Behavioral Health Acronyms & Definitions
Local Management Entity (LME) Directory
In 2007 the General Assembly incentivized the development of the local mental health 'crisis' system, and reiterated its desire for that system to include local community hospitals. The 2007 legislative session clarified that hospitals should be prepared to work with their Local Management Entity to determine whether, and if so how, to most appropriately to meet their communities' mental health needs. A map of the LMEs across North Carolina can be obtained from the NC Division of MH/DD/SAS website where it announces the new service regions.
Crisis Services Definitions
Community based inpatient psychiatric and substance abuse beds are one component of the MH crisis system, and several LMEs are now contracting with hospitals for the provision of these services to the uninsured. Most of the remaining "crisis" services are intended to support clients and prevent or lower the use of higher acuity (inpatient) services. Services should also be available to support patients upon discharge. Senate Bill 1741 established LME funding for a number of MH crisis services. LMEs were required to submit plans to the state specifically for crisis services in late 2006. However a 2006 survey of NCHA hospitals found that many of these services are not available to consumers.
24 Hour Crisis Telephone Lines
Telephone crisis service assesses the need for immediate crisis support response through screening, triage, preliminary counseling, information and resources, and referrals. If the telephone crisis responder, who is a qualified mental health professional, thinks there is an immediate need for face-to-face services, they will initiate and coordinate the contact. They will provide contact information for other providers for follow-up in non-crisis situations.
Walk In Crisis Services
Typically situated in Urgent Care Centers or similar facility (such as a local crisis center) and include typical services as screening and assessment, crisis stabilization (including medication), brief treatment and linkage with continuing services. May operate 24-7. Typically open extended evening hours.
Mobile Crisis Management
Mobile Crisis Management involves all support, services and treatments necessary to provide integrated crisis response, crisis stabilization interventions, and crisis prevention activities. Mobile Crisis Management services are available at all times, 24/7/365. Crisis response provides an immediate evaluation, triage and access to acute mental health, developmental disabilities, and/or substance abuse services, treatment, and supports to effect symptom reduction, harm reduction, and/or to safely transition persons in acute crises to appropriate crisis stabilization and detoxification supports/services. These services include immediate telephonic response to assess the crisis and determine the risk, mental status, medical stability, and appropriate response. Mobile Crisis Management also includes crisis prevention and supports that are designed to reduce the incidence of recurring crises. These supports and services should be specified in a recipient's Crisis Plan, which is a component of the Person Centered Plans that are required for consumers in each LME.
Crisis Respite/Residential Services
Temporary out-of-home respite and intensive support to prevent hospitalization and/or institutional placement.
23 Hour Beds
Called "Observation Beds" or extended observation units, may be a stand-alone service or embedded within a Crisis Stabilization Unit. These services are particularly oriented to individuals with thoughts of suicide and when the crisis can be effectively resolved within twenty-four hours. Services provided include medication administration, meeting with extended family or significant others, and referral to more appropriate services. Same requirements just designated as being for Behavioral Health/Substance Abuse. See "Facility Based Crisis" information.
Facility Based Crisis
May be called "Observation Beds" in North Carolina Hospital Licensure Regulations. Same requirements just designated as being for Behavioral Health/SA.
- 10A NCAC 27G .5000: Facility Based Crisis for individuals of all disability groups.
- This is a stand-alone facility licensed through DFS.
- The 23-hour observation chairs can be part of this service.
- This is an I-2 (Institutional 2) building, and requires sprinklers and other building code requirements.
- If the facility takes involuntary clients, it must be locked. Providers must comply with requirements of 10A NCAC 26C .0100 in order to request and be designated as a facility allowed to serve involuntary clients.
- The facility does not have to be locked if it takes only voluntary clients.
- If a facility is licensed for non-hospital detoxification and facility based crisis, they may interchange the beds, but must be staffed at the higher level required.
- Psychiatric Hospitals licensed under 122C or Acute Care Hospitals licensed under 131E.
- May provide crisis services as part of hospital license.
- Patient would be assessed in ED, and moved to "crisis unit" based on criteria established.
- Patient would be assessed and monitored in crisis unit and either discharged within 24 hours (similar to 23-hour observation chair in .5000 FBC) or moved to an acute care bed.
- Once moved to the crisis unit, the applicable rules/regulations would include10A NCAC 13B .4000: Outpatient Services, and 10A NCAC 13B .5200: Psychiatric Services.
Inpatient Hospital Psychiatric Service is an organized service that provides intensive evaluation and treatment delivered in an acute care inpatient setting by medical and nursing professionals under the supervision of a psychiatrist. This service is designed to provide continuous treatment for individuals with acute psychiatric problems.
A service that is available and designed to transport individuals safely, swiftly, and cost-effectively to the next level of care (higher or lower) when necessary. May involve contracts with local law enforcement and/or ambulance services to develop a variety of support systems and alternatives.