Crisis Response Center Starts Mental Health Treatment Early, Successfully Partners With Community

In part 2 of this video, Margaret (Margie) E. Balfour, MD, PhD, and Sergeant Jason Winsky, BA, continue to discuss how collaborative approaches to responding to behavioral health emergencies and starting treatment immediately can lead to patient and community success. In this video, Dr Balfour who is the chief of quality and clinical innovation at Connections Health Solutions in Tucson, Arizona, and Sgt Winsky, the supervisor of the Tucson Police Department’s Mental Health Support Team, discuss:

• The processes that occur at the Tucson, Arizona, Crisis Response Center (CRC) once a patient is being treated
• The successful patient-centered processes at the Crisis Response Center
• The community impact of the collaboration between the CRC and law enforcement
• The importance of aligning clinical and financial incentives

In the upcoming 3 of this series, they will discuss tips for family members and clinicians during a mental health crisis, and the upcoming 988 hotline launching in July, 2022.

Dr Balfour and Sgt Winsky recently published a paper titled, “Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies” that reviews best practices for law enforcement responding to mental health crises, strategies for collaboration, policy considerations, and more.

>>Catch up on Part 1: Tips From Program's Successful Collaboration With Law Enforcement During Mental Health Crises

>>Watch Part 3: New 988 Mental Health Crisis Response Hotline Highlighted Need for Standardization

>>Also Related: New 3-Digit Crisis Hotline Will Connect Callers With Mental Health Professionals

Read the transcript:

Dr Margie Balfour: As far as what happens at the Crisis Response Center, we have both services for adults and kids. We see about 12,000 adults in a year and about 2400 kids from 0 to 17. There's a couple different levels of care for both.

There is a 24/7 walk‑in urgent care where people can come in and see a social worker, a health care provider, psychiatrist, and nurse practitioner if needed. If they're new to town and need to be connected to services or need a medication refill, they can get their needs met within an hour or 2, and then go on about their business.

The heart of the operation is our 24‑hour observation unit. This is designed for the people who would otherwise be boarding, waiting in emergency rooms for hours or days to transfer to an inpatient hospital somewhere.

Our philosophy is that a lot of those folks don't need to go to the hospital if you can get the treatment that they need started early, and if you take an interdisciplinary approach and are really aggressively trying, they can get the community‑based care that they need.

We are staffed 24/7 by a psychiatric provider, either psychiatrists, nurse practitioners, PAs, nurses, or peer supports—people with their own lived experience with mental health challenges—, social workers, or behavioral health techs. We take an interdisciplinary approach where we want to start treatment as early as possible.

We measure our door‑to‑doctor time and try to keep that around 90 minutes so that treatment can start early, whether that's medications or other interventions. We can start medication‑assisted treatment for people with opiate dependence. We can do medically supervised detox for people who have alcohol dependence or other substance‑use needs.

Our social services staff and our peers are neatly on the phone with the person's family, their clinics trying to figure out what's going on with this person. Who's their clinic? Who's responsible for their care? How can we get what they need arranged for them in the community? We have this, it's a cognitive shift.

We don't ever say, "Oh, you're really sick. We're going to put you on the list to transfer you out to a psychiatric hospital somewhere." We always start with, "OK, we're going to get you onto our observation unit, and then we're going to figure out the things that we need to get your crisis resolved." We're going to assume that we can resolve it and work to do that.

Sometime within that 23 hours, we reassess them and see how they're doing. If they've gotten better, then we start to arrange them to have the outpatient care that they need after the crisis, whether that's any of the following: We have a post‑crisis transition clinic in our Phoenix facility that we are bringing down to Tucson. There are other facilities in town such as the Crisis Residential for step‑down, outpatient care, substance‑use care, whatever it is that they need.

About 60% to 70% of the people who come through the Crisis Response Center end up being able to go home or to community‑based care, instead of having to go to the hospital.

Sergeant Jason Winsky:  When we talk about doing training in crisis response in the community, one thing I wanted to mention as well is that we do Mental Health First Aid Training also for the community.

We partner with our Regional Behavioral Health Authority here in Tucson, which is an organization called Arizona Complete Health. They help sponsor that training and provide instructors as well.

We go out into the community and find Circle K employees, church organizations, neighborhood associations, people working with youth, people in the education system, and we help train them so that when the first responder comes to the scene, whether it's police, fire, EMS, in some cases, the community member themselves is Mental Health First Aid trained as well.

It's great to hear Dr Balfour talk about this continuum.

Just because we have this crisis center that functions really well here, as she described, doesn't mean that everyone needs to go there for every crisis. The idea is to stabilize the community whenever we can.

The result here for the community is actually really positive. If a person needs to go to the hospital, we have that on‑demand, no‑wrong‑door option. Also, if there's an opportunity for the person to be able to be stabilized in the community and to offer resources where they are, schedule appointments, do enrollments in the community, we have that option as well.

Dr Balfour: We meet regularly. People sometimes ask, "How do you maintain such a good relationship with the police?" We meet once a month, at least. We go over any outlier cases, any plans, although there's not many of those lately. We also look at our trends and see, "Are we getting more of police drop‑offs that came from a certain school or a certain hospital?"

We also have some programs where we look at our frequent visitors. We call them “familiar faces.” We look to see, "Why are they coming? Why do they have so many visits coming to the Crisis Response Center?" We work really closely with our Regional Behavioral Health Authority which oversees all of the crises. We all contract with them to provide the crisis continuum.

We look to see, "These are people who are not getting their needs met in the community. Why is that? Do other services need to be put in place to prevent these?"

There's also examples of improvements that have been made, from looking at our data that way, are things like targeting certain schools that we're having a lot of 911 calls, so the mobile teams go out to those schools instead, or that some in‑school services get beefed up in those particular schools to target them.

We're always looking at ways to improve the community systems so that we're preventing people from going into these more restrictive levels of care. What is nice about the crisis system is that the clinical incentives and the financial incentives are really closely aligned. People always ask, "How do you pay for this?"

The clinical incentives and the financial incentives are closely aligned, meaning that what I want as a psychiatrist is I want my patients to not be in emergency rooms languishing, waiting to be transferred to some psych hospital somewhere. I want them not to be in jail. I want them not to be locked up in an inpatient hospital against their will if they don't need to be.

If you're paying for stuff, you want those same things too because it's a lot less expensive to be doing well in community‑based care than it is to be locked up in jail or in emergency rooms in hospitals.

Over the years, there's been quite an investment in crisis services because it's a great example of how investing in the right kind of care creates the outcomes that are the ones that everybody wants.