Enhance behavioral health crisis systems to improve health, reduce costs

People with mental health and substance use disorder challenges are using emergency department (ED) services more frequently than in prior years.

This data shows there is a lot of money to be saved by eliminating unnecessary visits to the ED for behavioral health reasons. More important, the human toll is disturbing as well. One study reveals that an ED system of care triggers symptoms and stress for those experiencing a mental health crisis. Further, the services received from an ED visit were not adequate enough to meet individuals’ psychiatric care needs.

How, then, can we stop the unnecessary recycling of visits to the ED for mental health and substance use disorder (SUD) problems? An important starting point is the development of an effective crisis services system that focuses on prevention, recovery and resiliency over hospitalization and involuntary detention. Spotlighting May as Mental Health Awareness Month is an excellent prompt to reflect on improving the ‘old’ to forge a ground-breaking ‘new’.

A re-envisioned crisis system

First, what do we mean by a behavioral health crisis? What may be a crisis to one person may not be a crisis to another, and not all “crises” require the same level of care. Beacon Health Options has chosen to adopt a “self-definition” of crisis, in which individuals define for themselves, or with the help of a caregiver or professional, when they are approaching or experiencing a crisis. An excellent crisis services system is more than stabilizing a person at imminent risk and referring that individual to care; it involves ensuring individuals have access to care needed to prevent a crisis from developing in the first place.

An important starting point is the development of an effective crisis services system that focuses on prevention, recovery and resiliency over hospitalization and involuntary detention.

Therefore, we can no longer view crisis services as just services that respond to a crisis in the moment. Beacon promotes a system that supports individuals through all phases that lead up to and follow a crisis. The five phases of system involvement include:

  • Prevention
  • Early intervention
  • Acute intervention
  • Crisis treatment
  • Recovery and reintegration

To support these five phases, crisis services integrate into a wider array of community-based behavioral health services where every interaction presents an opportunity for becoming involved with the larger health and social services system. These services include a centralized contact center; mobile crisis teams; walk-in clinics or psychiatric urgent care; crisis stabilization units; crisis respite care and residential services; education, training and community services; peer support; and levels of care and resources that interact with the crisis system — behavioral health, medical and community.

In turn, these services require system management and oversight that entail a technology infrastructure to facilitate access, track available services, connect system stakeholders, share data and measure outcomes.

Crisis services systems in action

For three regions in Washington state, Beacon provides that crisis system management and oversight. In Washington, the behavioral health crisis system includes a 24/7 crisis hotline; mobile dispatch for community-based assessments and interventions; and care coordination. The story is a very good one: Mobile crisis services have resulted in more than 90 percent diversion from the ED or inpatient care to community-based services. Additionally,

  • 78 percent of issues are resolved by phone.
  • 82 percent of those seen by mobile crisis services receive follow-up within seven days.
  • The recidivism rate for hospitalizations is only 4 percent among those seen by mobile crisis services.

Beacon has seen similar success in Massachusetts, where Beacon’s Massachusetts Behavioral Health Partnership manages the statewide crisis system on behalf of Massachusetts Medicaid (MassHealth), including administering a toll-free crisis line. By typing in their zip code, callers connect with their local emergency team for support, which can include mobile crisis dispatch and intervention. Callers can also access multiple levels of community-based locations where they can stay safely until their crisis is stabilized. Using mobile crisis services has resulted in significantly reduced hospitalizations: 81 percent of youth and 61 percent of adults receiving mobile crisis interventions were referred to community-based outpatient and diversionary services instead of inpatient care.

In summary, a responsive crisis system ensures individuals have access to the right level of care at the right time without relying on unnecessary ED visits or inpatient beds, improving the patient experience and creating a more effective healthcare delivery system.


4 Comments. Leave new

Robert Plant
May 28, 2020 6:10 pm

Great article emphasizing a systems approach to service delivery. Based on my experiences previously overseeing statewide mobile crisis services for children and families in CT and my current role with Beacon that has included evaluation of statewide system of ED and crisis services, we believe that the best approach to serving children is in some ways fundamentally different than the approach to adults. I am wondering if that has also been the experience in the three regions referenced in the article?

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Patrick Glynn
May 28, 2020 7:09 pm

great message, and timely commentary to help us reimagine the system of care.

Reply

As a long time crisis response clinician, professional counselor and crisis intervention trainer, I applaud your efforts. The two models you have described do have a long history of really working with at risk populations. I have been a counselor since 1973 and worked in hospital, outpatient, private practice, business and academic settings. Early in my career I was an on call crisis clinician for a hospital here in CT. At that time we used a similar model that integrated crisis center hotline, respite and face to face counseling with the ED, Outpatient Clinic and PHP programs. We also had a good partnerships with the police,a domestic violence, and rape crisis organizations in the community and would respond with them to clients in crisis in the community. Sadly, as time went by, managed care took over and grants disappeared that integrated systems approach could not be sustained financially. I am happy to see that Beacon is advocating for the return of this approach. It works well and creates more stability, not just for the clients, but for the responding agencies who then come into open collaboration and can work as a team. ( I have actually trained many teams like this in the past and it is exciting to see what happens when they move from competing with each other for resources to collaborating with each other to obtain the funding and other resources necessary to create repeated successes.) I am also happy to say that I am part of the Beacon network of both crisis response clinicians and mental health clinicians and have been for a lot of years now. Keep up the good work both on the EAP response end and the Mental Health Counseling end of the work.

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Mary Grace Ventura
June 25, 2020 5:41 pm

Thank you. This was extremely valuable information that I appreciate very much.

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