The Evolution of Crisis Care: A Community Solution Presented by Heather Champion and Mark Severns of Spindletop Center

“ER flooded with psych” Timeline of events: Local private hospital announced closure of behavioral health unit. Community would lose substantial number of inpatient beds. Regulatory Issues “ER flooded with psych” Huge financial losses Countdown to Crisis

Timeline of events: Public Sector Participants LMHA – Spindletop Center County officials Law enforcement agencies Private Sector Participants EMS – Acadian Ambulance Hospitals Baptist Behavioral Christus St. Elizabeth The Medical Center of Southeast Texas Jefferson County Judge holds courthouse meeting of stakeholders to brainstorm solutions.

LMHA letter Pursuant to Texas Administrative Code as the local mental health authority, Spindletop Center invokes it’s power to designate all emergency departments as “suitable psychiatric facilities.”

Following LMHA letter, participants began to work together. A plan was developed Everyone had “skin in the game” No one entity must bear the burden alone Risk to all is too great – failure is not an option Compromise is the key

Our Model of Community Crisis Intervention Spindletop catchment Chambers County Hardin County Jefferson County Orange County Divided into 2 zones North Zone South Zone Five hospitals rotating on-call psychiatric response within emergency department Law enforcement and County officials divert to on-call ER LMHA embeds crisis interventionists in ER Our Model of Community Crisis Intervention

5 original hospitals eventually reduced to 3 largest hospital emergency departments Increased MCOT staff, added 12-hr shifts, meshed MCOT with MH Deputy team Struggles to incorporate tele-health and make it work Complex HR requirements for new contract staff in emergency departments EMS – voluntary patient’s right to choose Personalities, personalities, personalities! Lessons Learned

Lessons Learned Allows on-call hospital to “ramp up” resources Addition of crisis intervention specialists in ER at no cost to hospitals Improved communication among participants Expedited placement for inpatient needs Better diversion of inappropriate hospital admissions to alternative resources w/in community Lower recidivism rate Law enforcement better educated on MH needs Lessons Learned

Is it still working? Law Enforcement LMHA ER In the first year of our collaborative model, 1,256 unique individuals were served. Baptist Behavioral Hospital has been able to remain open. By incorporating LMHA staff in the ER, we have also increased awareness of outpatient alternatives to hospitalization.

How have we evolved? Crisis Stabilization Unit State beds 10 new beds for diversion from inpatient Generous in-kind donation from Baptist State beds 9 state funded beds under LMHA authority Housed within Medical Center of SETX MH Deputy Team and MCOT merged PSA addressing synthetic marijuana epidemic Task Force to address “super utilizers” How have we evolved?

With great power comes great responsibility Moving into the Future Tracking data including trends in volume, type of crisis, disposition Utilizing the data to identify preventive measures and better solutions Sharing data across systems Pooling resources to create a regional psychiatric crisis center With great power comes great responsibility

Can we do that too? Identify Partners Brainstorm Don’t leave anyone out Public & Private entities It doesn’t hurt to ask Get the “authorities” involved LMHA/LIDDA County officials Law enforcement Be open to all possible solutions Don’t be afraid to fail…or to succeed Keep communicating, even when it hurts Get in their face, literally Build upon the uniqueness of your community Can we do that too?