Rural crisis teams fill mental health gaps

(NewsNation) – In rural communities, people in crisis may be more likely to encounter a badge and a gun instead of scrubs and care.

At best, accidents waste time and resources for police and emergency room personnel, and at worst, they escalate into violence.

But mental health crisis teams are different. This model funnels patients into healthcare instead of a lengthy encounter with the criminal justice system.

A network that includes law enforcement agencies, private and public health systems, nonprofits, and advocacy organizations work together to reduce crises, get people treated, and then provide follow-up care.

“It really needs to be a community-focused service where everyone who touches this issue is brought into the same room,” said John Gale, a researcher at the Maine Rural Health Research Center. “No party can fix it.”

Take the pressure off

Similar models have existed in larger cities for years. Yet experts say they could have an even greater impact in rural areas where resources are limited and law enforcement responds to a slew of 911 calls.

“For someone who’s in a bit of a meltdown, who might be panicking, and[for]the police to show up … it creates an anxiety that exacerbates the situation in some ways,” said Gale. “They may not have any experience (cope with a mental breakdown). So what do they do? They do their best to calm the situation, often not well.”

Gale is part of a group of behavioral health experts across the country who believe rural crisis teams can fill the gaps in care left by an increase in safety net hospital closures and physician shortages.

Take, for example, a Nebraska mother who found her son after a suicide attempt in 2018. She did what many would have done and called 911.

The man, who had a history of depression and anxiety, was placed in a Nebraska jail cell for stealing pills from a pharmacy, according to an email redacted by the Lincoln Police Department.

Yet the local police knew they needed to contact the crisis team, providing background information and how to follow up.

The composition of the crisis teams appears to differ according to the mix of local resources available. Some employ specially trained workers to respond to 911 calls. Other times, police officers refer patients to mental health teams.

Julia Hanneken, a licensed clinical social worker for the Frontier Health team serving rural Tennessee and Virginia, performs telehealth assessments after being called from local schools or emergency rooms.

“It takes the pressure off other areas of the health care system,” he said. “(Doctors) are able to focus on medical emergencies and can rely on us for mental health.”

Solve problems

Program trials across the country have shown significant success. The average length of stay in an Indiana emergency room dropped from 18 hours to just 40 minutes after creating a 24-hour response line where trained crisis personnel could make assessments over the phone, Gale said.

An Oklahoma program that diverted calls from law enforcement agencies to a community health center has had surprising results. Mental health physicians increased the number of adults they see by more than 76 percent, reducing hospital visits by 80 percent between 2015 and 2019. The program also saved $718,000 in local law enforcement costs.

Another Nebraska program refers people with mental illness to a group of trained volunteers with a history of mental illness or substance abuse. This peer-to-peer program has significantly reduced the number of mental health calls over time, by at least 30% within the third year of its implementation.

Proponents attribute these findings to more than just the momentary cure. Workers build relationships with people with chronic mental illness over time, helping to reduce loneliness that can exacerbate symptoms.

While the technology that enables these teams is important, “the magic” is the process, John Cantwell told researchers studying the Oklahoma program. “Calls have to be answered every time and quickly,” he said. “And whoever calls must ask for help. It can’t be empathy; it must be troubleshooting.

However, all involved in these teams said that a shortage of workers, lack of internet access and barriers to transport prevent them from helping everyone.

“Unless we believe we can get the suppliers we need in the near future and afford to do that, we don’t have a solution,” Gale said. “Response to the crisis is crucial. … And every community needs it.”

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