CHARLOTTE, N.C. _ In moments of intense emotional distress _ when suicidal thoughts emerge, for example, or withdrawal symptoms become overwhelming _ thousands of Mecklenburg County residents turn to the Mobile Crisis Team.
But in recent months, some people calling for urgent help have been told it could take hours for response.
The service's president, Keshia Ginn, blames funding cuts for the delays. Cardinal Innovations Healthcare, the managed care organization that contracts with the Mobile Crisis Team, though, says it hasn't "cut" funding but changed the way services are reimbursed.
Recently, according to Ginn, a woman called the crisis hotline after her brother, who is diagnosed with paranoid schizophrenia, stopped taking his medication. She wanted a mobile clinician dispatched to develop an emergency care plan to diffuse the situation.
In the past, a mental health clinician could have met the woman and her brother in about 45 minutes.
Now, the wait for help can exceed three hours, Ginn said.
The woman's brother ended up in the hospital _ the exact outcome that crisis workers hope to avoid, Ginn told the Observer in an interview this week.
Ginn says the Mobile Crisis Team had to slash its staff in December, from eight to three full-time clinicians. Cardinal, the coordinator of care for thousands in the county, says it advised Ginn's team to maintain its staffing levels while financial terms were under discussion.
Since the staffing cut, 52 people in Mecklenburg County seeking immediate behavioral or mental health help were told they had to wait hours, call 911 or go to the nearest hospital.
"The human toll can't be so easily measured, and that's what is heart-wrenching," Ginn said.
"We don't just change lives positively as a result of this service _ we save lives."
'NOT ACCEPTABLE'
The Mecklenburg County CriSyS Crisis Response system is often referred to as the Mobile Crisis Team. The service responds to homes, businesses and schools across the county to provide rapid aid for people experiencing mental or behavioral health emergencies.
Since 2015, trained mobile clinicians have responded to more than 10,000 calls in Mecklenburg, Ginn says. Of those, more than 8,000 people were seen by clinicians instead of going to an emergency room or jail, where employees may lack the training or resources to deliver proper care.
Many patient advocates and leaders at both the state and local level across North Carolina have emphasized the need for community-based mental health clinicians to relieve pressure on hospitals, jails and social services.
Since Mecklenburg's Mobile Crisis Team reduced its staff, Ginn said, their phone line is still manned 24/7, but remaining clinicians juggle answering calls while also dispatching to help people.
Concerns and frustrations over the recent missed calls surfaced at the Mecklenburg County commissioners' meeting on Tuesday, as they reviewed a string of allegations against Cardinal.
Assistant County Manager Anthony Trotman accused the managed care organization of repeatedly denying or limiting services to some of Mecklenburg's neediest residents, including low-income clients navigating the justice system and youth neglected or abandoned by their families.
Trey Sutten, Cardinal's chief executive officer, told the Observer he is disappointed the county leveled its allegations without advanced warning. Sutten said Cardinal and Mecklenburg County previously maintained a close, collaborative relationship.
"What we really want is a constructive engagement with our community partners," Sutten said in an interview Tuesday afternoon, before the commissioners' meeting.
Some commissioners characterized the problems at Cardinal as a "crisis" and passionately endorsed Trotman's recommendation to explore cutting ties with the organization.
"It's just not acceptable for our community ... I'm really disappointed," Commissioner Susan Rodriguez-McDowell said in an interview. "The importance of mental health resources in our community can't be overstated."
A DIFFERENT FUNDING APPROACH
Cardinal coordinates services in 20 North Carolina counties for people who have a disability, need mental health care or require substance abuse treatment. Those eligible for services include people who qualify for Medicaid or have no insurance.
Previously, Cardinal allocated more than $1 million annually to the Mobile Crisis Team, Ginn said. The team also has contracts with Charlotte-Mecklenburg Schools and the Charlotte-Mecklenburg Police Department.
In July, Cardinal's funding for the Mobile Crisis Team changed from a prepayment structure to a fee-for-service model, said Dietrick Williams, Cardinal's chief operations officer. That means the crisis team is reimbursed by Cardinal for each person it serves, rather than receiving a set dollar amount per year.
Williams said the change brings the funding structure in line with standard practice among managed care organizations. The approach is "not about savings," Williams said.
"We will continue to reimburse for every individual that they serve," he added.
Williams said that since alerting Mobile Crisis to the new funding model in June, Cardinal has worked "very closely" with the team "to ensure they are being appropriately reimbursed."
But Ginn contends the Mobile Crisis Team has yet to be fully compensated and is now "hundreds of thousands of dollars in the hole." In late fall, Ginn said she told Cardinal representatives that staff layoffs would be necessary.
"We weren't able to come to a financial agreement," Ginn said. "We're still in that battle."
Williams says Cardinal believes the Mobile Crisis Team prematurely cut its staff but that it does not control any individual provider's business decisions.
"We asked them not to decrease staff, but they made a decision on their own," he said.
FUTURE DISCUSSIONS
Robert Ward, an assistant public defender for Mecklenburg County, said the brokenness of mental health care services goes beyond Cardinal.
"I see this as a consequence of how the state decided to establish the structure of the delivery of services," Ward said in an interview, referring to a 2015 state legislature decision to contract with private companies to provide certain mental health services.
In a December letter, Ward pleaded with County Manager Dena Diorio to provide supplemental funding to restore the Mobile Crisis Team's staff. Shortly after, Commissioners Rodriguez-McDowell, Susan Harden and Elaine Powell toured the team's facility.
"Aside from compelling arguments based on altruism, it's just smart government to prevent or mitigate harms and costs to our own citizens, agencies and institutions," Ward wrote in the letter, which he provided to the Observer.
The Mecklenburg County commissioners are expected to meet with Cardinal representatives in March. Trotman said the county had not invited anyone from Cardinal to attend last Tuesday's meeting, where several commissioners contemplated breaking away from Cardinal and finding another managed care organization.
Such a move would require approval from the state Department of Health and Human Services, Trotman said. The commissioners would also need to solicit public feedback, he said.
"Given what it takes to get in and out of these situations, I think ultimately what the county wants is some type of working agreement that both Cardinal and Mecklenburg County can agree to in terms of what services are going to be provided," George Dunlap, the chairman of the county commissioners, said in an interview. "I don't think staff really wants to go through this if they can get things to work out."
Dunlap also sits on Cardinal's Board of Directors, though he said may recuse himself from future discussions between the organizations.
Williams said Cardinal looks forward to developing a "stronger partnership" with local leaders.
"We absolutely are committed to our mission of serving the individuals in Mecklenburg County," he said.
