Envisioning a Comprehensive Behavioral Health Crisis Response System
nashville the national association of state mental health program directors what that means is that we work with the leadership across the country in mental health in all the states and territories our goal is to improve mental health services improve the quality improve the quantity so that everyone can get the service at the level that they need i think one of the good things that’s happening around the country is that the most suicide calls are answered in the timely during a in a timely fashion and that’s in large part due to the national suicide prevention lifeline and the work that they’ve done what isn’t working so well is the importance of having mobile crisis services stabilization units short-term residential that’s not standard across the country so typically what you end up getting is a 911 response similar to what you have with physical healthcare individuals in crisis they don’t know what to do or they call their after our therapist after hour uh answering uh lying for their therapist or someone in the mental health field and they say call 911 or go to the nearest emergency room as a result we have an over utilization of the emergency room and we have individuals that the response is such that they call often in 911 to resolve the issue the police will do an arrest and the individual would go will go to jail as a result with the current system we have too many people going to a level of service they don’t need or ending up in jail [Music] i would refer to the national guidelines that were put out by samsa in february what samhsa put out is a really nice guidance and we’ve been promoting that to all of our states so that they can look at their crisis services and compare what they have to what’s in the national guidelines what’s in the national guidelines includes crisis call line mobile crisis stabilization short-term residential in addition the what’s what’s what seems to work best is if you have a policy of accepting everyone and accepting them quickly with the uh covert 19 one of the things that that’s done is really put a lot of pressure and doing something other than arresting and taking people to jail so that has really emphasized the importance of crisis programs that have a uh where they do the triage in the community that what that means is that they basically will have people who walk in or who are dropped off by the police they’ll take over the case and then if the individual needs a higher level service they will connect them with that higher level service those programs that work very effectively with law enforcement so they have a fast drop off are what’s best arizona is used as a good example whether you’re talking about the tucson area or the phoenix area they’ve been in the leading among the leading states to set up a sequential intercept model trying to intervene as soon as possible and trying to be as friendly consumer-friendly police-friendly as possible as a result they’ve been very effective in working with the police the more we can work with the police decrease the involvement of the police have it so it’s much more consumer friendly giving the individual the service they need at the level that they need rather than pushing up so the triage is done at the emergency room or a higher level that’s really the best model and then and arizona uh and in tucson they’re doing it [Music] if we think of the individual who is dealing with the crisis or the loved one that is trying to get help for their their family member or friend trying to make it as easy as possible to get the service i think that’s the main advantage and making sure that the individual is getting the care at the level they need so they don’t have to go in the hospital they’re not going to jail they’re basically getting their service in the community at the level that they need it it’s important to point out that if somebody goes to the emergency room for a physical health care reason about 15 to 18 of the time those individuals get admitted if someone goes to the emergency room for a mental health or substance use disorder issue over 50 percent end up getting admitted so what does that mean we’re over utilizing resources it’s more costly as well as being unfair to the individual who’s getting a service that they at a level they don’t need so i would add that one of the big advantages and i think it’s important especially during this time that we’re looking at less revenue going to the state and local localities is that this example decreases the cost because you’re treating people at the service level they need you’re not sending them to jail and incurring all those costs you’re not tying up police time and incurring those costs you’re not overusing the emergency room in inpatient and incurring those costs so one of the big advantages of this type of an example of the national guidelines example is that it’s very very cost effective let me stop for a second and talk about the 988 system 988 has recently been approved by the fcc as the three-digit number to be used for crisis it’s currently being discussed in congress but we’re expecting it will be passed by congress if that happens then the three-digit number will go into effect july 2022. so if we think of that as being our target if we can get all the different leaders within states working together to magnify to market that 988 number to really think about it as more than just the number itself but really to look at it as an opportunity to move from a 9-1-1 system which is very effective for physical health care to a 988 system which could be equally efficient as 9-1-1 but have it equally efficient for them for the crisis system and for helping people with mental health issues substance use disorder issues so i i look at the example of what we could do with 988 and all the leadership of the states working together i think that would end up with a really good system so that in five years we’d really be proud of a 988 crisis system of care based on the samsa national guidelines for behavioral health crisis care and it would be standardized across the country
As states seek transformational change within public safety and response systems, innovative models have shown a significant reduction in unnecessary emergency department visits and incarceration for people experiencing mental health issues. ASTHO spoke with the National Association of State Mental Health Programs Executive Director Brian Hepburn, MD about re-envisioning a more comprehensive response system for people with acute mental health needs.
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