‘A real turning point’: Mobile crisis units offer new tool in mental health treatment

New Hampshire Bulletin
Published: 1/23/2022 8:50:21 PM
Modified: 1/23/2022 8:49:05 PM

Editor's Note: This story was first published on New Hampshire Bulletin.

For years, getting help during a mental health emergency usually began with two options, neither ideal and both often harmful: a call to police or a trip to the emergency room, where someone could wait hours, days, even weeks for care.

So-called “emergency room boarding” has led to upward of 30 children and often as many adults waiting for an inpatient bed, lawsuits and a state Supreme Court order.

As of this month, there’s a new option that mental health advocates have sought for at least a decade: a 24/7 phone line answered by trained mental health staff and, for those who need more, a mobile crisis response team that goes to them.

The hope is that a quicker response to the community will spare people emergency room waits and provide them the appropriate level of care, which can often be immediate stabilization and a next-day appointment with a counselor. Staff from Health and Human Services have said they expect call center staff will resolve 80% of cases without dispatching a crisis response team.

“Families tell us all the time, we wish we had another option because we went to the emergency department and we had to wait four or five hours,” said Dennis Walker, vice president of emergency services at the Seacoast Mental Health Center. “We had to tell our story three different times. We had to get labs. We had to do all those things, and it’s just so exhausting. To be able to bring crisis care directly to somebody’s home or wherever they might be, I think that’s what’s so exciting about this.”

The Rapid Response Access Point, more commonly referred to as mobile crisis response, began Jan. 1 with surprisingly little publicity by the state or the company contracted to run it. In fact, community mental health centers said their two biggest challenges are hiring enough staff and making sure the public knows how to access the new service.

The company did not return messages and has shared little information about the program on its website, including the telephone number or nh988.com web address, though those kinds of details — as well as overall marketing — are required under the terms of the contract.

The Seacoast Mental Health Center began spreading the word to local police departments and doctors’ offices this summer.

“I will say there’s so much more that we need to do to promote this to teach people about the model,” Walker said. “And a lot of that’s going to come from what we do but also how the state promotes it as well.”

Run by Beacon Health Options of Boston, the 24-hour phone and text line — 833-710-6477 — will be staffed by master’s-level clinicians, intake workers and peer support specialists who have lived experience with mental health or substance use disorders, according to its $9.2 million contract with the state.

Those in need can also reach help via a chat option at nh988.com. The phone and text line will be replaced with 988, the new national suicide prevention hotline, when it goes live in July.

In addition to helping people in their moment of crisis, Beacon’s staff are expected to follow up with callers to ensure they received the help they needed, according to the contract.

Currently, help for a mental health crisis largely depends on geography.

While the state’s 10-year mental health plan includes a statewide mobile crisis response, until this month, only three of the state’s 10 community mental health centers offered it: Manchester, Concord and Nashua — and they didn’t respond outside their regions. Elsewhere, law enforcement and school officials were often the first to respond to a crisis.

“If it was a family member, or if it was a police officer or the school, 9 times out of 10, if they couldn’t get us, they would send the person to the hospital,” said Bill Metcalfe, director of mobile crisis at West Central Behavioral Health, which has offices in Lebanon, Claremont and Newport. “There’s no other option. And in a lot of these cases, to be honest, a lot of times we were able to discharge people just with a good safety plan in place.”

Now, all 10 of the state’s community mental health centers will have a crisis response team thanks to a $52.4 million state contract.

West Central Behavioral Health will have two teams, each with about 11 people, to cover the Upper Valley and Sullivan County. (All teams will also be allowed to respond to other sites within an hour’s drive.) Metcalfe said he’s filled the jobs for the team based in Claremont but still needs to fill about six spots for the one in Lebanon.

Previously, Metcalfe said a team of four people tried to handle phone calls, walk-ins, and calls to the hospital. Having so few people made it challenging to help everyone in crisis. “The idea of having a child wait in the ER for 13 or 14 days to get a bed, it really hurts you. It was heartbreaking,” he said.

Ken Norton, executive director of NAMI NH, said mobile crisis response in other states has successfully diverted people from emergency rooms to more appropriate care — and more.

“Nationally, from data where mobile crisis is happening, it reduces the number of hospitalizations as well as arrests, and likely also reduces injuries and negative events toward first responders and the individual in crisis,” said Ken Norton, executive director of NAMI NH. “I think that this is a real turning point for us as a state.”

The arrival of statewide mobile crisis response will not eliminate law enforcement’s role in mental health calls, said leaders of the community mental health centers. Nor do they want it to, given that so many departments have embraced mental health response training for officers. NAMI NH this week began the latest round of its 40-hour Crisis Intervention Team training. But their role will change.

“At the end of the day, they’re not mental health clinicians,” Walker said. “I think this kind of system change allows us to see what the police have been up against, which are some very, very difficult situations, and be able to team up with them. Oftentimes that means that the police can leave us there and move on to other situations in the community knowing that that person that we’re working with is safe and being helped.”

Maggie Pritchard, CEO of Lakes Region Mental Health, said she has long worked closely with the Laconia police and gets a call when they respond to a mental health crisis. The new statewide crisis line will transfer all calls to community mental health centers to the new number, a change she hopes will not eliminate that partnership with the police.

“I think some in the (police department) are anxiously waiting to see how it’s going to play out,” she said. “They are very used to calling us. Putting someone in the middle is just a different way of being.”

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