Project Crisis Has No Schedule 2013 10


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October 2013 presentation on Era of Crisis is NOW (YouTube) -

The era for crisis is Now. A combination of factors, including concerns for public safety based upon recent tragedies, an enhanced focus on decreasing ER and inpatient utilization and cost savings and an emphasis on trauma informed care are creating a new prioritization of integrated crisis systems. In 2014, National Council will launch a special steering committee and host a crisis track at its Washington DC conference in May.

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  • John Hickenlooper and Colorado Department of Human Services Executive Director Reggie Bicha today introduced a plan to redesign and strengthen Colorado’s mental health services and support system. The plan is called “Strengthening Colorado’s Mental Health System: A Plan to Safeguard All Coloradans.”“For the past five months, in response to the Aurora shooting, we have been working to expand mental health care and services across Colorado,” Hickenlooper said. “No single plan can guarantee to stop dangerous people from doing harm to themselves or others. But we can help people from falling through the cracks. We believe these policies will reduce the probability of bad things happening to good people.”Five key strategies form the plan:Provide the right services to the right people at the right time.Align three statutes into one new civil commitment law. This alignment protects the civil liberties of people experiencing mental crises or substance abuse emergencies, and clarifies the process and options for providers of mental health and substance abuse services (requires legislative change).Authorize the Colorado State Judicial System to transfer mental health commitment records electronically and directly to the Colorado Bureau of Investigation in real-time so the information is available for firearm purchase background checks conducted by Colorado InstaCheck (requires legislative change).Enhance Colorado’s crisis response system ($10,272,874 budget request).Establish a single statewide mental health crisis hotline.Establish five, 24/7 walk-in crisis stabilization services for urgent mental health care needs.Expand hospital capacity ($2,063,438 budget request).Develop a 20-bed jailed-based restoration program in the Denver area.Enhance community care ($4,793,824 budget request).Develop community residential services for those transitioning from institutional care.Expand case management and wrap-around services for seriously mentally ill people in the communityDevelop two 15-bed Residential Facilities for short-term transition from mental health hospitals to the community.Target housing subsidies to add 107 housing vouchers for individuals with serious mental illness.Build a trauma-informed culture of care ($1,391,865 budget request).Develop peer support specialist positions in the state’s mental health hospitals.Provide de-escalation rooms at each of the state’s mental health hospitals.Develop a consolidated mental health/substance abuse data systemTo fund this plan, the governor is asking the General Assembly to approve $18.5 million in the FY 2013-14 budget.
  • The answer is E, all of the above. Mental health advocates have called for the first three (see Ron Manderscheid’s letter, for example). F is the wrong answer. Handwringing will no longer cut it. We must create robust, integrated crisis systems, and policy makers are requiring and funding it in increasing numbers.
  • The answer is D, 3x more likely. Scott (2000) and Hugo et al (2002) alongside data from the BHL Georgia Crisis & Access Line and mobile crisis response services suggest that diversion is 25% away from intrusive and costly higher end services without mobile crisis response, and 75% and higher with those services in place.
  • The answer is E, strongly disagree. Yes, we should do everything possible to engage someone voluntarily in care through peer supports, respect, collaboration, etc., but at the end of the day, medical and behavioral professionals have legal and ethical obligations to do no harm. We must perform active rescues or other intrusive interventions if health and safety of the person are others are at “imminent risk.”
  • The answer is E, Strongly Disagree.
  • Project Crisis Has No Schedule 2013 10

    1. 1. A Crisis Has No Schedule: The Era for Crisis is NOW DAVID COVINGTON, LPC, MBA— CRISIS ACCESS, LLC
    2. 2. Aurora, Colorado
    3. 3. Polling Question #1 Virginia Tech, Columbine, Tucson, Aurora, Newtown… We should do the following: A. B. C. D. E. F. Double Mental Health System Capacity Ban Assault Rifles Immediately Dramatically Expand MH First Aid Create Robust, Integrated Crisis Systems All of the Above None of the Above, as Tragedies Are Unavoidable
    4. 4. 55 Years of Crisis Services
    5. 5. First Crisis Services in US  Edwin Shneidman
    6. 6. CIT Law Enforcement Training  Response to shooting death of person with mental illness by Memphis police  Sam Cochran and Randy Dupont with NAMI  40 hours mental health and de-escalation  Now in 40 states and 2,000 jurisdictions
    7. 7. Joint Effort in St. Louis  Legislative response to shooting death of family members by person with mental illness  Board of Directors four local CMHCs
    8. 8. Harris County MHMRA
    9. 9. Statewide Crisis & Access Line  Single Point of Entry concept led to GCAL  Hurricane Katrina in 2005  Scheduling, Dashboards and Analytics
    10. 10. Crisis Response Center Tucson  2006 community bond packages $54 million  CPSA and University Physician’s Hospital  Co-located Call Center, Stabilization and more
    11. 11. Phoenix’s Full Array of Services  Peer Warm-line, Crisis Line & Mobile Crisis  24/7 Outpatient & Co-located Residential  Detox, Crisis Stabilization & Psych Inpatient Above, Community Bridges
    12. 12. Colorado’s Integrated Vision  Peer Warm Line  Crisis Line  Mobile Crisis Response  24/7 Walk-In  Crisis Stabilization  Crisis Respite
    13. 13. Why Now? External Forces Demanding Better Crisis Care
    14. 14. Importance of Mental Health in Public Safety On gun violence, Americans now more likely to blame mental health system over gun laws, a shift since 2011’s Tucson tragedy.
    15. 15. Polling Question #2 Without community based mobile crisis services law enforcement and ERs will hospitalize individuals: A. The Same Amount as if Those Services Were Available B. Less Likely to Hospitalize C. 2x More Likely D. 3x More Likely
    16. 16. Investment in Mental Health Wellness Act of 2013 “SB 82 [found] that 70% of people taken to ERs for psychiatric evaluation can be stabilized and transferred to a less intensive level of care. ”
    17. 17. California Senate Bill 82
    18. 18. The ADA & People with MI
    19. 19. Department of Justice
    20. 20. Professional Orientation
    21. 21. Risk Assessment Standards  John Draper
    22. 22. Polling Question #3 People have a right to suicide. We should do everything possible to engage someone at risk but not invasively intervene if they do not want our help. A. B. C. D. E. Strongly Agree Agree Don’t Know Disagree Strongly Disagree
    23. 23. Imminent Risk NSPL defined “Imminent Risk”: Staff believe the person’s current risk status/actions could lead to suicide Staff sense an obligation/immediate pressure to take urgent actions Individual has both a desire and intent to die and has the capability of carrying through
    24. 24. Emergency Intervention NSPL provided Nine Guidelines for Active Rescue: Active Engagement Least Invasive Intervention Initiation of life-saving services for attempts in progress Supervisory Consultation Active Rescue Caller I.D. Confirmation of Emergency Services Contact Procedures for Follow-Up When Emergency Services Contact Is Unsuccessful Third-Party callers Collaborative Relationships with Local Emergency/Crisis Services Provider
    25. 25. Engagement & Collaboration “From the very beginning I felt like she was an ally... It felt safe to really, really open up to her because she accepted me as I was, where I was. She listened to me and she heard me. . . I felt like she was a partner, working with me - and it felt safe…”
    26. 26. Polling Question #4 Individuals in crisis often feel out of control and seclusion and restraint are appropriate treatment interventions that help reduce anxiety and provide safety. A. B. C. D. E. Strongly Agree Agree Don’t Know Disagree Strongly Disagree
    27. 27. Recovery & Trauma
    28. 28. Trauma Informed Care
    29. 29. Seclusion & Restraint In 2000, Charles Curie won the Harvard Innovations in American Government Award for a Pennsylvania state hospital initiative that viewed seclusion and restraint as a treatment failure rather than an acceptable best practice intervention.
    30. 30. Recovery Response Center
    31. 31. No Force First 1. 2. 3. 4. 5. 6. 7. Define the use of force and coercion as a treatment failure Train staff in effective de-escalation techniques Debrief coercion and force and include the service recipient Perform critical incident reviews Track and report all types of forced interventions and provide feedback to staff Use active outreach, engagement and peer support Describe relationships as “risk sharing”
    32. 32. Follow-up & Chain of Care
    33. 33. Follow-Up Research Jerome Motto’s “caring letters” found a simple follow-up letter expressing concern following a hospital discharge reduced suicide attempts.  Madelyn Gould Madelyn Gould’s follow-up calls to persons contacting Lifeline found 54% indicated that the calls helped significantly with keeping them from killing themselves. The research has demonstrated that isolation and lack of connectedness elevate suicidality considerably. Knowing that someone cares helps persons feel less isolated.
    34. 34. Coordination of Care  Richard McKeon
    35. 35. Potential of High Tech Solutions
    36. 36. Air Traffic Control  Single Point of Entry and Secure Communication and Coordination of Care
    37. 37. National Council Steering Committee
    38. 38. Contact Us National Council Crisis Steering Committee Co-Leads Social Networking