Three minute plus video explains model crisis care system.
(10-26-20) What are we doing to create a better mental health care system?
CRISIS NOW, a four prong approach, is gaining national attention from SAMHSA and being endorsed by many of the nation’s largest mental health organizations, including The National Association of State Mental Health Program Directors (NASMHPD), the National Alliance on Mental Illness, Mental Health America, CIT International, RI International, the National Council for Behavioral Health, the National Action Alliance for Suicide Prevention and the National Suicide Prevention Lifeline.
That’s a powerful coalition so what is CRISIS NOW?
David Covington, the CEO and President of RI International, described the approach at a recent meeting of ISMICC, a federal panel appointed to advise Congress about the most innovative and best practices in mental health.
The goal behind CRISIS NOW is to create a uniform mental health system that is not so heavily dependent on the police and hospital emergency rooms. The first prong is creating Crisis Call Hubs, which can be contacted by voice, text, or chat through a specific telephone number rather than having those in crisis call 9-1-1. President Donald Trump recently signed into law bipartisan legislation identifying 9-8-8 as a three digit number for a Mental Health Crisis Hotline. Slated to go into effect nationally in July 2022, it will replace the current National Suicide Prevention Hotline, a more complicated 10-digit number — 1-800-273-TALK.
But this new number under the CRISIS NOW approach would offer much more than its predecessor.
Staffed by mental health professionals, HUB Coordinators would triage each call and offer tailored help to each caller.
What does that mean?
It means that HUB Coordinators would be able to schedule appointments for callers with therapists, psychologists, and psychiatrists, and inform callers how long of a wait it might be to see one. If someone needed a crisis bed, HUB Coordinators would have computer access to real time data that identified how many crisis care beds were available in a specific area and would be able to speak directly to each facility to reserve a bed so it would be waiting for that caller’s arrival. HUB Coordinators would assist callers in cutting through the red tape – such as medical clearances, insurance approvals, and transportation – to expedite the process and knock down roadblocks.
HUB Coordinators also could dispatch Mobile Crisis Response teams (the second prong in CRISIS NOW) rather than having police be first responders. The HUB Coordinators would use GPS-enabled tablets or smart phones to quickly and efficiently determine the closest available teams, track response times, and ensure clinician safety with real-time communication.
Rather than sending individuals to hospital emergency rooms, the HUB Coordinators would direct them and Mobile Crisis Response Teams to Crisis Receiving Facilities. (The third prong in Crisis Now.) These facilities would be designed specifically for those dealing with mental health and substance abuse issues and would be designed to be warm and welcoming centers.
Covington described them as “living rooms” where “guests” were welcomed rather than traumatized. Covington’s company, RI International, has build several such centers, which are described on the company’s website as, “Healing spaces with recliners, soft colors and a home-like atmosphere ..(staffed by) teams, comprised of doctors, nursing staff, and peers with lived experience, (who) weave recovery, clinical, and medical services together, providing comprehensive care.” The company further notes that it “makes every effort to eliminate seclusion and restraint and to serve all people regardless of level of acuity, without resorting to physical interventions. Peer-operated “Living Room” programs ensure that participants are paired with a team of Peer Support Specialists in recovery. Each guest is encouraged to work with the team and empowered to develop their own recovery plan.”
The final prong of CRISIS NOW is described as Essential Principles and Practices: The system must “include a recovery orientation, trauma-informed care, significant use of peer staff, a commitment to Zero Suicide/Suicide Safer Care, strong commitments to safety for consumers and staff, and collaboration with law enforcement.”
During Covington’s ISMICC presentation, I asked him how CRISIS NOW would deal with someone who refused help and posed a danger. He explained that the staff at a receiving center could have them involuntary committed if needed and that each state’s commitment laws would govern what happened next, but he emphasized that the use of involuntary commitment would be minimized as much as possible. He also noted that those seeking help are voluntary admissions.
CRISIS NOW has been referred to as an “air traffic controller” approach. On any given day, air traffic controllers oversee 45,000 flights per day. In a blog posted on the RI International webpage, Covington explained there were “two vitally important objectives” for air traffic controllers to guarantee each aircraft’s safety.
Objective 1: always know where the aircraft is – in time and space – and never lose contract. Objective 2: verify the hand-off has occurred and the airplane is safely in the hands of another controller.
He wrote that “technology systems and clear protocols ensure that there is absolutely accountability at all times, without fail.” That same accountability – following someone through the system from when they first call 9-8-8- or walk into a receiving center seeking help until services are delivered – would apply to mental health cases.
When my son, Kevin, had his first break, none of us knew what was happening. He agreed to go see a psychiatrist. That’s doctor’s grim diagnosis – that Kevin had an incurable illness, would always need medication, would most likely be unable to work, would gain weight – etc., plus the stigma associated with having a mental illness – clearly played a role in his refusal to admit that he needed help. It took six years and five hospitalizations for him to accept his illness and take control of its symptoms.
I was ignorant about who to call. If you’ve read my book, CRAZY: A Father’s Search Through America’s Mental Health Madness, you know that I took Kevin to an emergency room when he was in crisis after he’d been diagnosed with Bipolar disorder, only to be sent away because the doctor said Kevin didn’t pose a danger to himself or others. Days later, he broken into a stranger’s unoccupied house and was arrested and charged with two felonies. During another later break, he was twice tasered by police who’d I’d called.
Listening to Covington and reading about CRISIS NOW, I wonder how different Kevin’s fate would have been if I had been able to call 9-8-8, talk to someone who offered us help, and helped Kevin be linked to recovery based services.
CRISIS NOW’s website offers numerous short videos touting the program and kits that you can use in your community to push for its adoption. Take time to visit it. Covington’s company, RI International, also has information about how it has helped implement the air traffic control model in Georgia, New Mexico, Colorado and New York City.
Photo from RI International shows image of crisis care facility it will build in Riverside Ca.
According to Covington, “the mental health urgent care will provide 24/7/365 care including; around-the-clock assessment, psychiatric support, medication management and customized services to adults voluntarily seeking assistance for a mental health crisis. Guests may enter the urgent care at any time of the day or night, or may be referred to the walk-in center by mobile crisis teams or law enforcement for crisis and assessment services. All visits and stays are voluntary, and cannot exceed 24 hours. During their stay, individuals participate in developing their own care plan including options for recovery education, peer-to-peer support, mental health services, nutritional counseling, coordination and referrals to community-based services.”
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