project crisis has no schedule 2013 10
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October 2013 presentation on Era of Crisis is NOW (YouTube) - http://bit.ly/Crisis-NOW The era for crisis is Now. A combination of factors, including concerns for public safety based upon recent tragedies, an enhanced focus on decreasing ER and inpatient utilization and cost savings and an emphasis on trauma informed care are creating a new prioritization of integrated crisis systems. In 2014, National Council will launch a special steering committee and host a crisis track at its Washington DC conference in May.TRANSCRIPT
A Crisis Has No Schedule: The Era for Crisis is NOW
DAVID COVINGTON, LPC, MBA—CRISIS ACCESS, LLC
crisisaccess.com
Aurora, Colorado
Polling Question #1Virginia Tech, Columbine, Tucson, Aurora, Newtown… We should do the following:
A. Double Mental Health System CapacityB. Ban Assault Rifles ImmediatelyC. Dramatically Expand MH First AidD. Create Robust, Integrated Crisis SystemsE. All of the AboveF. None of the Above, as Tragedies Are
Unavoidable
55 Years of Crisis Services
First Crisis Services in US
Edwin Shneidman
CIT Law Enforcement Training
Response to shooting death of person with mental illness by Memphis police
Sam Cochran and Randy Dupont with NAMI
40 hours mental health and de-escalation
Now in 40 states and 2,000 jurisdictions
Legislative response to shooting death of family members by person with mental illness
Board of Directors four local CMHCs
Joint Effort in St. Louis
Harris County MHMRA
Statewide Crisis & Access Line
Single Point of Entry concept led to GCAL
Hurricane Katrina in 2005
Scheduling, Dashboards and Analytics
Crisis Response Center Tucson
2006 community bond packages $54 million
CPSA and University Physician’s Hospital
Co-located Call Center, Stabilization and more
Phoenix’s Full Array of Services
Peer Warm-line, Crisis Line & Mobile Crisis
24/7 Outpatient & Co-located Residential
Detox, Crisis Stabilization & Psych Inpatient
Above, Community Bridges
Colorado’s Integrated Vision
Peer Warm Line
Crisis Line
Mobile Crisis Response
24/7 Walk-In
Crisis Stabilization
Crisis Respite
Why Now? External Forces Demanding Better Crisis Care
On gun violence, Americans now more likely to blame mental
health system over gun laws, a shift since 2011’s Tucson tragedy.
Importance of Mental Health in Public Safety
Polling Question #2Without community based mobile crisis services law enforcement and ERs will hospitalize individuals:
A. The Same Amount as if Those Services Were Available
B. Less Likely to HospitalizeC. 2x More LikelyD. 3x More Likely
“SB 82 [found] that 70% of people taken to ERs for
psychiatric evaluation can be stabilized and transferred to a less intensive level of care. ”
Investment in Mental Health Wellness Act of 2013
California Senate Bill 82
The ADA & People with MI
Department of Justice
Professional Orientation
Risk Assessment Standards
John Draper
Polling Question #3People have a right to suicide. We should do everything possible to engage someone at risk but not invasively intervene if they do not want our help.
A. Strongly AgreeB. AgreeC. Don’t KnowD. DisagreeE. Strongly Disagree
Imminent RiskNSPL defined “Imminent Risk”:
Staff believe the person’s current risk status/actions could lead to suicide
Staff sense an obligation/immediate pressure to take urgent actions
Individual has both a desire and intent to die and has the capability of carrying through
Emergency InterventionNSPL provided Nine Guidelines for Active Rescue:
Active Engagement Least Invasive Intervention
Initiation of life-saving services for attempts in
progress
Supervisory Consultation
Active Rescue Caller I.D.
Confirmation of Emergency Services Contact
Procedures for Follow-Up When Emergency Services
Contact Is Unsuccessful
Third-Party callers Collaborative Relationships with Local Emergency/Crisis
Services Provider
“From the very beginning I felt like she was an ally... It felt safe to really, really
open up to her because she accepted me as I was, where I was. She listened to me and she heard me. . . I felt like she was a
partner, working with me - and it felt safe…”
Engagement & Collaboration
Polling Question #4Individuals in crisis often feel out of control and seclusion and restraint are appropriate treatment interventions that help reduce anxiety and provide safety.
A. Strongly AgreeB. AgreeC. Don’t KnowD. DisagreeE. Strongly Disagree
Recovery & Trauma
Trauma Informed Care
Seclusion & RestraintIn 2000, Charles Curie won the Harvard Innovations in American Government Award for a Pennsylvania state hospital initiative that viewed seclusion and restraint as a treatment failure rather than an acceptable best practice intervention.
Recovery Response Center
No Force First1. Define the use of force and coercion
as a treatment failure2. Train staff in effective de-escalation
techniques3. Debrief coercion and force and
include the service recipient4. Perform critical incident reviews5. Track and report all types of forced
interventions and provide feedback to staff
6. Use active outreach, engagement and peer support
7. Describe relationships as “risk sharing”
Follow-up & Chain of Care
Follow-Up Research
Madelyn Gould
Jerome Motto’s “caring letters” found a simple follow-up letter expressing concern following a hospital discharge reduced suicide attempts.
Madelyn Gould’s follow-up calls to persons contacting Lifeline found 54% indicated that the calls helped significantly with keeping them from killing themselves.
The research has demonstrated that isolation and lack of connectedness elevate suicidalityconsiderably. Knowing that someone cares helps persons feel less isolated.
Coordination of Care
Richard McKeon
Potential of High Tech Solutions
Air Traffic Control
Single Point of Entry and Secure Communication and Coordination of Care
National Council Steering Committee
Contact UsNational Council Crisis Steering Committee Co-Leads
Social Networking
http://www.linkedin.com/in/davidwcovington
https://twitter.com/davidwcovington
https://www.facebook.com/david.covington
http://www.youtube.com/davidcovington
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