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A conversation with Monarch CEO Dr. Peggy Terhune

May is Mental Health Month and Monarch is celebrating 10 years of providing behavioral health. Addressing mental health before Stage 4—this year’s theme for May is Mental Health Month—calls attention to the importance addressing mental health symptoms early, identifying potential underlying diseases, and planning an appropriate course of action on a path towards overall health. Monarch CEO Dr. Peggy Terhune discusses the importance of mental health as  well as Monarch's evolution and future plans for providing quality care and services that are evidenced-based.

Q: Did you know 10 years ago just how important behavioral health services would be today?

DrPeggyTerhune 2014Dr. Terhune: When I came to Monarch in 1995, the organization served primarily people with intellectual and developmental disabilities (I/DD). We had our share of issues and concerns, of course, but one of them was that it seemed there was only one psychiatrist in the entire state who knew how to serve people with I/DD, and he was retiring. Our folks often waited weeks and months to get psychiatric services. It was very frustrating.

As a foster parent, I experienced teenagers and children in need of mental health services as well. The wait time was long, and often my foster children were treated poorly because they received Medicaid. One child that we had was a 16-year old who was abused by her mother. I took her to therapy and the therapist told her that it was all her fault that she was being beaten, as she had been rude to her mother. I was horrified that he would blame a teenager for a mother’s abuse. I knew that the lack of mental health services was also dangerous. I had been told of several suicides in one of the local high schools. Having worked in the past in mental health, I was aware of the incredible need for this service.

About eleven years ago, when I would go to meetings with the local management entity (then Piedmont Behavioral Health, now Cardinal Innovations Healthcare Solutions) where they would regularly make an announcement – “If anyone would be interested in becoming a comprehensive care provider, talk to us.” When I asked what that was, I was told it would consist of an array of mental health services that would create a one stop shop for children and adults with mental illness. Finally, one day I approached our agency representative from Piedmont and said, “I’m not sure what this is, and I’m not sure how to do it, and we primarily serve people with intellectual and developmental disabilities. However, if you would like us to do this, and will help us, we would be willing to do this.”

Did I know how important these services would become in ten years? No. I knew there was a huge need, and that people were hurting, and that we could help. I thought that if we could hire our own psychiatrists and therapists, we could ensure effective treatment for children and people with disabilities. We also could provide easy and fast access as needed.

Q: Please share more about the recent awards for Facility-Based Crisis (FBC) and the importance of this vital service.

Dr. Terhune: You may know that almost two years ago, the state convened a crisis coalition to look at how to better deliver crisis services in the state. At the time (and in some cases, still), people in a mental health crisis could go to an emergency department (ED) and wait two weeks in the ED for a bed in a hospital or hospital unit. The residents of North Carolina were upset with this situation, and the crisis coalition was tasked with looking at this and other issues relating to mental health crises. The recommendations from the task force made their way through the various committees to the floor of the legislative assembly where $4 million was allocated to open four facility based crisis programs. These programs would address some of the problem because, instead of going to an ED, someone could come to a FBC program, be admitted immediately, get a 4-5 day course of treatment, and get connected to a community provider, housing assistance, and other types of assistance, and this would ease the burden on the emergency departments while improving care.

There were many applications, and a lot of competition. The awards were given to MCOs who gave their proposal with a stated community partner named in the proposal. Monarch was asked to partner with three different MCOs. The awards were given to four MCOs, Smoky, Cardinal, CenterPoint and Eastpointe. Although unheard of in the state, that meant that Monarch was awarded three of the four programs. We are so excited to be chosen!

We are most excited about our child and adolescent program that will open in Charlotte. It will be the first of its kind in North Carolina and is badly needed. As you know, one in four people will experience a significant mental illness in their lifetime. Unfortunately, more and more children are impacted.

Q: What is necessary to meet the demand in the behavioral health industry?

Dr. Terhune: Good question! The first thing that is necessary is to reduce the stigma of mental illness. Our society used to think that mental illness was a result of a weak personality or poor morals. Today, we know that mental illness is just like diabetes or any other chronic condition. You didn’t cause it to happen, you can’t control that it happened, and you can’t cure it without medical help. The reason this is so important is that we know today that the sooner a mental illness is addressed, the more likely a person is to recover fully.

Think of it like this. A person has a cold. They don’t do anything, and the cold turns into a bacterial sinus infection. The person still does not go to the doctor, and now the infection has gone into the individual’s lungs. At some point, the person presents at the emergency department (to maintain consistency with the above) with severe, life threatening pneumonia. The person is hospitalized while the doctors fight for the person’s life. After several weeks in the hospital, the person is discharged to home. The person will forever have scarring on his/her lungs, and is now more susceptible to repeated infections.

Wouldn’t it have been better, less expensive, and much easier to get the sinus infection treated?

This scenario is the same for mental illness. If people would recognize and treat depression early, the chances of recovery are faster and better than if the person becomes so distressed they attempt to take their own life. Early intervention and treatment are critical.

The second thing necessary is to ensure that practitioners are using evidence-based practices. These are techniques and approaches for which there is evidence that the treatment works. You wouldn’t go to a physician who prescribed snake oil for every ailment. Why would you want to visit someone who was not using effective treatment for mental illness?

And finally, we need appropriate services that can be delivered where and when an individual needs them. We need to ensure that a primary care physician is talking to a psychiatrist and therapist, and that everyone is working together to meet the individual’s needs. We call this integrated care. In many situations, primary care physicians can handle mental illness before it exacerbates and becomes very serious. Working together, psychiatrists and primary medical doctors can coordinate care so the care happens at the earliest possible and least expensive point. We need to use all our resources.

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