Behavioral Health Crisis Response
The Alaska Mental Health Trust Authority (the Trust), the Department of Health and Social Services (DHSS) and other partners are evaluating the existing crisis system of care to identify models that demonstrate improved outcomes for those in behavioral health crisis.
Alaska primarily relies upon law enforcement, EMS, and hospital emergency rooms to serve people in behavioral health crisis. Law enforcement and EMS officers respond to a wide range of issues, including homelessness and behavioral health crisis, in addition to crime, accidents and fire. Responding to behavioral health crises is largely outside of their scope and training. Most Alaska communities do not have the appropriate facilities and services where officers can take people to receive appropriate care.
Law enforcement and EMS response sometimes results in negative outcomes for the person experiencing the crisis, unnecessary violence, or additional trauma. It also diverts public safety resources away from crime prevention and other law enforcement activities. Public safety engagement in behavioral health emergencies further stigmatizes and criminalizes mental illness and addiction.
Alongside DHSS and other community partners, the Trust has been working to plan for and implement the Crisis Now model in Anchorage, the Mat-Su, and Fairbanks. The Crisis Now model is a continuum of three components that are working in many communities to prevent suicide, reduce wait times in emergency rooms and correctional settings, and to provide the best supports for individuals in crisis. The components of the Crisis Now model include:
- A regional or statewide crisis call center that coordinates in real time with the other components;
- Centrally deployed, 24/7 mobile crisis teams (ideally, a clinician and a peer) to respond in-person to individuals in crisis;
- 23-hour and short-term stabilization, which may be operated separately or jointly, offering a safe, supportive and appropriate behavioral health crisis placement for those who cannot be stabilized by call center clinicians or mobile crisis team response.
The Trust led a stakeholder outreach effort in Anchorage, Fairbanks, and the Mat-Su, along with contractor RI International (RI), an operator and consultant on the Crisis Now framework, to recommend how services could be implemented in Alaska. In late 2019, the Trust led a site visit to Maricopa County, Arizona, with Trust leadership, DHSS representatives, and other key partners during which attendees toured the community’s Crisis Now services.
RI International drafted a report that identifies gaps in existing services, projected demand, feasibility and costs associated with implementation, and made recommendations for policy and regulatory changes to support the Crisis Now components in the three identified communities and statewide.
This report builds from two studies of Alaska’s acute behavioral health system initiated by the Trust (links below in Resources section).
- The Alaska State Hospital and Nursing Home Association’s (ASHNHA) Acute Behavioral Health Improvement Project examined the issue of psychiatric boarding in hospital emergency departments.
- The Division of Behavioral Health’s Forensic Psychiatric Hospital Feasibility Study examined the backlog in competency to stand trial evaluations and restoration in the forensic psychiatric system.
These reports highlighted challenges in access to behavioral health care through civil and forensic access points, indicating the need for a different approach to care for people in crisis, and the need to divert individuals in behavioral health crisis from inappropriate care settings (medical emergency departments and jail, respectively).
Stakeholders participating in the ASHNHA project reiterated that improving behavioral health care in emergency departments requires investment across the continuum of care, and that access to psychiatrists and appropriate discharge are vital.
The Forensic Psychiatric Hospital Feasibility Study recommended implementation of the Crisis Now model as a form of pre-arrest diversion from jail, and ultimately the overburdened forensic evaluation and restoration process.
Comp Plan Strategy Alignment
Work at the Trust aligns with goals and objectives outlined in Strengthening the System, Alaska's Comprehensive Integrated Mental Health Program Plan, 2020-2024 (Comp Plan).
Efforts to build out and optimize crisis response systems to include a robust crisis call line, dispatched mobile crisis teams, and 23 hour/short term crisis stabilization programs support these plan objectives:
Goal 5, Objective 5.1: Coordinate prevention efforts to ensure that Alaskans have access to a comprehensive suicide prevention system, and
Goal 5, Objective 5.2: Support and improve the system to assist individuals in crisis.
- Crisis Now Consultation Report, RI International, December 2019
- White Paper: Transforming Services Is Within Our Reach, 2016 (Crisisnow.com)
- Forensic Psychiatric Hospital Feasibility Study, Phase 2, 2019 (Agnew:: Beck for DHSS, partially funded by the Trust)
- Acute Behavioral Health Improvement Project, 2019(Agnew::Beck for ASHNA, funded by the Trust)
- Video: Crisis Now
- Video: Crisis Now Call Center Hub
- Business Case: The Crisis Now Model, 2016 (RI International)
- SAMHSA National Guidelines for Behavioral Health Crisis Care
- A Comprehensive Crisis System: Ending Unnecessary Emergency Room Admissions and Jail Bookings Associated with Mental Illness, 2018 (NASMHPD)
- Crisis Services’ Role in Reducing Avoidable Hospitalization,2017 (NASMHPD)
- Psychological Boarding” and Community-Based Behavioral Health Crisis Stabilization, 2018 (Community Mental Health Journal)
- Zero Suicide: The Dogged Pursuit of Perfection in Health Care, 2019 (Psychiatric Times)
- We Must Change How Our Criminal Justice System Treats People with Mental Illness (Time)
- Webinar Series: Behavioral Health Crisis Response Systems (Northwest MHTTC, SAMSHA)