NCPA Blog: What's On Our Mind
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December 12, 2017 - Rex Hospital's ER May Soon Have Fewer Mentally Ill Patients. Here's Why

By JOHN MURAWSKI

The rooms are under 24-hour video surveillance. The chairs are weighted with metal plates to discourage patients from flinging them. Even the small window cranks, which could be turned into weapons, are removable and kept by nurses.

The $2.5 million behavioral health zone, funded by an anonymous donor, is UNC Rex Healthcare’s attempt to keep mentally ill patients out of emergency rooms. The facility allows patients to be quickly moved from the ER and into sunlit, private rooms until space becomes available at a psychiatric hospital or they are stable enough to go home.

Rex officials provided a tour of the facility Tuesday, demonstrating features such as the virtually indestructible metal soap dispensers, and airtight paper towel dispensers that won’t burn if deliberately set on fire. The safety features are based on best practices recommended by consultants and also used in psychiatric hospitals. The facility is undergoing finishing touches and will be ready for patients this month.

The eight individual rooms are bathed in natural lighting, offset in gentle green and blue hues that are believed to induce a calming effect, said Jennifer Sollami, Rex’s emergency department manager. A common area is available for socializing, playing games and relaxing. She said it’s the first facility of its type in the state, and several other hospitals are now planning their own.

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December 7, 2017 - Mental Health Providers Get Ready to Add Physical Care to Services

By ROSE HOBAN

As North Carolina Medicaid changes from being the current fee-for- service system in the next two years to being a one run by large managed care organizations, leaders in the mental health system will have to rethink how they deliver care.

That was the message at the annual meeting of the state’s public mental health managed care organizations (known as LME-MCOs) in Pinehurst this week.

Right now, a behavioral health patient with Medicaid in North Carolina sees a mental health provider, but care often “stops at the neck” and the patient’s physical health needs can go unaddressed. Under the vision outlined by the General Assembly and by the Department of Health and Human Services, that’s going to change profoundly. What they’re looking for is a way to integrate behavioral and physical health care.

It’s a vision that’s being embraced by the North Carolina Council of Community Programs, which until now has been the umbrella organization for the LME-MCOs. The council is changing its name, its mission statement and its board of directors to position itself to represent all the new players who will be involved in mental health services once Medicaid transforms to managed care, probably in 2019.

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December 7, 2017 - Being a Doctor is Hard. It's Harder for Women.

By DHRUV KHULLAR

Happy medical residents are all alike. Every unhappy resident would take a long time to count.

It’s no secret that medical training is grueling: long hours, little sleep, rigid hierarchies, steep learning curves. It’s unfortunate but not surprising, then, that nearly one-third of residents experience symptoms of depression, and more than 10 percent of medical students report having suicidal thoughts. But is it worse for women than men?

A new study in JAMA Internal Medicine suggests yes. Dr. Constance Guille and colleagues analyzed the mental health of more than 3,100 newly minted doctors at 44 hospitals across the country. Before starting residency, men and women had similar levels of depressive symptoms. After six months on the job, both genders experienced a sharp rise in depression scores — but the effect was much more pronounced for women. A major reason: work-family conflict, which accounted for more than a third of the disparity.

Despite large increases in the number of women in medicine, female physicians continue to shoulder the bulk of household and child care duties. This unequal distribution of domestic labor is not unique to medicine, of course, but its manifestations are particularly acute in a physically and emotionally demanding profession with a lengthy training process that allows few, if any, breaks.

The structure of medical training has changed little since the 1960s, when almost all residents were men with few household duties. Support for those trying to balance home and work life hasn’t kept pace with changing demographics, nor has the division of domestic labor shifted to reflect the rise of women in the medical work force. Today, women account for more than one-third of practicing physicians and about half of physicians-in-training. In 1966, only 7 percent of graduating medical students were women.

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