Crisis Services: How to Get Where We Want to Be
This editorial appears in the Crisis to Recovery issue of the National Council Magazine.
The distraught young man whose family brought him into the Bronx hospital looked familiar. After a closer look, I realized I had briefly dated him.
I was working in a triage office for a new program to keep people in psychiatric crisis out of hospital emergency rooms, places that could do little more than sedate and restrain them while they waited—sometimes for days—for treatment.
This was the late 1970s. Mental health professionals have known for a long time that it’s more effective and far less traumatic to keep someone who is in the midst of a crisis out of the places they too often end up: hospital emergency rooms or even jail.
It’s the underlying theme of the newest issue of National Council magazine. Article after article shows how crucial community-based services are for people in crisis and the work they do—from preventing suicides to diligently keeping track of patients’ progress and making sure they get the ongoing help they need.
There is, for instance, Bart Andrews’ story of how it took BHR Worldwide in Missouri six months of intensive follow-up to convince a troubled kid’s parents to get him into therapy. With this kind of commitment, BHR diverts 90 percent of the most troubled from emergency rooms and hospitals to effective community treatments.
Or there’s Leon Evans’ recounting of how the Center for Health Care Services created San Antonio’s Restoration Center, a “one stop shop” for receiving people in crisis so they can stay out of jails and emergency rooms. It has diverted almost 100,000 people into treatment programs since 2008, saving taxpayers an estimated $50 million.
There is more progress to report in other articles. Yet we still have a long way to go. Far too many people in crisis still wind up in the wrong places with inadequate care and little follow-up, or get no care at all with disastrous consequences.
So it is crucial we educate the public to understand, first, that “crisis” in the context of an addiction or a mental illness does not mean “over in an instant.” As we know, it can mean intense work with a patient over weeks and months.
And, second, we must convince people that these crises should be treated with the same urgency and get the same kind of effective response as, say, emergency care for a physical ailment like a broken leg.
We’d be horrified to think someone with a broken bone or a deep gash wouldn’t get appropriate treatment quickly. Yet people rarely think about all the people with mental illness or addictions who continue to fall through the cracks of our imperfect systems.
There’s one crucial difference, though, between dressing a physical wound and treating a behavioral one: The extensive follow-up with counseling, therapy and other assistance that the severe mental illness or addiction requires, often involving social workers, psychiatrists and even job counselors.
That’s a far more expensive proposition than sewing up a cut and sending the patient home with some antibiotics.
Fortunately, we have important new tools to analyze reams of “big data” that can tell us which interventions work for which people and can help us better target those people most likely to need help.
You’ll remember that Nobel-Prize-winning economist’s groundbreaking research late last year that gave us a more precise picture of who’s more likely to overdose on drugs and alcohol or complete suicide. And surprisingly, even to behavioral health professionals, they’re white, middle-aged, working-class men. That use of big data can direct our efforts and potentially save lives. What we think is too often based upon belief, not evidence.
We’ve all read about Virginia State Sen. Creigh Deeds, who recently sued the state’s mental health system for $6 million after he was told there were no beds for his troubled son.
The adult son was released from emergency custody only to stab his father repeatedly and then kill himself. There were beds available, it turned out. Virginia legislators have created a statewide bed registry—using data—so mental health workers can find placement for a person in crisis.
For the past three years, 11 states have increased spending on mental health, including crisis services. One of them is Colorado, where a gunman in Aurora killed 12 and wounded 70 in a movie theater in 2012.
We need to turn these tragedies into positives by taking advantage of the light they shine on people in crisis and the shortcomings of our treatment systems.
Our job as behavioral health advocates must be to convince the public and our elected officials that the problem is literally life-and death and that with effective treatment, we can save lives and mend ruined ones.
That’s how we honor the people we lost. Congress is already aware of the pressing need to help people with addictions and mental illnesses and the need for a full continuum of services in every community. What we need to do is keep the heat on and make it happen, including expanding the Excellence in Mental Health Act to all states.
We’re not there yet on crisis care, but we are far closer than when I worked in that triage unit as a young mental health professional.
As for that young man in the Bronx hospital? The mobile crisis team kept him out of the hospital, visited his home and involved his family in group support and treatment with other families. Much improved, he moved to outpatient treatment. Last I heard, he had started looking for a job.