Transcription
Building a CrisisResponse System inNevadaPresentation to the NorthernRegion Behavioral HealthPolicy BoardAugust 5, 20212 pm
PresenterKelly Marschall, MSW President, Social Entrepreneurs, Inc. (SEI) Nevada 988 Planning Coalition ProjectManager Led Nevada TTI Crisis Response Planningand Statewide Virtual Immersion 2020 Project Lead for Crisis Response Asset andGap Mapping and for the Northern Region
National Suicide HotlineDesignation Act of 2020 The Federal Communications Commission hasadopted rules to establish 988 as the new,nationwide, 3-digit phone number for Americans incrisis to connect with suicide prevention andmental health crisis counselors. The rules require all phone service providers todirect all 988 calls to the existing National SuicidePrevention Lifeline by July 16, 2022.Nevada 988 Implementation3
National Suicide HotlineDesignation Act of 2020 Became law October 17, 2020 Requires states to move from a 10 digit number to a 3 digitnumber (988) Enables states to establish a fee or charge for commercialmobile service or IP-voice over service for 988 services (doesnot exclude land lines) If a fee or change is imposed, requires states to establish a fundsequestered to be obligated and expended only in support of988 and crisis services Use of the funds are limited to 988, mobile crisis, and crisisservices.Federal legislation mandating the rollout of the 988behavioral health and suicide crisis number by July 16, 2022Nevada 988 Implementation4
What is 988A 988 crisis line that is effectively resourced and promoted willbe able to: Connect a person in a behavioral health crisis to trained staffwho can address their immediate needs and help connectthem to ongoing care. Reduce healthcare spending with more cost-effective earlyintervention. Reduce use of law enforcement, public health, and othersafety resources. Meet the growing need for crisis intervention. Help end stigma toward those seeking or accessing behavioralhealthcare.988 Implementation5
Implications of 988 NV received a planning grant to implement 988 Implementation Plan Draft is due September 30, 2021 Implementation must account for 8 Core Elements and plan forInteroperability with 911 which has implications for dispatchers asapproximately 10-15% of 911 calls nationally are estimated to becrisis or mental health related The separate fee and fund that was established legislativelythrough SB 390 is capped at no more than .35 per phone lineand funds must go to 988 and to the degree available MCTs andCSUs. They would not and can not supplant existing resourcesor 911 funds 988 is not intended to serve as a public safety resource, ratherto divert non medical, fire, police, and emergency calls that aresuicide or mental health related out of the 911 system and tobehavioral health professionals988 Implementation6
Crisis Response System –National GuidelinesCrisis Center (someone to talk to)Crisis Mobile Team Response (someone to respond)Crisis Receiving and Stabilization Services (somewhereto go)Essential Crisis Principles and Practices (best practices)988 Implementation7
988 is the Foundation for CrisisCare988 Implementation8
National GuidelinesBest practice crisis careincorporates a set ofcore principlesthroughout the entirecrisis service deliverysystem; offeringelements that must besystematically “bakedin” to excellent crisissystems in addition tothe core structuralelements that aredefined as essential formodern crisis systems.Addressing recovery needsSignificant role for peersZero Suicide/Suicide SaferCareTrauma-informed careSafety/Security for staff andpeople in crisisCrisis Response Partnershipswith Law Enforcement,Dispatch and EmergencyMedical Services (EMS).9
Emergency Medical Service988 Implementation10
MPDS P-25988 Implementation11
REMSA P-25988 Implementation12
P-25 Transports988 Implementation13
Houston Case Study988 Implementation14
LA Design988 Implementation15
988 Call Projections988 Implementation16
Roadmap to the Ideal CrisisSystemThe Committee on Psychiatry and theCommunity for Group forAdvancement of Psychiatry (GAP)defines understandable, achievable,and measurable expectations for idealbehavioral health crisis systemperformance, so any community canknow what its crisis system should beand take steps over time to achievethat goal.Nevada 988 Implementation17
8 Core Elements forImplementation Plan1. 24/7 coverage by Lifeline member contact centers for988 calls, chats and texts2. Funding streams to support call centers answering 988calls, chats and texts3. Capacity building for current and projected 988 volumefor calls, texts, chats and follow-up services4. State support of Lifeline’s operational, clinical andperformance standards for centers answering 988(including completion of the Landscape Analysis)Nevada 988 Implementation18
8 Core Elements forImplementation Plan5. Key stakeholders for 988 rollout and gatheringstakeholder feedback as part of the 988implementation coalition6. Systems are in place so that Lifeline member centershave up-to-date local resource and referral listings7. Centers are able to provide follow-up services to 988callers, texters and chatters8. Alignment with national initiatives around publicmessaging and marketing framework for 988Nevada 988 Implementation19
Continuum of Care988 Implementation20
What is a Behavioral Health CrisisSystem? It is more than a single crisis program, such as a mobile crisisteam, a psychiatric emergency service or a crisis residentialunit, and more even than just a few of those distinctelements It is an organized set of structures, processes, and servicesthat are in place to meet all the urgent and emergentbehavioral health crisis needs of a defined population in acommunity, as soon as possible and for as long asnecessary It involves an array or continuum of components, processes,and services managed collaboratively and interlinked It is intended to be distinguished from the routine system ofshort-term or ongoing care, although the two mustnecessarily interact seamlessly for service users and988 Implementationproviders alike.21
Basic Clinical Practice: KeyTakeaways Staff must know how to develop andutilize advance directives and crisisplans. Essential competencies include formalsuicide and violence risk screening andintervention.Nevada 988 Implementation22
Basic Clinical Practice: KeyTakeaways “No force first” is a required standard ofpractice. Risk screening guidelines for medical andsubstance use disorder (SUD)-related issuesmust facilitate rather than inhibit access tobehavioral health crisis care. Utilizing peer support in all crisis settings is apriority.Nevada 988 Implementation23
System Design Guidance for theIdeal System1. Based on specified, agreed-upon values2. Accountable for people and populations3. Have the expectation that systems, populations andindividuals in crisis are complexNevada 988 Implementation24
System Design Guidance for theIdeal System4. Designed to be clinically effective5. Designed to be cost-effective6. Provide values-based involuntary interventions when thereis no other way to prevent harm7. Use shared data for continuous improvement988 Implementation25
Other Federal Efforts andInitiatives Crisis Assistance Helping Out On The Streets (CAHOOTS) Act Help states adopt mobile crisis response teams that can be dispatchedwhen a person is experiencing a behavioral health or substance usedisorder (SUD) crisis instead of immediately involving law enforcement. Provides funding through an enhanced federal match rate for stateMedicaid programs. American Rescue Plan Includes additional funding for block grants for community behavioralhealth services and block grants for prevention and treatment ofsubstance abuse Includes temporary increases for the Medicaid federal medicalassistance percentage (FMAP) 85% FMAP for Mobile Crisis Teams (MCTs)Nevada 988 Implementation26
“What if we treated themental health crisis with asmuch urgency as we treatedthe COVID crisis? What if itwas that big of a deal?”Grant Denton27
Questions and Discussion988 Implementation28
Thank youIf you have questions, please reach out to Kelly Marschall, SEI, atkmarschall@socialent.com988 Implementation29
Nevada 988 Implementation 3. National Suicide Hotline Designation Act of 2020 Became law October 17, 2020 . Crisis Center (someone to talk to) Crisis Mobile Team Response (someone to respond) Crisis Receiving and Stabilization Services (somewhere
