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.
- From 2006 to 2013, there has been a 52 percent increase in ED utilization by people with serious mental illness (SMI).
- ED visits for opioid overdoses increased by 29.7 percent from 2016 to 2017.
- One out of every eight visits to the ED involves a mental health issue at an average cost of $1,198 – $2,264 per visit.
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:
- 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.