Meeting Individuals with Mental Health Crises Outside the Hospital

When mental health patients find services in the community, they avoid coming to the emergency department as a last resort.

“If you cross the threshold of the emergency department, the likelihood of your case being elevated to a higher level of care accelerates,” says Peter Evers, CEO of Riverbend Community Mental Health, Concord, Massachusetts. “If we can triage people who need psychiatric help or help with behavioral issues out in the community, we can often keep those people out of the hospital.

In this interview, Evers discusses how his organization, a comprehensive, regional community mental health agency, helps those with mental health or behavioral needs find service in the community rather than in the hospital.

One of Riverbend’s newest programs is a crisis treatment drop-off center that aims to keep individuals needing psychiatric care in the community. How did that program begin?

Evers: In 2013, the Department of Justice filed an ADA [Americans with Disabilities Act] lawsuit against the state of New Hampshire because the state was not providing enough community resources to treat individuals with mental health needs or behavioral issues. The settlement of this suit led to increased state funding in this area, so we applied for funding to start our drop-off center. Though we have not received that funding from the state yet, we were able to begin the program with other funding. The idea is that first responders can drop off these individuals at our crisis treatment center instead of taking them to the emergency department. We had to get state law changed for ambulances to be allowed to drop patients off here instead of the hospital.

To accommodate the drop-off center, we renovated a three-story building in downtown Concord that we previously had used as a long-term care community support program. That program was relocated, and the building was turned into a mobile crisis center hub. It is staffed 24 hours a day by masters’ level clinicians and peer support specialists. There are crisis apartments upstairs. It’s a nurturing environment that helps stabilize individuals with mental health crises.

What other programs does Riverbend operate that help keep these individuals out of the emergency department?

Evers: About two and a half years ago, we started a program that works with Concord police and EMTs to identify individuals in need of mental health care. Police officers or EMTs call us and say, “We have someone here who needs help. Can you come with us?” We send out a masters-level clinician and a peer specialist and meet the police or EMT at the location. When appropriate, we arrange for these people to go to our apartments, and get the community support they need.

We also have a 24-hour triage line people can call, instead of calling 911. We’re persuading people to call the triage line when they’re experiencing a crisis, so a clinician can evaluate them.

What are peer specialists?

Evers: Peer specialists are individuals with mental or behavioral issues who are in recovery. They go through a week-long training program that certifies them in a skill called intentional peer support. The training shows them how to use their experiences to benefit other people. Because they have been down that road before, they can demonstrate to people in crisis that there’s a light at the end of the tunnel. That’s incredibly supportive to individuals in crisis.

Why is keeping people out of the ED important?

Evers: Data show that 75 percent of people with mental health or behavioral problems who go the emergency department end up being admitted. In some cases, it’s a liability issue. A classic example is the person who is intoxicated who says, “I want to kill myself.” The police bring him to the emergency department, and when he sobers up, he says he doesn’t feel like that anymore. But the emergency department doctor says, “I’m not going to take that risk on my watch. You’re going to a facility.” Well, if we meet those individuals out in the community, we can help them through that crisis and get them other resources short of being admitted to the hospital.

I think the use of emergency psychiatric services is a symptom of the underfunding of the ongoing system of mental health. We don’t tend to fund the day-to-day services adequately, so we are unable to treat people before they get to the acute phase.

How successful have your programs been in keeping people out of the emergency department?

Evers: Our data show that about 100 cases a month are diverted from the emergency department.

Ed Avis is a freelance writer and editor and a regular contributor to HFMA publications.

Interviewed for this article:

Peter Evers is CEO, Riverbend Community Mental Health, Concord, Mass..