North Carolina must increase its crisis response capacity for long-term success, according to a new report by the mental-health policy group Inseparable. The report analyzes 988 crisis lifeline responses in every state and proposes improvements.

One key area it says requires attention in North Carolina is the need for more crisis-response mobile units and beds. Kelly Crosbie, director of the Division of Mental Health, Developmental Disabilities and Substance Use Services at the North Carolina Department of Health and Human Services, acknowledged this challenge and said funding from the General Assembly is addressing the need.

"So, now we have 19 'urgent cares' opening across the state," she said. "In the community crisis center space, we've added about 64 new beds for adults and 44 new beds for children."

The report shows an 81% call capacity rate, with a recommended goal of 90%. Crosbie said current numbers are higher, with call capacity at 98% and calls being answered in about 14 seconds. North Carolina's 988 line receives around 8,000 calls monthly.

In order to sustain this progress for the long term, Crosbie said, the 988 system will need sustainable funding.

"We really need insurers to recognize this as an appropriate level of care and to cover it. So they all cover 'urgent cares' now, right? Folks who go to an urgent care, and you have Aetna or Blue Cross, they're going to cover it," she said. "You go to a mental-health 'urgent care'; that should be covered as well."

Angela Kimball, chief advocacy officer for the group Inseparable, said the report calls on state legislatures to focus on creating sustainable funding sources and accountability measures for their crisis response systems.

"By having these accountability pieces," she said, "this allows legislators to oversee the system over the long haul, and to set up the structures for continuous learning, continuous system improvement."

She said data collection, annual reporting and coordination between the 988 and 911 systems are ways states can make them more accountable.

New York doctors are advising people how to stay healthy in the summer heat.

Temperatures across the state will reach the high 80s and mid-90s in the coming days. Some climatologists estimate 2024 will overtake 2023 as the hottest year on record, and New York's average temperature has risen 3 degrees since the 1970s.

Dr. Steven Foulis, a physician at
UBMD Primary Care, said people need to always stay hydrated.

"When you sweat, you lose a good deal of salt and other solubles through the sweat," he said, "so being able to replete those with whether it be a sports drink or really, any drink that has electrolytes in it would be an important thing to replete what your body is losing during warm days."

Foulis said people need to wear sunscreen when they're outdoors, since some aren't aware of the risks direct sun exposure poses. However, he added, this shouldn't stop anyone from getting away from their screens to enjoy the outdoors. New York Gov. Kathy Hochul's "Get Offline, Get Outside" campaign champions this by making all state park pools free this summer.

Not staying hydrated can lead to heat stroke or heat exhaustion, in turn leading to an emergency room visit. A Centers for Disease Control and Prevention study finds heat-related ER visits rose in 2023.

Dr. Donna O'Shea, chief medical officer for population health at UnitedHealthcare, said virtual care can help you decide whether a situation is serious enough to seek emergency care.

"You can decide, with a knowledgeable caregiver, 'Do I need more?' Most of the time, if it's related to hydration and heat stroke, if you're able to keep fluids down, virtual care can help determine how much, how long to wait before you go to the emergency room," she said. "Same thing even for sunburns or for bike safety."

She added that using virtual care can be a less time-consuming and less expensive option than going directly to a hospital. While telehealth can cost around $50, an in-person emergency room visit can cost around $2,700.

Health experts are urging residents to stay hydrated and stay out of the sun during peak periods, especially during the heat wave that is gripping parts of Kentucky and the rest of the United States.

According to the Centers for Disease Control and Prevention, older adults, young children, and people with chronic diseases are at highest risk for heat-related illness. But the heat also poses dangers to healthy people, especially during prolonged or strenuous activities in hot weather.

Donna O'Shea, chief medical officer for population health and value-based care at UnitedHealthcare, said people use health-care services a lot more on very hot days, and hospitals report a spike in emergency-room visits.

"And so one thing we do want people to remember," she said, "is that virtual care can help people connect with a health-care professional, 24/7 from their home when they have concerns that arise."

The Department of Health and Human Services has said extreme heat can trigger asthma and chronic obstructive pulmonary disease in some people. Blazing heat can also pose risks for people struggling with mental-health issues, and can worsen acute psychiatric and substance-use symptoms.

Dr. Rob Tagher, president of the American Academy of Pediatrics' Kentucky chapter, said noticeable symptoms of dehydration or heat stroke can include irritability, lethargy or fussiness in toddlers. He explained that it's important to ensure small children stay hydrated.

"I always tell adults that are taking care of kids and toddlers that if you're uncomfortable, the child is much more uncomfortable than you with regards to temperature," he said.

Tagher added that pediatricians often see an influx of young patients with insect bites, poison ivy and other summer rashes. Because there aren't many treatment options available other than waiting for the rash to resolve and trying to alleviate itching, he said prevention is key.

"Knowing which plants to stay away from," he said, "good observation and parenting to keep kids away from more dangerous plants, keeping them away from dawn and dusk, when the mosquitoes and bugs are a lot worse."

A lending library for medical and mobility supplies opened in Sioux Falls just last fall and now its parent nonprofit is making moves to go mobile.

Under the umbrella of The Legacy Foundation, Owen's Outfitters lends out a huge variety of medical equipment-from tiny syringes to hospital beds, as well as mobility devices and equipment for therapy and exercise. There is no cost to borrow items and no deadline for returns.

Since the library's October 2023 launch, nearly 4,000 items have been borrowed by roughly 430 clients, most of whom are enrolled in Medicare or Medicaid.

Eleanor Turner, co-founder and president of The Legacy Foundation, said the library helps fill gaps.

"We have a lot of folks say that Medicaid or Medicare does not cover these items," Turner pointed out. "Or perhaps their insurance will cover one type, but not another type of what they need."

Turner noted when the library received positive community response, the foundation started toying with the idea of traveling to reach more rural parts of the state. A 2024 AARP Community Challenge grant and a bus donation is jump-starting the project, which Turner added she hopes to roll out this fall.

The bus donated for the mobile library is a small school bus, which Turner stressed is beneficial because it does not require a commercial driver's license to operate, like a large school bus does.

"In terms of how far we go, really the state border is the limit," Turner emphasized. "If we have the volunteers to drive the bus, we see no reason to limit ourselves. Have bus, will travel. I think that's the new motto."

Turner explained Owen's Outfitters is modeled after a library in Milwaukee, which she used while living there with her late son, who was born with a rare chromosome disorder, and for whom the Sioux Falls library is named.


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