The need for behavioral health crisis services in the United States has never been stronger. Traumatic national catastrophes, such as mass shootings, are on the rise. The opioid epidemic shows no signs of abating. The stigma around accessing mental health services persists. Suicide rates are high and rising. Access to mental health services remains elusive for many Americans.
However, with challenge comes an opportunity for innovation. Emergencies – whether it’s a natural disaster, an anxiety episode, an overdose or any event that affects daily living and functioning – provide an opening to improve upon the current behavioral health crisis delivery system. In fact, studies find that “significant cost savings can result from crisis services, due to reduced inpatient utilization, emergency department diversion and more appropriate use of community-based behavioral health services.”
The timing for crisis services is now
Beacon has identified six factors contributing to the rising demand for crisis services.
- The opioid epidemic. This crisis is showing no signs of ending soon. Experts are predicting annual opioid overdose deaths to reach 82,000 by 2025; in 2017, that number was approximately 70,000.
- Reliance on emergency departments or law enforcement as the de facto crisis system. The ER is the de facto safety net for individuals with mental health and substance use disorder conditions. According to a 2017 Agency for Healthcare Research and Quality report, from 2006 – 2014, visits to the ER for these conditions increased by 44%, and ER use by these individuals is on the rise. Additionally, there is an over-reliance on officers to be frontline and first responders to behavioral health crises, even though they often have little or no formal training for trauma-informed crisis response.
- Increasing suicide rates. Between 2001 and 2017, the rate has increased by 31%, according to the Centers for Disease Control and Prevention and is at its highest in 50 years.
- Inadequate access to behavioral health care. Several factors contribute to access issues, including cost, limited options, stigma, system complexity and more.
- Stigma. There are three forms of stigma – public, institutional and self – which makes stigma that much harder to address.
- National catastrophes on the rise. Catastrophes, by definition, are unexpected and out of an individual’s control, and can lead to new mental health conditions as well as exacerbate existing ones.
What does an effective crisis system look like?
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The word “crisis” evokes a reactive, put-out-the-fire action or response. However, what may be a crisis to one person may not be a crisis to another, and not all “crises” require the same level of care. Beacon Health Options, in redesigning an effective behavioral health crisis system, has chosen to adopt a “self-definition” of crisis, in which individuals define for themselves, or with the help of a caregiver or professional, when they are approaching or experiencing a crisis. Therefore, an excellent crisis system is more than stabilizing a person at imminent risk and referring that individual to care.
Beacon stands behind a system that supports individuals through all phases that lead up to and follow a crisis episode. The five phases of system involvement include:
- Early intervention
- Acute intervention
- Crisis treatment
- Recovery and reintegration
In other words, we can no longer view crisis services as just those services that respond to a crisis in real-time. An effective crisis system goes beyond stabilization to focus on prevention, recovery and resiliency over hospitalization or detention. To do so, crisis services integrate into a wider array of community-based behavioral health services where every interaction presents an opportunity for meaningful engagement in the larger health and social services system. Finally, effective crisis services require system management and oversight that entail a technology infrastructure to facilitate access, track available services, connect system providers and stakeholders, share data and measure outcomes.
In summary, an effective crisis system goes beyond in-the-moment crisis stabilization. Promotion of better prevention, early detection and proactive planning helps to divert crises from occurring at all, while follow-up and transition-of-care support drives reintegration into the community and long-term recovery.
To learn more, visit Beacon’s website.
By Briana Duffy
President, West Region
Beacon Health Options