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David W. Covington, CEO & President, RI International and Michael Hogan, Independent Advisor and Consultant, Hogan Health Solutions; Co-leads, Crisis Services Task Force, National Action Alliance for Suicide Prevention

When Crisis Happens “Now”

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This article appears in the Crisis to Recovery issue of the National Council Magazine.

Our country’s approach to crisis mental health care must be transformed. It is time and we have the tools to prevent tragedies like these:

  • Unspeakable family pain: In November 2013, Sen. Creigh Deeds (D-VA) told CNN that he was alive for just one reason: to work for change in mental health. Just a week earlier, his son, Gus, stabbed him 10 times and then ended his own life by suicide. This happened only hours after a mental health evaluation determined that Gus needed more intensive services, but unfortunately, he had to be released from custody before the appropriate services could be found
  • Psychiatric boarding: The month before Sen. Deeds’ family crisis, the Seattle Times concluded its investigation of the experience of individuals with mental health needs in emergency departments. “The patients wait on average three days—and in some cases months—in chaotic hospital emergency departments and ill-equipped medical rooms. They are frequently parked in hallways or bound to beds, usually given medication, but otherwise no psychiatric care.” In 2014, the state supreme court ruled the practice of “psychiatric boarding” unconstitutional.
  • The wrong care, in the wrong place, compromising other urgent medical care: In April 2014, California approved $75 million for residential and crisis stabilization and mobile support teams. This investment was based on the belief that three out of four visits to hospital emergency departments for mental health and addiction issues could be avoided with adequate community-based care.
  • Thousands of Americans dying alone and in desperation from suicide: In 2015, the National Action Alliance for Suicide Prevention launched the Crisis Task Force with the goal to provide stronger 24/7 supports to the nine million Americans at risk each year. Every day, more than 115 people in the U.S. die alone and in despair.

There are four different compelling reasons why “crisis is now”: public safety, civil rights, extraordinary and impactible waste of public funds and the opportunity to address one of our most intractible human problems. The time really is now and the burning platform is clear.

It does not have to be this way. In a few states and communities across the U.S., solutions are in place. But until now we have not had the vision or will to approach crisis care with national resolve and energy. These three examples highlight what can be done differently with “power”:

  1. Power of data and technology. The Georgia Crisis and Access Line uses technology and secure web interfaces to provide a kind of “air traffic control” that brings big data to crisis care and coordination in real time.
  2. Power of peer staff. People, Inc.’s Living Room model, peer staffing and retreat model provide safety, relief and recovery in an environment more like a home than an institution.
  3. Power of going to the person. Colorado Access’ mobile crisis teams don’t wait for law enforcement to transport a person in need to the hospital. They go to the person. Colorado is the first state to prove this can be done in urban, rural and, yes, even frontier areas.

33California, Colorado, Georgia and Washington state were driven to new approaches because of vastly different primary drivers, but five key elements stood out:

  1. Expansion of community-based mobile crisis services to 24/7 outreach and support with a contractually-required response time. (Colorado and Georgia)
  2. Introduction of crisis stabilization programs that offer 23-hour observation and sub-acute short-term stays at lower costs without the overhead of hospital-based acute care. (All)
  3. Crisis triage call centers with strong use of technology and information across a system of care, leveraging big data for performance improvement and systems accountability while providing high-touch support informed by suicide prevention best practices. (All)
  4. Engagement of peer staff, trauma-informed care principles and recovery cultures to improve the experience and outcomes.
  5. Involvement of government leaders, with activating legislation in California and Colorado, key engagement of the governor in Colorado and Georgia and the judicial branch (Department of Justice and Supreme Court) in Georgia and Washington state.

Crisis is happening now and we can do far better to respond to it. Our society takes for granted a national emergency medical response system—911 centers with high technology to ensure individuals with other medical problems do not fall through the cracks. This system has transformed stroke and heart attack care. Ambulance services go to the person directly to ensure immediate life-saving care with emergency medical services in every area of the country— urban, rural and frontier. We can do the same for mental health crises.

We must.

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