Crisis Mobile Erica Chestnut-Ramirez, EMPACT-SPC Nick Margiotta, - - PowerPoint PPT Presentation

Crisis Mobile

Erica Chestnut-Ramirez, EMPACT-SPC Nick Margiotta, Crisis System Solutions

Prevention/Outpatient Telephonic Mobile Crisis Facility ED & Inpatient

Ho How Mobile Crisis Fits w Mobile Crisis Fits in the in the “Crisis No “Crisis Now” Model w” Model

Key “Precepts” y “Precepts”

 Ideal precepts of a mobile team – how to get there can differ

 Community Based-not hospital  Stabilization vs. assessment  24/7 “Quick” Response  2 Person Responses  ED/Jail Diversion are key to key program and fiscal goals  Centrally Deployed “ATC” Model  Majority of responses do not require a law-enforcement response

What Does a Mobile Crisis T What Does a Mobile Crisis Team “Do” am “Do”

 Provide Crisis Assessment, including a comprehensive

Risk Assessment

 Crisis Intervention and de-escalation  Safety plan with family/friends/supports involved;  Arrange for HLOC if necessary (Detox, Crisis Facility)  Transport When Necessary & Appropriate rather than

using law-enforcement

 Set up follow up services; coordinate care for individual;  Emergent petition/Non-emergent petition process

“Goals” “Goals”

 Community stabilization

 Individuals tend do better in their natural environment: builds confidence for

future crisis  Reduce Costs:

 Prevent over-use and misuse of emergency departments, psychiatric

hospitalizations, and unnecessary law enforcement involvement  Reduce trauma  Facilitate referrals  Removes barriers to seeking mental health crisis care  Collaboration with key partners (in the community at

key intercept points)

“Pr “Process”

• cess”

 Respond via central dispatch, that does initial safety

triage and coordination

 Can respond without L.E. to DTS, STO, etc. based on certain parameters

 Two-Person Responses…several variations i.e.

 Masters Level Clinician and Bachelors/BHT staff  Two BHT Staff  Peer Staff Partnered with other BH Staff

 On-Scene Assessment & Risk Considerations

 Typically MT requests a L.E. Response less than 5% of all responses  If police already on-scene, focus is on releasing L.E. from scene as soon as

possible.  Level-of Care Determination & Transport  Coordination and Referrals

Wh Why Collaboration is y Collaboration is Im Impor portant ant

 Law Enforcement is often first to encounter individuals with

mental health issues.

 Can be Nexus to BH System & Treatment

 Does behavioral health really want individuals with mental

health/substance abuse issues in the criminal justice system?

 Help Achieve BH System Goals

 Reduce Suicide  Improved Client Outcomes  Efficiency

 Reconnections & Recovery Opportunities  Early Intercepts are key to healthy communities, reducing suicide,

reducing use jail, ER, crime, etc.

La Law-Enf Enforcement “Considerations” ement “Considerations”

 Accessible and expedient hand offs to mobile crisis



Quick and Certain Response Times



“We got this” attitude



Get Officers of-scene as soon as possible

 Behavioral health only calling PD when safety concern exist

 Builds trust between law enforcement and behavioral health  Reduces belief about “dumping” 

Individuals in Crisis may be escalated by PD presence; mobile team looks like 2 people coming to visit in an unmarked mini van

 Law-Enforcement Requested Mobile Teams

 I.e. 3,000 Times a

• Year. Of the 18,000 MT Responses, less than 1,800 required any

Police Response).

 Vast majority Stabilized in their Community, only about 15% Transported to

Psychiatric/Substance Community Based Receiving Center by Mobile Team.

 Less than 3% Transported to Med/Surge E.D.

DRAFT

• No. of PD Calls by Purpose

23 9 4 2 15 8 1 5 1 9 9 2 1 1 5 3 60 1 8 1 8 121 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 10 10 1 10 2 10 3 10 4 10 5 10 6 10 7 10 8 10 9 11 11 1 11 2 11 3 11 4 11 5 11 6 11 7 11 8 11 9 12 12 1 12 2 12 3 12 4 12 5 12 6 12 7 12 8 12 9 13 Aggressive/Assaultive Behavior Anxiety/Panic Attack Bereavement/Grief Coordination of Care-Follow up Coordination of Care-General Depression Economic Problems-Chronic Elder Issues Faxed Transport Request Homicidal Housing Problems Legal Medical Medication Parent-Child Relational Partner-Relational Psychotic Symptoms PTSD Self Harm Behavior Social Substance Abuse Suicidal

 20,000 Crisis Calls a Month

• Less than 10% result in Crisis Mobile Dispatch
• Less than 1% result in a Police Response Requested

 1,600 Mobile Team Responses a Month

• Less than 10% of Mobile Team Responses required a Police

Response

• Roughly 75% Of all Mobile Team Responses Stabilize

individuals in their “Community”

• Of those that needed a HLOC, less than 3% transported to

Med/Surge E.D. (i.e. minimal use of Ambo)

 Crisis Observation Admissions

• Approximately 70‐80% Stabilized and Discharged to

Community

 Involuntary Admissions

• About 70% do not “complete” the involuntary process (i.e.

community stabilized, convert to voluntary, other levels of care, etc.)

Prevention/Outpatient Telephonic Mobile Crisis Facility ED & Inpatient

Examples

Im Implementation & “Lessons Learned” plementation & “Lessons Learned”

 Staffing:

 Outpatient “perspective”  Shift-Work/Work Force  Funder Expectations  Perceptions:

• Has “schizophrenia”, don’t go alone, keep cops on, etc
• Nights are scary

 Core measures…response time, time to release,

community stabilization, etc.

 Roles of Peers

Im Implementation & “Lessons Learned” plementation & “Lessons Learned”

 Rural Considerations  Different culture & Language barriers  L.E. More likely to use Crisis System when easy to

navigate and faith that service will be fast and reliable

 MT responds quickly  Not a lot of “U.M.” or Triage  Get officers off-scene early as possible

Questions????? Questions?????