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Why and How States and Local Communities are Focused on Funding Dedicated Behavioral Health Crisis Centers
In 2022, $2.6 billion was pumped into behavioral health tech companies looking to solve the nation’s mental health crisis. Thanks to legislation and organizations innovating in the space, the use of teletherapy has significantly increased since the start of the COVID-19 pandemic. Digital solutions have been a huge win for allowing more individuals in need to have access mental healthcare at their fingertips.
But what happens when a person has an emergency mental health crisis that can’t be solved virtually? Where can they go to get immediate in-person care and treatment? Who is helping fund these efforts to help ensure individuals with an acute need get care ASAP? The answer: It depends and often varies.
In-Person Options: Emergency Department or Jail
For years, individuals have either sought care for acute behavioral health conditions at a local emergency room or, if a first responder team is dispatched, individuals could be taken to jail. The reality is that both places are not equipped to treat and stabilize the behavioral health emergency, and individuals in need are often left to board in the emergency department until a bed at a local psychiatric hospital becomes available or taken to jail until they can be released. Neither is an effective outcome and oftentimes exacerbates the behavioral health crisis.
According to a RAND Corporation study from 2022 during the launch of the 988 Suicide and Crisis Lifeline, only 28% of survey respondents stated their agency’s jurisdiction had access to a mental health urgent care; only 19% said they had sufficient psychiatric emergency bed capacity. The good news: Significant progress is being made across the country to give individuals in need a safe and treatment-oriented place to go.
Community-Based Crisis Response Centers
With the implementation of 988 funding for mental health services, it is up to states to determine how to permanently fund required crisis services, including crisis stabilization or response centers.
Services provided by a Crisis Response Center (CRC) can vary from state to state or even county to county. Connections Health Solutions defines a CRC as a dedicated facility providing 24/7/365 behavioral health crisis care, that accepts—and never turns away—individuals in need. The facility must accept 100% of police and first responder drop-offs and include a 24/7 urgent care and a 23-hour psychiatric emergency observation unit. In the simplest healthcare terms, a CRC is a Level 1 behavioral health trauma center.
With strong momentum to fund CRCs in local communities, stakeholders are taking matters into their own hands and getting creative with how they are ensuring individuals physically have a place to go when they are in need. With more than 20 states introducing legislation to fund, license, or pilot crisis stabilization models, 2 states in particular have taken interesting paths to improve access and ensure individuals in need have a place to go.
Ohio: Data and a Start-by-Listening Approach
Ohio recently published its Behavioral Health Crisis System 2023 Landscape Analysis, a landmark assessment of the state’s crisis service infrastructure designed to stimulate conversation elevating Ohio’s behavioral health system of care and developing the system that was never fully built.
State leaders are asking all stakeholders to consider how their organization fits into the full crisis continuum, as everyone plays a role in the support of people and families experiencing a crisis by providing direct/indirect care or developing access roads to care. The Ohio Department of Mental Health and Addiction Services will conduct listening sessions following the release of this report. The Ohio Crisis Task Force, comprised of members representing various state departments, Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Boards, provider agencies, foundations, centers of excellence, peer and advocacy organizations, payers, and stakeholder groups from around the state will lead the development of a statewide strategic implementation of SAMHSA’s Roadmap to the Ideal Crisis System.
In December 2022, Governor Mike DeWine and the Ohio state legislature approved a spending package that included $90 million in appropriations to expand the state’s crisis infrastructure, which includes stabilization units, short-term crisis residential services, hospital diversion and step-down centers, mobile crisis response, and behavioral health urgent care centers.
Washington: State and Local Approach to Create “No Wrong Door” Facilities
In April 2023, the Washington state legislature passed SB 5120 “Establishing 23-hour crisis relief centers in Washington state.” The bill creates an alternative to emergency rooms and jails for people with behavioral health needs by establishing a system for certified crisis relief centers. This new type of crisis diversion facility can provide short-term help to patients regardless of behavioral health acuity. Currently, behavioral health facilities require a cumbersome medical clearance before accepting someone in crisis, resulting in first responders taking individuals in need to emergency rooms or jails instead.
SB 5120 was sponsored by state Sen. Manka Dhingra and establishes a “no-wrong-door” framework, meaning that people in mental health and substance use crises will not be turned away. In these centers, people can get short-term care and make connections to longer-term services that can help them re-acclimate to a stable lifestyle. It also directs the Department of Health to create rules for licensure or certification for 24-hour, 7-days-a-week community-based facilities that offer access to mental health and substance use care for patients.
Also in April 2023, Washington’s King County voters approved a Crisis Care Centers levy with 57% support. The initiative is Executive Dow Constantine’s proposal to create a countywide network of 5 crisis care centers, restore and expand residential treatment beds, and grow the community behavioral health workforce.
Building upon the unanimous support of the King County Council and city leaders from across the region, voters’ approval of the levy’s generational investment in places for people in crisis to go will create more capacity in hospitals and generate therapeutic alternatives to jail. The Crisis Care Centers levy will begin collections in 2024 and is the most significant local investment in behavioral health facilities in county history.
The levy will generate more than $1.2 billion over 9 years and will cost the median King County property owner an estimated $119 per year.
Connections Health Solutions will open a multi-service behavioral health crisis response center in King County, Washington. The center will provide a spectrum of care services, from walk-in behavioral health urgent care to continued stabilization, to individuals experiencing all types of behavioral health or substance use crises.
All Roads Lead to Improving Access
While 2 states have been highlighted for their chosen path to improving access for those in need of a safe, treatment-oriented place to go while in crisis, there is no right or wrong approach. State and county officials are working with key stakeholders across party lines to create and sustainably fund a crisis system that meets the needs of their community. Regardless of the path taken, improving immediate access to a dedicated and safe place for individuals in crisis to go is a win for everyone.
Matt Miller is chief growth and development officer for Connections Health Solutions. Chris Santarsiero is the organization’s vice president of government affairs.
The views expressed in Perspectives are solely those of the authors and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
References
State of Digital Health. CB Insights; 2022.
Crisis Systems Landscape Analysis. Ohio Mental Health & Addiction Services; 2023.
