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MOBILE CRISIS

Presentation to Joint Legislative Oversight Committee

on Mental Health, Developmental Disabilitiesand Substance Abuse Services

Beth Melcher, PhDAssistant Secretary for MH/DD/SA Development

Department of Health and Human Services

December 8, 2010

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Mobile Crisis Team

Service Definition approved in 2006 First state appropriation in 2008 Funded by state funds and Medicaid fee for service Critical component in crisis service array Available 24/7/365Available 24/7/365 Meet the individual where they are Meet the individual where they are –– as close to a as close to a

persons home as possiblepersons home as possible Goal is to avoid Emergency Room or Inpatient Goal is to avoid Emergency Room or Inpatient

admissionadmission Currently 41 Teams covering all countiesCurrently 41 Teams covering all counties

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North Carolina RegionalMobile Crisis Teams

Western Region Central Region Eastern Region

Eastpointe

Anson

Ashe

Avery

Beaufort

Bertie

Bladen

Brunswick

Burke

Cabarrus

Caldwell

Carteret

Catawba Chatham

CherokeeClay

Cleveland

Columbus

Craven

Currituck

Gaston

Gates

Graham

Granville

Guilford

Halifax

HarnettHenderson

Hertford

Jackson

Jones

LeeLincoln

Macon

Madison

Montgomery

Moore

Nash

Northampton

Onslow

Pamlico

Pender

Pitt

Polk

Randolph

Robeson

Rowan

Rutherford

StokesSurry

Swain

Union

Vance

Wake

Warren

Watauga Wilkes

Wilson

Yadkin

Yancey

Piedmont

SoutheasternRegional Southeastern

Center

CenterPointCrossroads OPC

East Carolina Behavioral HealthPathways

Buncombe

Mecklenburg

Orange

Transylvania

Person

Cumberland

Haywood

New Hanover

Durham

Iredell

Johnston

DuplinSampson

Wayne Lenoir

Dare

Hyde

Martin TyrrellWashington

Camden

PerquimansPasquotank

Chowan

Edgecombe

Greene

The Beacon Center

Forsyth Franklin

HokeRichmond

McDowell

MitchellAlexander

Alleghany

Mental Health Partners Sandhills Center

RockinghamCaswell

Alamance

Davidson

Stanly

Davie

Five County

Scotland

Smoky Mountain Center

Western Highlands Network

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Mobile Crisis Funding

Recurring state allocations $5.7 million

Medicaid fee for service $3.1 million

IPRS $3.6 million

Non-allocated non-UCR funds $3.8 millionCost per episode of care approximately $552

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Mobile Crisis Team Staffing

Psychiatrist availability Substance Abuse staff (CCS,CSAC,CCAS) QP who is a Nurse, CSW, or Psychologist QP or AP with experience in Developmental

Disabilities Other team members may be non-licensed

qualified professionals and paraprofessionals

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Accessing Mobile Crisis

Crisis Call to LME STR Direct Call From

Law Enforcement Magistrates Behavioral health providers Non-behavioral health providers Emergency Room

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Mobile Crisis Activities Provide support to decrease crisis and allow individual to

remain in their home Crisis Assessment (including assessment of appropriate

setting for continued care of patient based on risk factors for danger to self or others

Recommendations for behavioral management of disruptive behavior

Coordinate with police Crisis Intervention Teams Help locating an inpatient psychiatric bed if needed Coordinate services required to discharge an individual

from an Emergency Room to community based service Facilitate referrals to crisis stabilization resources, or

other community intervention services or supports Brief Treatment/Intervention Development of a Crisis Plan

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Response Location Individual’s home Schools Magistrate’s offices Urgent care centers Group homes Consumer’s Home Medical/primary care offices Emergency departments Police stations, jails, and other community

sites

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Mobile Crisis: 15,184 Total Referralsfrom January to June 2010

16%

10%

21%

2%4%

33%

2%1%

4%

2% 1%3%

0%

5%

10%

15%

20%

25%

30%

35%

Self

Family/ S

uppo

rt Sys

temLM

E STR/ Cris

is Lin

e

First R

espond

er/ Clin

ical H

ome

Other P

rovide

r Age

ncy

Hospit

al Emerg

ency D

epart

ment

Schoo

l

Social

Service

s Depa

rtmen

tLa

w Enfo

rcemen

tJu

stice

Sys

temOthe

r Pub

lic Age

ncyOthe

r/ Unk

nown

Referral Source

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Results of Mobile Crisis Interventions 15,110 episodes of service Jan15,110 episodes of service Jan--June, 2010June, 2010 Increase from 13,335 episodes of service over the Increase from 13,335 episodes of service over the

previous 6 monthsprevious 6 months 77% of dispositions were to community and 23% to 77% of dispositions were to community and 23% to

an inpatient settingan inpatient setting Dispositions to Emergency Department decreased Dispositions to Emergency Department decreased

from 5% to 4% from the previous 6 monthsfrom 5% to 4% from the previous 6 months Dispositions to Facility Based Crisis increased to 6% Dispositions to Facility Based Crisis increased to 6%

from 5% over the previous 6 monthsfrom 5% over the previous 6 months Dispositions to Hospital inpatient setting decreased Dispositions to Hospital inpatient setting decreased

from 31% to 23%from 31% to 23%

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Mobile Crisis: 15,110 Total Dispositionfrom January to June 2010

36%

5%4%

6%

4%

21%

2%1%

2%

19%

0%

5%

10%

15%

20%

25%

30%

35%

40%

CurrentSetting

AlternativeNaturalSupport

Referral toMedical/

EmergencyDepartment

Facility-Based Crisis

CommunityDetox

CommunityHospital

(psych unit)

StatePsychiatric

Hospital

State ADATC Jail orDetention

OtherDisposition

Disposition

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Questions?