“Groundbreaking” Report Shows Steps To Create An Ideal Crisis Care System In YOUR Community

(4-20-21)

In most American communities today, the behavioral health crisis system isn’t really a system at all, but a combination of services provided by law enforcement and hospital emergency rooms that are typically not designed to meet the needs of individuals in the midst of behavioral health crises,

So begins Roadmap To The Ideal Crisis System, a much-anticipated, recently released report written to provide advocates, local leaders, and your community with a step-by-step blueprint that shows how to create an “ideal system.”

The 208 page report – yep its thorough – leaves no aspect of crisis care uncovered. It was spurred, in part, by Miami Dade Judge Steven Leifman’s request for a practical guide that communities could use that would explain what an ideal system looks like and how to go about implementing one.

That was a daunting challenge.

The timing of the report is important because in 2022, the nation is scheduled to replace its national suicide hotline number with a much broader crisis hotline number – 9-8-8. In anticipation of the 9-8-8 switch, the report’s authors are urging communities to review what services are currently available and begin implementing its recommendations for forging an “ideal” system.

The report explains how 9-8-8 hubs can be used as an entryway into services where callers are triaged by specially trained experts capable of connecting them to crisis care services best suited for their individual needs – whether the caller is experiencing suicidal thoughts or is having a mental health or drug crisis.

Called “groundbreaking” by the National Council for Behavioral Health, the report spells out how “to design and implement a mental health crisis system and demonstrates how a community’s response must be fully integrated with the treatment system.” Read the full report or read the executive summary.” The council, which represents mental health providers and is pushing the report’s recommendations, states:

The comprehensive new report attempts to address every point in the continuum of crisis services. And because it is the first report of its kind, this blueprint will serve a vital role for any community that is planning its crisis system. With 9-8-8 fast approaching, it’s time to begin the work to plan, design and implement that system of care so the resources are in place when people call for help.

To help politicians, advocates, and legislators, the report includes a Report Card for grading your community. A section of the report also lists its recommendations for reducing reliance on police as first responders during mental health and drug crises.

The report is divided into three sections. Robust community services require robust financing, which is why the report includes a section about how to finance and make your community system accountable. The other sections explain what sort of basic crisis services need to be available in every community and what basic clinical responses and resources need to be in place.

The framework for designing an ideal crisis system for any community begins with the aspirational vision: Every person gets the right response, in the right place, every time. Therefore, the design process must begin by putting the customers in the center of the framework and articulating a set of principles and values that guide every aspect of their experience.

The next challenge is to identify the “right response” to delineate the best practice (evidence-based and experience based) crisis intervention services that individuals, families, collateral caregivers and first responders (the customers) are provided and to align those best practices with these customer-oriented principles and values.

Next, it is important to identify the “right place” to delineate a comprehensive continuum of crisis capacities and components that match the diverse crisis needs and presentations of the population.

Finally, it is important to have a system that responds to everyone, rather than a disconnected set of components or different responses for different populations. This requires a mechanism for system design and oversight, including adequate financing, performance monitoring and quality improvement to ensure that the “right response” is provided in the “right place, every time.” This process of oversight requires delineation of measurable criteria for each element of the system, as well as an implementation process that is governed by best practices of system performance management and continuous quality improvement.

The report cites successful examples, such as how a 9-8-8- central hub number can improve services:

The crisis hub is the virtual center of a functional crisis system. This is the command and control center that keeps all the other components functioning collaboratively and effectively. A crisis hub example is Common Ground in Oakland County, Michigan, which incorporates a call center with triage and dispatch, suicide prevention hotline, “air traffic control” care coordination, 24-hour behavioral health urgent care, secure police drop-off with 23-hour observation and intervention, medical/nursing intensive residential crisis services, sobering support unit and intensive crisis intervention follow-up. This program serves all ages, has been operating for nearly two decades and continues to grow and expand. It has demonstrated significant impact for both public and private payers in reducing hospitalization rates.

The report and its recommendations were written by the Committee on Psychiatry and the Community for the Group for the Advancement of Psychiatry.  Dr. Kenneth Minkoff, who serves with me on a federal panel that advises Congress, was co-chair along with Dr. Jacqueline Maus Feldman.

Forwards to the report were written from different perspectives. Judge Leifman provided the judicial view. Heather Rae, President and CEO of Common Ground, Pontiac, Michigan, offered the providers’ perspective. Ron L. Bruno, Executive Director of CIT International and who also serves on the federal panel advising Congress, writes from a law enforcement view and Keris Jan Myrick, chief of peer services and allied health professions at the Los Angeles Mental Health Department, offers the perspective of those with lived experience.

Because this report is so comprehensive, it’s not a quick read. That’s not surprising because of all the wrongs it hopes to correct. But I am grateful to Judge Leifman, Dr. Minkoff, and the reports’ other authors for taking on such a huge challenge and providing us with a guide to follow to create the “ideal” system in our nation.

The next step in implementing it should be for President Joe Biden and the White House to recommend Judge Leifman as the next Assistant Secretary for Mental Health and Substance Abuse and put him in charge of SAMHSA.