Regional Crisis Centers – Move Forward Cautiously

In the bonding bill passed by the 2018 legislature was $28.1 million for what they are calling “behavioral health crisis facilities.” This funding is for buying land and building or renovating facilities (bricks and mortar), up to $5 million per project. Only a publicly owned hospital, city, county or housing and redevelopment authority can apply and must be working with the mental health authority or a regional consortium of organizations that serve people with a mental illness or substance use disorder.
The facilities must provide mental health or substance use disorder services. Proposals are now being developed to be submitted to the Department of Human Services (DHS) and according to the law must:
  • Demonstrate a need for the program;
  • Provide a detailed service plan regarding the mental health care that will be provided including staffing requirements;
  • Provide an estimated cost of operating the program;
  • Confirm the financial sustainability of the facility including third party payments from private insurance and Medical Assistance;
  • Demonstrate an ability and willingness to build on existing resources within the community;
  • Agree to regular evaluations by the Department of Human Services on the quality and financial sustainability of the program.

NAMI Minnesota has had concerns from the beginning over what these “facilities” would look like and provide. There has been a lot of confusion – even among legislators. Some have told NAMI staff that we are going back to developing regional treatment centers; others say we’re modeling what Florida, Texas, Kansas and other states are doing by creating “central receiving centers” or “assessment centers.”

NAMI Minnesota urges people to move forward with great caution. Any further development of our mental health system must make it easier for the individual with mental illness and their family to access appropriate treatment. It’s not about making it easier for police or ED physicians.

Here are some of NAMI Minnesota other concerns:

Central Receiving Centers/Assessment Centers: These have largely been developed to make it easier for police to drop people off rather than bring them to jail or an emergency department (ED). They are assessed and referred to treatment and services typically within 23 hours – often to services that don’t really exist (Florida and Texas are ranked near the bottom in terms of funding for community-based mental health services). In many states the only way to enter these facilities is if a police officer brings you there. You cannot simply walk up and ask for help. These centers do not routinely track recidivism rates but off the record have said that they see many of the same people over and over again. Let’s not develop these in Minnesota- let’s develop the services people need.

Furthermore, at a time when we are trying to integrate health care and mental health care why establish separate assessment centers? Think about our crisis numbers – over 40 in our state – and how virtually no one knows what they are off the top of their heads. But everyone knows 911. If we had to do it all over again, we would require 911 to link people to mental health crisis teams. So why create separate mental health crisis centers that people won’t know about? Why spend money on marketing when nearly everyone knows where the nearest emergency department is in their community?

People talk about how difficult it is to be in an emergency room with the loud sounds and bright lights when you’re having a mental health crisis. Some hospitals have created psychiatric emergency rooms that are quieter and are staffed by mental health practitioners and professionals. People still come to the ER – which is a known place – they just walk to a different part of the building to obtain the care they need. Why not develop more psychiatric EDs? It should be noted that these funds can be used for renovation – so it could be used to build a psychiatric emergency department.

People also say that there are lots of people experiencing a mental health crisis who go to the ED but aren’t admitted to the hospital so we should have a different place for them to go. Of course, the same is true for other health care conditions. According to a CDC report there were 136.9 million ED visits in 2015 and 12.3 million were admitted – that’s less than 9%. Where have hospitals tried to get people to go instead of the ED? Urgent Cares. But the Urgent Cares in Minnesota don’t take a mental health client – even if they are just trying to get their medications continued until they can see their psychiatrist. So before building something that isn’t part of the health care system, let’s try reforming the current health care system to address the needs of people with mental illnesses.

Services Needed: People do get assessed in an ED and are not admitted to an inpatient unit because they don’t need that level of care. They need something else, like stabilization services, a crisis home, and residential treatment programs. The problem isn’t being able to be assessed; it’s finding the right level of services once you find out that the person doesn’t need hospital level of care. So let’s build that right level of care so people have a place to go to obtain the treatment they need. Let’s examine the data of people who went to the ED and weren’t admitted and what was it that they needed.

Funding: Many of the services people are talking about providing in these new buildings cannot be billed to insurance. During the last recession the mental health system lost over $53 million. Reliance on grants to provide services is not a good idea. We will end up with shiny new empty buildings.

An important feature of these crisis centers is their integration into already existing community mental health resources, particularly because the bonding dollars will only support developing the facility itself. A key feature is the capacity of these facilities to bill for providing mental health services. Without this commitment, the crisis centers will become an expensive, revolving door for people with mental health needs and be unable to fill any of the gaps in our mental health system.

Data: When thinking about the importance of integrating these facilities into existing resources, the crisis centers should not address a single problem like emergency department wait-lists. Instead they should enhance the continuum as a whole. When gathering data counties and others need to look at the ED data – is the problem lack of appropriate services to refer people to or is it really people are coming to the ED when they could have gone somewhere else (like current Urgent Cares).

Let’s not get excited about building a new building until we look closely at the data. Let’s make sure that whatever is developed is easy for people to find and use and addresses a current need in our mental health system.