Brian Sandoval Governor Richard Whitley Director State of

Brian Sandoval Governor Richard Whitley Director State of

Brian Sandoval Governor Richard Whitley Director State of Nevada Department of Health and Human Services Division Name The Crisis Now Model: Transforming Services is Within Our Reach Stephanie Woodard, PhD DHHS Senior Advisor on Behavioral Health Behavioral Health Commissioner Helping People. Its who we are and what we do. Crisis Now Crisis mental health care in the United States is inconsistent and inadequate. This is tragic in that good crisis care is a known effective strategy for suicide prevention, a preferred strategy for the person in distress, a key element to reduce psychiatric

hospital bed overuse, and crucial to reducing the fragmentation of mental health care. Crisis Services Task Force Action Alliance Helping People. Its who we are and what we do. Statistics Nearly 10 million individuals in the United States are estimated to live with a diagnosable psychiatric condition sufficiently serious to impair their personal, social, and economic functioning. 1 Approximately 20% of the population struggles with a mental illness at any time, and suicide is the 2nd leading cause of death for people under age 35. 3 Nevadas population has grown by an estimated 10% since 2010. 2 While mental health utilization has decreased from state-funded facilities, hospital visits to both the emergency department and inpatient

admissions have increased since 2009, especially for depression and anxiety. 2 Between 2009 and 2017, Nevada had its highest age-adjusted suicide rate in 2016, which was 20.6 per 100,000 population while the lowest rate was in 2012, with 17.8 per 100,000 population. 2 1 Joint Commission 2 Nevada Epidemiological Report 3 Center for Disease Control. Leading Causes of Death Reports, 1981-2016. Retrieved from: https://webappa.cdc.gov/sasweb/ncipc/leadcause.html Helping People. Its who we are and what we do. Suicide Rates Nevada Age-Adjusted Suicide Rates (Per 100,000) 2010-2017 Year NV All

Suicides Rate 2010 2011 2012 2013 2014 2015 2016 2017 20.3 18.7 18.4 18.9 19.6 18.8 21.2 20.4 American Association of Suicidology Office of Suicide Prevention, Department of Health and Human Services, Office of Analytics

Helping People. Its who we are and what we do. National Suicide Rates (CDC) 12.1 12.3 12.6 12.6 13.0 13.3 13.4 -- Crisis Intervention Cost Service in NAC Service Description Billing Code Crisis Intervention

Crisis Intervention Services, per 15 minutes H2011 Crisis Intervention Services, per 15 minutes (team services) H2011 HT Provider Type Rate $21.71 -PT 20 (Psychiatrist) -PT 26 (Psychologist) -PT 82, Spec. 300 (Behavioral Health

Rehabilitative Treatment- QMHP) $34.22 -PT 20 (Psychiatrist) -PT 26 (Psychologist) -PT 82, Spec. 300 (Behavioral Health Rehabilitative Treatment- QMHP) Crisis Triage Center Billing Toolkit Helping People. Its who we are and what we do. One Size Fits All The Problem Most communities in the United States build their behavioral health services under the binary assumption that a person needs outpatient or inpatient treatment.

In communities where there is not a sufficient array of crisis services, providers match people with the next available higher service level. National Association of State Mental Health Program Directors Helping People. Its who we are and what we do. Preventable Tragedies Suicide Family pain Psychiatric Boarding The wrong care in the wrong place Law enforcement working as mobile crisis National Association of State Mental Health Program Directors Helping People. Its who we are and what we do. Assessing Level Of Care

1.2 million caller episodes of care were evaluated for higher intensity cases in which emergency department, law enforcement or mobile crisis were involved 54% warranted non-secure sub-acute crisis level of care which is often unavailable in communities. Georgia Crisis & Access Line LOCUS (2006-2017) Behavioral Health Link Helping People. Its who we are and what we do. CORE ELEMENTS High-Tech Crisis Call Centers 24/7 Mobile Crisis Crisis Stabilization Essential Principles and Practices National Association of State Mental Health Program Directors National Action Alliance for Suicide Prevention Crisis Now Helping People. Its who we are and what we do.

High-Tech Crisis Call Centers Crisis Call Center Specialists that can coordinate all levels of crisis care. Specialists can support and stabilize up to 90% of cases. Air traffic control center that dispatches appropriate resources and supporting resources. National Association of State Mental Health Program Directors National Action Alliance for Suicide Prevention Crisis Now Helping People. Its who we are and what we do. Historical Data Summary FY15 FY16 FY17 FY18 Total

65085 54947 62915 52207 66554 55911 194554 204936 Location Nevada National Unknown Total FY15 FY16 FY17 FY18 16445 13414 15902 19456 25237 40744 34298 32947

189 789 2007 3508 41871 54947 52207 55911 Total 65217 133226 6493 204936 Resolution De-escalated Escalated No change Total FY15 FY16 FY17 FY18 24806 34860 30942 33371 571

643 539 761 16494 19444 20725 21779 41871 54947 52207 55911 Total 123979 2514 78442 204936 Deployed Alternative Services Welfare Check - All Contacts Welfare Check - Nevada Only FY15 Total 2716 All Contacts (includes hangups) Total Crisis Contacts

Crisis Call Center not available 41871 220 FY16 FY17 FY18 240 436 1820 1044 Nevada Crisis Call Center Helping People. Its who we are and what we do. 11 Crisis Call

Center % of contacts FY18 Data Summary Total All Contacts (Including repeat and hangups) Crisis Contacts Text Messages Sexual assault survivors helped 66554 55911 11407 450 Issues Abuse / Violence / Crime (VOCA) Child Abuse Elder Abuse

% of Total contacts 21692 38.80% 17688 31.64% 1050 1.88% Addictions / Substances Basic Needs / Unmet Needs Physical and Mental Health Relationships / Family / Stressors 8234 4736 23262 26018 Nevada only 14.73% contacts: 3418 8.47% 41.61% 46.53%

Suicide/Suicide About Another/Survivor of Suicide Loss 10707 19.15% Nevada Crisis Call Center Helping People. Its who we are and what we do. 20.40% 24/7 Mobile Crisis Mobile crisis teams meeting people where they are resolving the crisis right then. Dispatched by crisis call center hub, alleviates law enforcement resources. Reducing stigma surrounding law enforcement knocking on doors. National Association of State Mental Health Program Directors National Action Alliance for Suicide Prevention Crisis Now

Helping People. Its who we are and what we do. Crisis Stabilization Programs Short term sub acute care for individual who need support and observation but not an emergency room. Operate 24/7 Law enforcement drop off time is no more than 5-7 minutes. Living room model to be more warm and welcoming. National Association of State Mental Health Program Directors National Action Alliance for Suicide Prevention Crisis Now Helping People. Its who we are and what we do. 14 Essential Crisis Care Principles and Practices. Must include: Recovery Orientation

Trauma-informed care Significant use of peer staff Commitment to Zero Suicide/Suicide Safer Care Strong commitments to safety for consumers/staff, and Collaboration with Law Enforcement. National Association of State Mental Health Program Directors National Action Alliance for Suicide Prevention Crisis Now Helping People. Its who we are and what we do. 15 Zero Suicide Shift from fragmented suicide care toward a holistic and comprehensive approach to patient safety and quality improvement within healthcare systems. Lead system-wide culture change committed to reducing suicides Train a competent, confident and caring workforce Identify patients with suicide risk with comprehensive screenings Engage all individuals at-risk of suicide with a suicide care management plan

Treat suicidal thoughts and behaviors using evidenced based treatments Transition individuals through care with warm-handoffs and supportive contacts Improve policies and procedures through continuous quality improvement Education Development Center (2018) Helping People. Its who we are and what we do. Crisis Now National Association of State Mental Health Program Directors National Action Alliance for Suicide Prevention Crisis Now, RI International Helping People. Its who we are and what we do. 17 Crisis Now National Association of State Mental Health Program Directors National Action Alliance for Suicide Prevention

Crisis Now, RI International Helping People. Its who we are and what we do. 18 Making the Business Case Based on 4-million person community of Maricopa County (Phoenix, Arizona) 37 FTE Police Officers Engaged in Public Safety instead of Mental Health Transportation/Security (Resource savings for fire fighters also exist but are not yet quantified.) National Association of State Mental Health Program Directors National Action Alliance for Suicide Prevention Crisis Now Helping People. Its who we are and what we do. 19 Making the Business

Case Based on 4-million person community of Maricopa County (Phoenix, Arizona) Reduction of 45 Cumulative Years of Psychiatric Boarding (aka waiting in the ED) Creating a saving to hospitals of $37 million in avoided cost/losses. National Association of State Mental Health Program Directors National Action Alliance for Suicide Prevention Crisis Now Helping People. Its who we are and what we do. 20 Making the Business Case Based on 4-million person community of Maricopa County (Phoenix, Arizona) Reduced Potential State Acute Care Inpatient Expense by $260 million. The cost avoidance represents the net savings of $100 million investment in a full, integrated crisis

continuum. National Association of State Mental Health Program Directors National Action Alliance for Suicide Prevention Crisis Now Helping People. Its who we are and what we do. 21 Conclusion Individuals in a mental health crisis benefit when their communities have a fully developed continuum of crisis services. The Crisis Now Model plays a critical role in a healthy crisis continuum, and their continued sustainability brings hope for the future to any individual suffering with mental illness. National Association of State Mental Health Program Directors National Action Alliance for Suicide Prevention Crisis Now Helping People. Its who we are and what we do.

22 Questions ????? Helping People. Its who we are and what we do. 23 References National Action Alliance for Suicide Prevention: Crisis Services Task Force. (2016). Crisis now: Transforming services is within our reach. Washington, DC: Education Development Center, Inc. https://theactionalliance.org/sites/default/files/crisisnow.pdf https://www.cbsnews.com/news/virginia-sen-recounts-mentally-ill-son-attacking-him/ https://davidwcovington.com/2014/02/06/air-traffic-control/ State of Nevada Epidemiology Reports NASMHPD: National Association of State Mental Health Program Director http://bhltest2.com/#the_video http://bhltest2.com/wp-content/uploads/2018/05/CrisisNow-BusinessCase.pdf http://bhltest2.com/wp-content/uploads/2018/05/TACPaper1-BeyondBeds.pdf http://crisisnow.com/the Washoe County Regional Medical Examiners Office - 2016 Data on Suicides in Northern Nevada American Association of Suicidology- http://www.suicidology.org/resources/facts-statistics

American Foundation for Suicide Prevention- afsp.org Office of Suicide Prevention, Department of Health and Human Services, Office of Analytics Nevada Crisis Call Center Helping People. Its who we are and what we do. 24 Contact Information Stephanie Woodard, Psy.D [email protected] Helping People. Its who we are and what we do. 25

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