Mental Health Series
This is Part 2 in a solutions series that examines how a proven concept can expand access to mental health services. Part 1 was published on July 30.
MOUNT VERNON — The 2021 Knox County Community Health Improvement Plan reports that better access to mental health services could improve mental health in the county.
“Increasing awareness of and reducing stigma are two components of successfully treating mental health,” said Kathryn Spergel, executive director of Mental Health & Recovery for Licking and Knox Counties (MHRB).
“Increasing access to care is another.”
To help increase access, Behavioral Healthcare Partners of Central Ohio opened a behavioral health urgent care center on South Mulberry Street in Mount Vernon in 2022.
The Care Now Clinic offers early crisis intervention services for those age 12 and older.
BHP CEO Kathryn St. James likened the clinic to a medical urgent care center that bridges the gap between an emergency room and waiting to see a family physician.
“Behavioral urgent care itself is a brand new concept,” she said. “When we started looking at a brick-and-mortar urgent care center for behavioral health, there were no models. We used medical urgent care as our model.”
Those models show that urgent care centers reduce visits to the emergency room, typically cost less, and provide support in managing chronic conditions.
More significantly, they offer immediate access to care and provide the first line of defense against illness for underserved communities.
Two years after opening its Care Now Clinic, BHP is taking the urgent care concept on the road with its mobile crisis unit, increasing access to care by meeting residents where they are.
Mobile crisis unit provides missing level of care
BHP calls its mobile crisis unit the Mobile Care Now Clinic. The idea is that individuals can walk in and get immediate services rather than going on a waitlist or trying to navigate the system.
“The need for it hearkens back to the reason why we opened the brick-and-mortar behavioral health center,” St. James said.
“This was a missing level of care for folks needing some care but were not at the level of crisis who couldn’t wait until a service provider became available or don’t have access to a provider.”
St. James said she is impressed with how clients utilize the brick-and-mortar Care Now Clinic.
“But what we worry about are folks outside of Mount Vernon having the same level of care. The van is in essence everything that we have in the brick-and-mortar clinic, we can just take it out into the communities.”
Staffing is the same as the Mulberry Street center:
• Licensed counselor.
• Psychiatric nurse practitioner who can prescribe medications.
• Nursing assistant who makes sure the person is medically stable.
• Care coordinator to link the person to other resources.
“Usually, the staff will be physically in the van,” St. James said. “If the nurse practitioner is on vacation, we might connect to the Mount Vernon or Newark site online that day.”
Nimble and flexible mental health services
The van has no set schedule. It might be in Frazeysburg one day and Danville the next.
“We don’t want it to be specific to this day we’re here, and then the next week we repeat it,” St. James explained. “That would limit the communities we can get to.
“We want to be nimble and flexible.”
It will go to communities, homeless shelters, and wellness day events.
Businesses that want employees to have easy access to a behavioral health professional can schedule the van to be on-site. Organizations and schools can request that it come to a community.
Individuals can check the van’s calendar and opt to visit the mobile unit or one of BHP’s brick-and-mortar locations.
The mobile unit accepts public and private insurance and self-pay clients. It also accepts MHRB funding if the client qualifies.
“It will operate much the same way as our urgent care and outpatient facilities operate,” St. James said. “As with our other services, we will not turn anybody away because of their inability to pay.”
BHP bought the van through a Care Source Community Investment Programming grant.
MHRB provides financial support through a reimbursement program using state, grant, or levy funds.
A concept that’s catching on
BHP is the first in Ohio to launch a mental health mobile crisis unit. Earlier this year, several municipalities across the country started a similar service.
Detroit, Michigan, launched one in January, as did Santa Monica, California, and Linn County, Oregon.
All will respond via 911 calls through law enforcement’s dispatch center or the 988 suicide and crisis lifeline. They also respond to hospitals.
Todd Noble, health administrator/mental health for Linn County, said the community is used to going to the hospital for mental health services.
“It takes a while for the community to realize we can come to them,” he told Knox Pages earlier this month. “It will probably take months, if not years, for them to realize that.
“That is one of the goals, not to go to the hospital,” he added. “At this point, we continue to show up in the community with police sometimes and at the emergency department.
“I suspect we will start getting more direct calls.”
Although the county’s mobile unit is in its early stages, the state has had crisis response for emergencies through the CAHOOTS model for decades. Noble said Oregon mandates counties to have crisis response.
Two clinicians respond in Linn County’s mobile unit. Ideally, they would hold mid-level master’s degrees.
“Because of our huge work shortage, Oregon allows a qualified mental health associate at bachelor’s level,” Noble said, adding that the program’s biggest challenge is a workforce.
“Since the pandemic we have not recovered our workforce, even though we’re paying very well in the market and recruiting outside.”
Noble said telehealth benefits have negatively affected staffing because many clinicians have left community programs to work at home in telehealth.
Oregon’s Coordinated Care program is the primary funder of the county’s mobile van.
Future challenges
St. James said that 60% of those accessing care in BHP’s brick-and-mortar clinic have not previously accessed services.
“Some is because [mental health issues] are becoming more prevalent, but there’s still the stigma. And it’s confusing accessing the system,” she said.
“We want to make it easy for people to come and get help if they need it.”
Spergel agreed.
“If we can address stigma and work through that, it helps to have the greater access to care and hopefully greater health.”
She noted that staffing is an ongoing challenge.
“Unless we have a workforce, we’re not able to provide services. We’ve got some work to do. And it’s not just getting people, it’s getting them to stay,” Spergel said.
Long-term, Spergel wants to see how much the mobile van impacts suicides and other substance-abuse deaths and the number of people who report depression and anxiety.
“That will not happen overnight,” she said. “Sometimes, it takes some time to determine the level of impact.
“Data is crucial. It backs up anecdotal data and gives credibility to what we are trying to do.”
Leading the way in Ohio
BHP is the first in Ohio to launch the mobile behavioral health care concept.
“We know from MHR board research over the past number of years that Knox County has a high rate of ‘death by despair,’” St. James said. “This manifests itself in accidental overdose and suicide. If you intervene early, you can help prevent that.”
St. James said health officials know rural communities struggle because they don’t have access to mental health services.
Additionally, the farming sector has a high rate of suicide.
“Knowing that we have both communities and both communities are vulnerable, the earlier you intervene, the better outcomes you have,” she said.
“When you think about the number of people who aren’t being served and have needs, then you realize how much potential a van like this could be,” Spergel said.
BHP will host an event on Thursday, Aug. 8, from 11:30 a.m. to 1 p.m. at Ariel-Foundation Park. A ribbon-cutting is scheduled for 12:15 p.m. in the Park National Bank Pavilion.
The community is invited to attend.
Click here to read Part 1 of this series.