Better Coordination Needed for Mental Health Emergencies, House Panel Told

WASHINGTON — Better coordination between police departments and mental health providers is needed to help those having mental health crises, witnesses said at a House hearing Thursday.

“Communities in Connecticut and across the country do their best to patch together various types or levels of mental health response with insufficient resources,” said Charles Dike (pronounced Dee-KAY), MD, medical director of the Connecticut Department of Mental Health and Addiction Services. “This patchwork typically relies too much on emergency rooms and police departments, and can result in patients languishing in emergency rooms, criminalization of persons with mental health and substance use disorders, and at times, the unnecessary and tragic loss of life.”

Dike was speaking at a hearing on building a robust crisis response system in mental health emergencies that was sponsored by the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies.

Instead, he continued, “the ideal system provides a person in crisis [with] someone to talk to, someone to respond, and a place to go.” Dike provided specific examples of each. “Crisis call centers provide someone to talk to, and should be regional, 24/7, clinically staffed hubs … Mobile crisis teams provide someone to respond and should be available to reach any person experiencing a crisis throughout a defined service area, in his or her home, workplace, or any other community-based location in a timely manner … Crisis receiving and stabilization facilities provide places to go to, to receive appropriate care. They provide short-term 24-hour observation in a home-like, non-hospital environment.”

“988” Hotline Coming

Robert Gebbia, CEO of the American Foundation for Suicide Prevention, expressed optimism about the new nationwide “988” mental health hotline set to debut in July 2022. “988 will connect callers to the National Suicide Prevention Lifeline, which consists of a network of over 180 local- and state-funded crisis centers across the U.S.,” he said. “Counselors at these centers answer millions of calls and chats from people in distress coming through the lifeline every year … The lifeline is a key component of crisis response, and it will need increased funding to meet the anticipated increase in call volume when 988 is promoted and available nationwide.”

Tonja Myles, a certified peer support specialist and community liaison at the Bridge Center for Hope in Baton Rouge, Louisiana, spoke of her own experience. “During a challenging time in my marriage of 27 years, my husband and I separated and I felt like a failure,” she said. “I felt hopeless and alone, and felt like my life was over. I felt so ashamed because my husband and I are leaders in the community and people seem to look at us and think that we have a perfect life.”

One night she wrote goodbye letters to family and friends, got some pills, and got into her car “to find a place where I could die in peace, easily be found and be laid quickly to rest,” she said. Eventually, a police officer intervened and de-escalated the situation. “I was able to go to the hospital that day for 7 days,” said Myles. “I can probably say I haven’t had a suicide attempt or thought for the last 5 years, and that’s because I’m going to treatment … I have a continuum of care. There’s a lot of people like me who don’t have that, and we have to change that. And I believe we can.”

Mobile Crisis Response Team a Success

Chris Richardson, associate director for criminal justice services at the Mental Health Center of Denver, described the mobile crisis mental health response team he helps to lead in that city, known as Support Team Assisted Response, or STAR. The team responds to “low-risk, low-acuity” 911 calls, many of which are related to substance use and mental health concerns.

“Dressed in street clothes, we provide direct clinical de-escalation and a community service connection, as well as on-demand resources, such as water, food, clothing, and basic living supports,” Richardson explained. “When STAR pulls up, the individual can be assured that interaction is grounded in a harm-reduction, trauma-informed philosophy with people able to creatively meet whatever needs they are presenting.” Over the past 11 months since its June 1, 2020 launch, STAR has successfully responded to 1,323 calls “and there has not been a single arrest, no injury, and no need for police backup,” he said.

Committee chair Rep. Rosa DeLauro (D-Conn.) asked about the best way to reach homeless people who suffer from mental illness issues. Dike gave the example of a program in New Haven called Street Psychiatric Services. “It has a psychiatrist, a social worker, a program coordinator, a vocational specialist, and a peer support specialist, and basically these individuals spend the whole day, going to where homeless people congregate.” Because a psychiatrist is present, those who need immediate substance use treatment, such as Suboxone, get prescriptions on the spot, as do those who need other medications that are prescribed. They can also take people to a hospital or crisis respite center if needed, he said.

Rep. Jaime Herrera Beutler (R-Wash.), co-chair of the House Addiction and Mental Health Task Force, asked panelists what the biggest barriers were to access care. She noted that for patients on Medicaid who live near a state border, “crossing state lines becomes a real barrier” for mental health treatment due to rules about coverage.

“I think there are so many different things that come together in barriers, apart from the lack of adequate workforce,” said Dike. “We’ve got to pay attention to the workforce, so that we can have enough people in all the different disciplines to provide the care that is necessary. We also need to increase access in different ways, maybe by continuing the use of telehealth… And a lot of effort has to go into drumming up the support for mental health services, and support for accessing care, trying to find out what communities need” and meeting people where they are, he said.

Issues With Psychiatric “Boarding” in the ED

Rep. Josh Harder (D-Calif.) asked what could be done about the “boarding” of patients with psychiatric issues in the emergency department. “Coordination on the front end is terrific, but it doesn’t do us much good if there’s no place for people to actually go,” he said.

“It’s actually tragic that we are boarding psychiatric patients in emergency rooms,” Dike responded. “Emergency rooms are loud, chaotic, and more likely, actually, to cause more deterioration in people’s mental health than not. So the kind of services that we need would be a range of services that can cater to people at different stages,” including crisis stabilization and long-term respite care.

Rep. Lois Frankel (D-Fla.) raised the issue of those who commit mass shootings. “One of the big concerns in this country right now has been the mass shootings, and so many times it seems like somebody with a mental health issue. Is there any way to be screening for this kind of activity?”

“From a law enforcement perspective, it’s disheartening to us when we experience mass shootings, and when you really dig into the background, nearly every time there’s either family or friends or neighbors who say, ‘Well, I was worried about this person,’ or ‘He’s made some disturbing statements in the past,’ or a variety of things that should have raised a red flag,” said witness Steven Casstevens, immediate past president of the International Association of Chiefs of Police.

This calls into question whether appropriate services are available, as well as the stigma associated with having a mental health issue, he said. “If you break your leg and you have a cast on it, everybody comes running to you to sign your cast, but if you have a mental health problem — which is an injured brain instead of an injured leg — everybody runs the other way.”