Vijay Ganju, Ph.D.

CEO, Behavioral Health Knowledge Management

vkganju@gmail.com

April 19, 2015

Behavioral Health Crisis Response: The Reality and the Promise

Crisis Response as a Priority “Discharges from hospitals and ERs destined for

failure”

Crisis interventions are often experience as more traumatic than the reason for which services were sought

The crisis “industry” : consumers as commodities

Burden on other social and community services

Olmstead

MODELS AND SERVICES WITH BETTER OUTCOMES AND LOWER COSTS

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Behavioral Health Crisis Response Services

Continuum of services for a person experiencing a behavioral health emergency

Core crisis services include: 23-hour crisis stabilization/observation beds, short term crisis residential services and crisis stabilization, mobile crisis services, 24/7 crisis hotlines, warm lines, advance directives, and peer crisis services.

The primary goals:

to stabilize and reduce distress

to engage individuals in appropriate treatment services

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Crisis Response: The Evidence Base

Evidence base is emergent and varies for the different crisis services.

23-hour Crisis Stabilization lowered rates of hospital admissions

Residential services may be as effective and less costly than standard inpatient units.

Mobile crisis are effective in diverting people from hospitalization, linking people to outpatient services.

Warmlines reduce use of traditional crisis services

Peer crisis associated with better outcomes and lower costs.

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Need for Crisis Response Services

2.2 million hospitalizations related to a mental health diagnosis

5.3 million Emergency Room visits related to mental health diagnosis

BOTTOM LINE: The need for crisis response services is directly related to inadequacies of the community behavioral health system.

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Building a Crisis Response

Continuum

PREVENTION – WRAP, Crisis Planning,

Housing, Employment,

Health, Peer and Family

Support

EARLY INTERVENTION – Crisis Respite, Peer

and Family

Support, Warm Lines,

Crisis Phones

CRISIS SERVICES – Mobile Crisis, CIT/EMS

Partnerships, 24/7 Crisis

Walk-In, 23- hour

Stabilization, Peer and Family

Support

POSTVENTION – Peer Support, Care

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Crisis Response –

Ten Essential Values

(SAMHSA) Avoiding harm

Intervening in person-centered ways

Shared responsibility

Addressing trauma

Establishing feelings of personal safety

Based on strengths

The whole person

The person as credible source

Recovery, resilience, and natural supports

Prevention

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“No Force First”

Controlling and Managing No Force First

Full body strip search

Uniformed security guards 24/7

Seclusion room

All medications staff administered

Outside communication restricted

From Lori Ashcraft and Gene Johnson, Recovery Response Systems

Risk-sharing discussion

Safety through relationship

De-escalation techniques

Medication self-administration offered

Internet and email available

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CRISIS RESPONSE MODELS:

Some State and Local

ExamplesState Models

Arizona

Massachusetts

Georgia

Delaware

Texas

Washington

Oregon

Louisiana

Missouri

Local Models

Maricopa Co.

San Antonio

Western Mass.

Pierce Co.

Salt Lake Co.

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FUNDING CRISIS SERVICES:

New Opportunities

Medicaid:

1915(i) Home and Community-Based Services state plan option

1915(c) Home and Community-Based Services waivers

Certified Community Mental Health Centers (Section 223)

ICARE Initiative

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INCREASING CRISIS ACCESS RESPONSES EFFORTS (ICARE)

SAMHSA FY2016 Budget Request for $10 million

$5million – MH; $5million - SA

Funding for crisis systems capable of preventing and deescalating BH crises and connecting individuals and families with post-crises services

Program Goals: to increase the engagement with and the functioning of individuals in crisis; increased support for families and caregivers; decreased use of emergency room and inpatient care; and increased understanding by the community of BH crises.

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CRISIS RESPONSE: The New Frontier

Traditional Crisis Recovery-Oriented Crisis

Directed, coercive

Crisis Service

“To” or “for” consumer

Reduce danger to

self or others

Crisis defined by

system perspective

Recovery-oriented;

trauma-informed

Crisis Continuum

“With” consumer

Support and safety

Crisis defined by

consumer or family perspective

Crisis Response /Vijay Ganju