As health care continues to focus on accountability for improved clinical outcomes, usage of lower cost services, improved public safety and a demand for positive client experiences, the importance of crisis services grows. With increasing attention to the value of crisis services, how do we support excellence? Financing, collaborative partnerships, standard operating procedures, current research, use of data and innovative technology are cornerstones of effective intervention delivery for hotlines, mobile teams and crisis stabilization. Come take an in-depth look into the tools and solutions available to quickly build the clinical, administration and financial supports to keep track with the new national focus.

1. Current Federal Initiatives
Promoting Crisis Services
Richard McKeon Ph.D.
Chief, Suicide Prevention Branch

3. Centers of Excellence
On March 31, 2014, Congress
passed the Protecting Access to
Medicare Act (H.R. 4302), which
included a demonstration
program (Section 223) of
Certified Community Mental
Health Centers (CCBHCs). CCBHCs
will increase Americans’ access
to community mental health and substance use treatment
services while improving Medicaid reimbursement for these
services.

4. Section 223 of Protecting Access to
Medicare Act
• November 12th Listening Session
• Creates criteria for certified community
behavioral health clinics
• Provides $25,000,000 that will be available to
states as planning grants for the two year
pilot. Only states that receive a planning grant
will be eligible to apply for the pilot
• Stipulates that 8 states will be selected to
participate in the pilot.

5. Section 223
• Selected states will receive a 90% FMAP for all
of the required services provided by the
Certified Community Behavioral Health Clinics
• Under the scope of services is listed:
• Crisis Mental Health Services, including 24
hour mobile crisis teams, emergency crisis
intervention services, and crisis stabilization
• Medicaid demonstration project with recs
from Sec. HHS to Congress at conclusio

6. Increasing Crisis Access Response
Efforts
• $10m demonstration activity to help
communities build, fund, and sustain crisis
systems capable of preventing and
deescalating behavioral health crises as well
as connecting individuals and families with
needed post-crisis services. In many
incidences, responses to these situations are
poorly coordinated and ineffective.

7. Behavioral Health at the Crossroads
Current system is:
• Fragmented
• Deficit-based
• Crisis-driven
–Ineffective
–Costly
–Harmful

8. Building a Crisis Services Continuum
Crisis Respite
Outpatient Provider
Family & Community Support
Crisis Telephone Line
WRAP
Crisis Planning
Housing & Employment
Health Care
23-hour Stabilization
Mobile Crisis Team
CIT Partnership
EMS Partnership
24/7 Crisis Walk-in Clinic
Hospital Emergency Dept.
Integration/Re-integration
into Treatment & Supports
Peer Support
Non-hospital detox
Care Coordination
EARLY
INTERVENTION RESPONSE
POSTVENTIONPREVENTION
TRANSITION SUPPORTS
Critical Time Intervention, Peer Support & Peer Crisis Navigators
TO MATCH A CONTINUUM OF CRISIS INTERVENTION NEEDS

9. Components of Comprehensive
Crisis Systems
• Mobile crisis response teams
• Crisis stabilization beds
• Hotlines and warmlines
• Crisis respite
• Psych emergency/walk in
• Post crisis follow up engagement and support
• Role of peers
• Report commissioned on crisis components

10. Comprehensive Crisis Response

11. Peer Respite
Second Story

12. Ten Essential Values of Crisis Services
1. Avoiding harm
2. Intervening in person-centered ways
3. Shared responsibility
4. Addressing trauma
5. Establishing feelings of personal safety
6. Based on strengths
7. The whole person
8. The person as credible source
9. Recovery, resilience, and natural supports
10. Prevention

13. Current SAMHSA initiatives
• Promoting Comprehensive Crisis Systems
• Work with CMS Community Care Transitions
• National Suicide Prevention Lifeline-expansion
to 24 hour crisis chat coverage
• Focus on mobile outreach, Emergency
Department Care, and Care Transitions/post
discharge follow up

14. Comprehensive Crisis Systems
• SAMHSA interested in how comprehensive
crisis systems are designed, funded and
staffed
• While there are models in different states,
comprehensive crisis systems are not
generally available across the United States
• This leads to huge pressures on Emergency
Departments and law enforcement, poor
outcomes.

15. Comprehensive crisis services
• Growing evidence base on the effectiveness of
comprehensive crisis services, particularly as
diversions from hospitalization or
incarceration
• Growing evidence of cost-effectiveness in ROI
studies.
• Most crisis services have had to depend on
multiple funding sources “collaborative
funding”.

16. Recent SAMHSA crisis initiatives
• Paper-Crisis Services, Effectiveness, Cost
Effectiveness and Funding Strategies
• Financing study of post discharge follow up
• Financing study of telemental health ,
including financing of crisis services
• Incorporation of postdischarge follow up/care
transitions as a focus in GLS and NSSP grants

17. MISSED OPPORTUNITIES = LIVES LOST
• The numbers of people being seen in EDs for
a suicide attempt has been increasing, while
the proportion hospitalized has been
decreasing (Larkin, 2008)
• Only 48% of adult Medicaid recipients seen in
EDs for a suicide attempt received a mental
health evaluation and only 52% received
outpatient follow up within 30 days

18. MISSED OPPORTUNITIES = LIVES LOST
• For youth age 10-19 who receive Medicaid
and were seen in the ED for a suicide attempt,
almost 73% were discharged BUT only 39%
received a mental health evaluation, and 43%
received outpatient treatment within 30 days
• Best predictor of outpatient follow up was
recent outpatient mental health treatment

19. EMERGENCY DEPARTMENT F/U
• Fleischmann et al (2008)
– Randomized controlled trial; 1867 Suicide attempt
survivors
from five countries (all outside US)
– Brief (1 hour) intervention as close to attempt as possible
– 9 F/u contacts (phone calls or visits) over 18 months
0
0.5
1
1.5
2
2.5
3
Died of Any Cause Died by Suicide
PercentofPatients
Results at 18 Month F/U
Usual Care Brief Intervention

20. major international efforts have
reduced suicides
• Taiwan-nationwide effort to intervene with
those who have attempted suicide, 50,000+
• 63.5% reduction in suicide attempts among
those who accepted the program. Those who
refused but then persuaded 22% reduction.
• English National Strategy- 24 hours crisis care
strongly associated with reduction in suicides.
• Proactive outreach and discharge f/u 7 days

21. National Strategy for Suicide Prevention

22. Objective 8.4
• There is substantial evidence that
discontinuities in treatment and
fragmentation of care can increase the risk for
suicide. Death by suicide in the period after
discharge from inpatient psychiatric units is
more frequent than at any other time during
treatment.92
Promote continuity of care and the safety and well-
being of all patients treated for suicide risk in
emergency departments or hospital inpatient units.

23. NSSP Objective 8.8
• NSSP Objective 8.8-Develop collaborations
between Emergency Departments and other
health care providers to provide alternatives
to emergency department care and
hospitalization when appropriate, and to
promote rapid follow up after discharge.

24. Contact information:
Richard McKeon, Ph.D., M.P.H.
Branch Chief, Suicide Prevention, SAMHSA
240-276-1873
Richard.mckeon@samhsa.hhs.gov