Mental Health & Disability Services
Regional Crisis Services
Mental Health Conference
October 6, 2015
Julie Jetter, DHS, MHDS Jan Heikes, DHS, MHDS Anne Uetz, Polk County Health Services Jennifer Vitko, South Central Behavioral Health Region
Iowa’s MHDS Regions
• 14 Regions (as of 11/1/15)
• Size varies from 1 to 22 counties
• Population ranges from 29,988 to
582,074
(2014 National Census Estimate)• Officially began operations on 7/1/14
Approved MHDS Regions Lyon Osceola Sioux Grundy Dubuque Jackson Mitchell Worth
Dickinson Emmet Winnebago Howard Winneshiek Allamakee O’Brien Clay Palo Alto
Kossuth
Hancock Cerro Gordo Floyd Chickasaw
Woodbury
Plymouth Cherokee Buena Vista Pocahontas Humboldt Franklin Butler Bremer Fayette Clayton
Ida Sac Calhoun
Black Hawk Buchanan Delaware Monona Crawford Carroll Greene Story Marshall Tama Benton Linn Jones
Clinton Harrison Shelby AudubonGuthrie Dallas Polk Poweshiek Iowa Johnson
Cedar Scott Muscatine Pottawattamie Cass Adair Madison Warren * Marion * Mahaska Keokuk Washington
Louisa Mills Montgomery Adams Clarke Lucas Monroe Wapello Jefferson Henry
Des Moines Fremont Page Taylor Ringgold Decatur Wayne AppanooseDavis Van Buren
Lee Boone Wright Hardin Hamilton Webster Jasper Union September 8, 2015
North West Iowa
Care Connection County Social Services
MHDS of East Central Region
Sioux Rivers MHDS Rolling Hills Community Services Southwest Iowa MHDS Heart of Iowa Southern Hills Regional Mental Health County Rural Offices of Social Services South Central Behavioral Health Eastern Iowa MHDS
Southeast Iowa Link
Central Iowa Community Services
*Effective 11/1/2015 the Mid Iowa Region (Marion & Mahaska Counties) will Join regions reflected on this map.
Core Service Domain:
Basic Crisis Response
24 Hour Access to Crisis Response • Definition: Services are available 24
hours a day, 365 days a year providing access to crisis screening and
assessment and linkage to mental health services.
• Access Standard: 24 hours/365 days a year.
Core Service Domain:
Basic Crisis Response
Crisis Evaluation/Assessment
• Definition: Face to face clinical interview to ascertain an individual’s current and previous level of functioning, potential for dangerousness, physical health, and psychiatric and medical condition. The crisis assessment becomes part of the individual’s action plan
Core Service Domain:
Basic Crisis Response
Personal Emergency Response System • Definition: The personal emergency
response system is an electronic device that transmits a signal to a central monitoring station to summon assistance in the event of an emergency.
• Access Standard: first unit of service within 4 weeks of request.
Core Services Domain: Crisis
Services
• Regional Overview
Additional Core Domain:
Comprehensive Facility and
Community-Based Crisis Services
24 Hour Crisis Hotline
• Definition: A crisis line providing information and referral, counseling, crisis service coordination, and linkage to crisis screening and mental health services 24 hours a day
Additional Core Domain:
Comprehensive Facility and
Community-Based Crisis Services
24 Hour Crisis Hotline
• Regional OverviewAdditional Core Domain:
Comprehensive Facility and
Community-Based Crisis Services
Warm Line
• Definition: A telephone line staffed by individuals with lived experience who provide
nonjudgmental, nondirective support to an individual who is experiencing a personal crisis.
Additional Core Domain:
Comprehensive Facility and
Community-Based Crisis Services
Additional Core Domain:
Comprehensive Facility and
Community-Based Crisis Services
Additional Core Domain:
Comprehensive Facility and
Community-Based Crisis Services
23 Hour Crisis Holding and Observation
• Definition: A level of care provided for up to 23hours in a secure and protected, medically staffed, psychiatrically supervised treatment environment
Additional Core Domain:
Comprehensive Facility and
Community-Based Crisis Services
Community Based Crisis Stabilization
• Definition: Short-term services designed to
de-escalate a crisis situation and stabilize
an individual following a mental health
crisis and provided where the individual
lives, works, or recreates.
Additional Core Domain:
Comprehensive Facility and
Community-Based Crisis Services
Residential Crisis Stabilization
• Definition: A short-term alternative living
arrangement designed to de-escalate a
crisis situation and stabilize an individual
following a mental health crisis and is
provided in organization-arranged settings
of no more than 16 beds.
Additional Core Domain:
Comprehensive Facility and
Community-Based Crisis Services
Residential Crisis Stabilization
• Regional Overview
Mobile Crisis Response
Team
Developing Polk County’s Model
• Convene work group
– Police from city, suburbs, & county sheriff – Mental health providers
– Mental health consumers, family members, advocates
– County manager – State Representative
– PCHS staff and board members – National Alliance for Mental Illness staff • Facilitated by Technical Assistance
Collaborative (TAC)
Developing Polk County’s Model,
Cont’d…
• System has to be…
– Responsive – ½ hour response time or less, ability to access information quickly (are they in the county mental health system)
– Have defined protocols – rules that define when mobile crisis is appropriate – Have a point of referral – will calls come
from the police, will there be a “hot line”, direct access to the community, etc.
Polk County’s MCRT
• Responsibility of MCRT – Mental health assessments
– On-site counseling and problem solving – Crisis plan development
– Coordinate hospitalizations
– Provide medication in consultation with psychiatric consultant
– Arrange/provide temporary respite services as needed
Polk County’s MCRT, Cont’d…
• Care Coordination
Polk County’s MCRT, Cont’d…
MCRT Cost Avoidance
July 2014 – June 2015
– 850 people treated in field would have cost
• $2.4 million if taken to jail
• $850,000 if taken to Emergency Room • $3.4 million if taken to hospital
– 509 taken to hospital for treatment would have cost $1.4 million if taken to jail
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• Becoming the ‘experts’ in many areas that are not typically considered a mental health issue • Providing education to medical providers on how
to respond to patients who present in crisis • Officer’s increased awareness and ability to
interact well with individuals who has a mental illness
• The lack of linkage to services and the need for greater access to mental health treatment
Lessons Learned
Crisis Observation Center
• November 2010: visited Bexar County, Texas • April and August 2011: held Community
Conversations
• November 2011- March 2012: held 3 Stakeholder Meeting
• March 2012 to late fall 2013: Waited • Very late fall 2013: Identify site • January 2014: Begin Weekly Meetings
Developing the Crisis
Observation Center
• February 2014: Site Visit to Bexar County
• April 2014: Site visit
• April 2014: Begin workflow and service
design
• May 2014: Begin remodeling site
• June 2014 Begin hiring and training staff
• Open July 2014
Developing the Crisis
Observation Center
• Mental health crisis assessment
• Observation
• Crisis therapy
• Crisis planning/begin WRAP
• Telemedicine
• Substance abuse assessment
• Discharge planning
• Follow along warm hand-off
• Four key pieces
– How did people get there – How long did they stay – Where did they go to
– Where would the person have gone
Data Collection-Regional System
Crisis Observation Center Cost
Avoidance
July 2014 - June 2015
– 363 people treated at COC would have cost • $363,000 if an Emergency Room Visit • $1.4 million if admitted to the hospital – 24 brought by police
• $68,640 if taken to jail
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• Fewer issue with substance use disorders
• People with children at home
• Missing person in another state
• Rightsizing expectations
• Partners
Lessons Learned
Crisis Stabilization Center
• November 2010: visited Bexar County, Texas
Developing the Crisis
Stabilization Center
• February 2014: Site Visit to Bexar County
Developing the Crisis
Stabilization Center
• Crisis stabilization – Treatment focus
• Intensive outpatient format is the vision
• Current group work with emphasis on
WRAP
• Connectivity as needed
Service
• 9 Beds available
• Served 45 people
• Average 56 days
• Referred from: All 45 from Crisis
Observation
• 74% were on the streets or homeless
• Collecting LOCUS Scores at admission
and discharge
People Served
September 15 through July 30
• 95% are in stable housing
• 95% are stable with their medications
• 95% are active in therapy
• 89% are involved in Integrated Health
Homes or Service Coordination
In September 2015, follow up calls
were made to those who have been
discharged
• First 48-72 hours is rest to get better
engagement
• Over train on boundaries
• First come, first served policy
• Evening relaxation group
• Educate on community resources
Lessons Learned
South Central Behavioral Health
Region
Wapello
Appanoose Davis Mahaska
Crisis Mental Health
Bridging the Gap in a rural CommunityWho are we?
The Appanoose County Mental Health Coalition
• South Central Behavioral Health Region/Appanoose-Davis-Wapello Counties
• Mercy Medical Center
• Appanoose County & Centerville Law Enforcement • Centerville Community Betterment
• 8thDistrict Court
• Community Health Centers of Southern Iowa
Purpose
To improve mental health access in Appanoose, Davis and Wapello Counties through the cooperative efforts of local providers to intervene with existing resources, providing the appropriate crisis stabilization and ensure follow up mental health care and treatment.
The Need
• Appanoose Community Health Needs Assessment ranked mental health as the #1 community health issue.
• The coalition came together to talk about the problems taking care of mentally ill in the county. • Fractured system - frustrations for all involved.
building understanding of how the process affects each of those involved.
• Identified that no crisis intervention resources locally, waiting list for therapy appointments, with no option but committal
South Central Behavioral Health Region – Appanoose, Davis & Wapello Counties • Providing payment for the licensed social workers on call as well as providing payment for ER and hospital services when utilized. • Developed an Emergency Prescreening
option now offered to families who access the courts – an alternative to committal. There is an option for the loved one to see a therapist within 24 hours.
• Providing seed funding for crisis stabilization house
Grant Funding
July 1, 2014
Stabilization House
• Identify and address immediate needs – food, clothing, shelter, sleep, etc.)
• Intervention by therapist – medication management, therapy
• Develop care plan
• Referral to other services as needed.
• Evidence Based Practices (The WRAP program)
Therapists
• Participating in a call schedule utilized by law enforcement, county, court and hospital. • Providing assessments, assisting with
placement of patient when a bed is needed. • Making referrals to each other’s
organizations when needed.
• Providing individual follow up treatment with patients.
• Opened up an appointment daily for crisis assessment if needed.
Impact Since July 1, 2013
• 123 pre-screens completed 90 seen in the ER • 33 diverted from the ER
19 seen at the jail
14 seen in office or other setting • 26 referred to Inpatient
• 44 voluntary admission to Oak Place • 48 received community services
0 10 20 30 40 50 60 CY 2012 CY 2013 CY 2014 CY215
Mental Health Committals
Cost Savings
CY 2013 CY 2014 Inpatient $714,000.00 $204,000.00 Law Transfers 19,250.00 10,250.00 Court Cost 42,848.00 12,240.00 ER Committal 30,800.00 25,176.00 Pre-screenings 0.00 36,900.00 Stabilization House 0.00 360,000.00Model for the State
• Initiative is being viewed as a rural model for the state of Iowa that can be replicated.
• Design a model that utilizes local resources and fits the needs of the individual location.
• Demonstrate that investment in intervention: - More effective
- Less Costly
- Less restrictive alternative
• Mental health crisis resolved through support and care coordination rather than intensive medical interventions.