Separate Systems May Not Increase Access

As policy makers grapple with addressing the increasing numbers of people with mental illnesses who are deemed incompetent to stand trial, who are being boarded in emergency departments, who are ending up in our jails – we urge them to proceed with caution. Several states and counties are building separate systems in an attempt to divert people from ERs or jails. They are trying to make it easy for police to bring someone in crisis somewhere other than the jail or emergency department.

While on the surface this may seem like a good idea, let’s dig deeper. At a time when we are trying to integrate mental health and health care, why would we create separate systems? People generally understand our health care system so why not make it easier to access mental health care through normal channels?

We have over 40 mental health crisis numbers in Minnesota. Right now, if you know your county’s crisis number off the top of your head raise your hand. I can guarantee you that few people out there are raising their hands. But everyone knows the number 911. When calling 911 the operators send out a firefighter, an EMT or a police officer depending on the type of emergency. Why can’t every 911Call Center send out a mental health crisis team to a mental health emergency? We would have far fewer police responding to calls if the appropriate emergency personnel could be dispatched. Instead of trying to get people to memorize a new number for an emergency let’s make the existing emergency system handle mental health crises.

Central receiving centers, serving only people experiencing a mental health crisis are separate from the health care system. Generally they keep people for under 24 hours and refer people to services in the community (if they have any). Few people other than police will know about them. This results in increased access to mental health services through the criminal justice system – the opposite of what we want.

Everyone knows emergency departments and urgent care clinics. They are appropriate places to go when you have an emergency or urgent health care issue. They should be better at meeting the needs of people experiencing a mental health crisis instead of creating separate places. By creating mental health crisis rooms within or down the hall from the emergency department and staffing urgent cares with mental health professionals – even if by telemedicine – we improve access to mental health through existing places people already know.

Only a small percentage of people ever going to the ER, regardless of the health care issue, are hospitalized. It’s no different in the mental health world. The difference of course, is that if we had people with cardiac conditions waiting in the emergency department for days for a bed, a new unit or new beds would be added immediately.

Let’s make it easy for the individual and their family to access mental health care. Let’s not create different paths for accessing mental health treatment, which ultimately makes it infinitely more difficult to navigate the mental health system.