In any industry, the quality of service or whether one receives services at all hinges on one critical element: access. For those needing mental health services, the North Carolina Statewide Telepsychiatry Program, or NC-STeP, offers unprecedented access through an innovative delivery system connecting qualified doctors to mental health and substance abuse patients who sorely need their help. It is altering the landscape of psychiatric treatment and availability in the state.

NC-STeP provides expert psychiatric assessments and consultations through a network of 80-plus hospitals statewide. Those hospital emergency departments use telemedicine technologies—secure, real-time interactive audio and video technology at the bedside—to treat patients in rural and underserved areas. NC-STeP’s level of reach has enabled over 21,000 patient encounters. As a result, emergency departments have seen shorter lengths of stay, fewer involuntary commitments, less recidivism, and most importantly, measurable cost savings. Established through state legislation in 2013 with $2 million annually, NC-STeP is administered by the East Carolina University Center for Telepsychiatry and E-Behavioral Health (CTeBH), and is overseen by the DHHS Office of Rural Health.

“This $2 million dollar investment from the state has generated five to six million in cost savings when you consider that forty percent of patients have been sent home and connected to a community provider. It prevents unnecessary hospitalization,” says Dr. Sy Saeed, M.D., the director of both NC-STeP and CTeBH.

How does the system work? A nurse at the remote referring site rolls a portable cart outfitted with a monitor, camera, and microphone into the patient’s bay or room, establishes a secure link to the psychiatric provider site, and introduces the patient to a psychologist or social worker who has reviewed the patient’s information. Once that individual explores the patient’s situation and gathers any pertinent information from family members, a psychiatrist interviews the patient and makes recommendations to the referring hospital physician, who is ultimately responsible for care decisions.

Saeed points out that today’s emergency departments are jammed, especially in North Carolina due to mental health reform and the dismantling of the community-based system. The public may be surprised to learn that the emergency department arrivals are not, as often thought, using the facilities in place of a standard doctor’s visit.

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