Crisis Now, Transforming Crisis Services

Program Description

Inspired by innovations in the Arizona Crisis System and after reviewing approaches to crisis care across the United States, the Crisis Services Task Force of the National Action Alliance for Suicide Prevention (Action Alliance) believes now is the time for crisis care to change. The Task Force, established to advance objective 8.2 of the National Strategy for Suicide Prevention (NSSP), comprises many experts, including leaders who have built and operate many of the most acclaimed crisis programs in the nation. Our comprehensive review finds that now is the time for crisis services to expand because of a confluence of factors and forces, including: •Crisis care often being the preferred and most efficient care for people in crisis •The absence of core elements of successful crisis care in many communities •Mental health reform proposals that are on the table but fail to seize the opportunity to improve crisis care •Mental health parity legislation and coverage expansion The Crisis Now system framework provides a comprehensive assessment tool, crisis system framework and business case for providers and funders. This system will allow for continuity in crisis systems across the Nation.

Creativity

The Crisis Now process brought together over 35 provider agencies, Health Plans, Law Enforcement entities and government organizations to design the most comprehensive crisis framework in the U.S.. This team brought together practices and innovations from 14 different State crisis systems to create a model that addresses the needs of providers, funders and first responders. In response, Arizona’s State Medicaid leader worked with members of the Crisis Now task force to develop a comprehensive crisis score card. This score card allow providers, funders and State leaders to measure their crisis systems to determine how close they are to the crisis now frame work. This innovation gives providers and funders common crisis system goals that will help dramatically improve care while dramatically reducing cost. The idea of combining the best practices of crisis systems across the Nation into a comprehensive model is the first of it’s kind in behavioral health.

Leadership

The Crisis Now framework has been designed in concert with national leaders in the crisis field. These leaders participated in a task force that studied elements of successful programs from across the nation and reviewed their effectiveness. The task force found that very few communities had a full crisis continuum. Many of the communities crisis systems were inadequate at best. The Crisis Now framework gives completely free access to the Crisis Now white paper through the Suicide Prevention Resource Center online at SPRC.org. Leaders can utilize the model and framework at no charge. In addition, Task force leaders are presenting on the Crisis Now model in such venues as the American Association of Suicidology’s annual conference, the National Association of State Mental Health Directors 2017 conference and live Webinar. The crisis now model is scheduled to be presented on at the 2018 International Institute for Mental Health Leadership in Sweden.

Sustainability

The Crisis Now, crisis framework is designed to continue to innovate. Interested parties include the International Initiative for Mental Health Leadership, SAMHSA, National Action Alliance for Suicide Prevention, Optum, Cenpatico, Mercy Care Plan. The model’s three components include; 1) mobile crisis teams that respond directly to calls in the community including law enforcement. 2) high tech “Air Traffic Control” crisis call center hubs that connect services and ensure timely access to services and data. 3) Crisis receiving centers that accept direct referrals from law enforcement returning them to the community within 5-7 minutes. This model saved Maricopa County AZ with a population of 4 million. The equivalent of 37 FTE police officers, a reduction of 45 cumulative years of Psychiatric Boarding, reduced hospital costs of 37 million and a reduced potential State acute care inpatient expense of 260 Million. The model’s savings makes it sustainable and the reason funders express interest.

Replicability

The Crisis Now document and framework will be published online at no charge to anyone interested at crisisnow.org. The program can be duplicated and replicated to meet any urban, rural or frontier population where psychiatric boarding and high inpatient hospitalizations are problematic. The program is currently being replicated in major urban markets such as Phoenix Arizona and Atlanta Georgia, medium markets such as Tucson Arizona and Palm Springs California and rural markets such as Ellendale Delaware and Henderson North Carolina. Partner members of the crisis now task force are available to consult on the model. These consultants are experts in the crisis now model and will provide guidance to States, Counties, Health Plans and Direct Service providers who want to replicate and implement the Crisis Now model in their communities.

Results/Outcomes

The Crisis Now framework is inspired by innovations in the 4-million-person community of Maricopa County (Phoenix, Arizona). Maricopa County scores a 4.5 / 5 on the Crisis Now assessment. : • Reduced average time of contact by police with people in a mental health crisis from an average of 3 hours to an average of 45 – 60 minutes. This means the equivalent of 37 FTE officers are available for other public safety needs. • Decreased psychiatric boarding in emergency rooms by a cumulative 45 years, creating a savings to hospitals of $37 million in avoided costs/losses. • Reduced potential state acute care inpatient expenses by $260 million The Crisis Now framework represents the net savings of a $100 million investment in a full, integrated crisis continuum while improving utilization and access to care. Crisis Now influenced the latest Interdepartmental Serious Mental Illness Coordinating Committee’s (ISMICC) report to SAMSHA.