack of Available In-Patient and Out-Patient Treatment Opportunities 

• Lack of Awareness of Available Resources 

• Shortage of Mental Health Care Providers 

• Perception of the ED as a Safety Net for Care 

• Shortage of Primary Care Providers 

• Poor Care Coordination 

• Lack of Defined/Standardized Referral Network

• Increase in Involuntary Comittments  

As of 2023, Kershaw County has one mental health care provider for every 610 residents positioning the county significantly lower than the state average of 1 provider for every 490 residents and the U.S. average of 1 provider for every 340 residents [2].

Source: County Rankings and Roadmaps

What factors are pushing down on the data?
The Mental Health Workgroup identified a number of factors that are positively influencing the data. Some of these factors include:

• Mental Health First Aid Training 

• Mobile Crisis Unit 

• CIT Training 

• CCRI 

• ED Based DMH Staff 

• Peer Crisis Response 

• Telehealth Services 

The Mental Health Workgroup identified the following community partners and organizations as integral components of the ongoing development and implementation of the 2023 Kershaw County Community Health Improvement Plan. These partners play a crucial role in ensuring that all residents of Kershaw County are mentally healthy. 

What partners should we engage to address the factors?

• MUSC 

• DMH

• Office of the Probate Judge

• Law Enforcement 

• NAMI

• NAMI Peer Support Specialists 

• EMS 

• CMC

• AccessKershaw

• Mobile Crisis On-Call Physicians 

• Crisis Team

• Kershaw County Library Social Worker 

• Kershaw County School District 

• SC Hopes

The Mental Health Workgroup identified the following strategy areas for the 2023 Kershaw County Community Health Improvement Plan to work towards all residents of Kershaw County being mentally healthy. 
 

• Strategy Area 1: Community-Wide Education and Messaging about Mental Health and Local Resources

• Strategy Area 2: Strengthen Capacity to Connect People to Resources and Care After a Crisis or Emergency 

• Strategy Area 3: Mental Health Training for Partner Organizations and Community Members

• Strategy Area 4: Suicide Prevention Training and Education

• Strategy Area 5: Strengthen and Sustain Training and Crisis Response Efforts in Law Enforcement 

• Strategy Area 6: Support Peer Support Models 

• Strategy Area 7: Support Harm Reduction Initiatives