HJBR May/Jun 2022

LDH CORNER COLUMN LDH CORNER How a NewMental Health Crisis System of Care WILL EMPOWER INDIVIDUALS SEEKING URGENT HELP WHEN an individual is experiencing a men- tal health crisis, they need help immediately. Getting help tomorrow, a week from now, a month from now — is not an option when someone is going through the extreme distress that comes with a serious mental health episode. The healthcare system in Louisiana is oriented toward providing immediate help for a mental health crisis through an in- voluntary hospital stay, which is often a frightening, overwhelmingly negative ex- perience. So, while individuals are getting the services they need during a mental health crisis, we’re also finding that those services too often end when the person is discharged from the hospital. About half of all psychiatric hospitaliza- tions tend to be for people who are not cur- rently engaged in mental health treatment, making psychiatric hospitals and emer- gency departments the default entry points for treatment services. While Louisiana’s front-line healthcare workers are highly compassionate and competent in the care they provide, these settings are not ideal for providing therapeutic interventions or convincing individuals that long-term be- havioral health treatment is an appropriate, viable option. Involuntary treatment can often leave a person in crisis mistrustful of pital leaders expressed concern about the constant cycle of individuals returning to the emergency department every time their symptoms reached unbearable levels. In 2019, there were 40,000 hospitalizations of Louisiana Medicaid enrollees due to se- rious mental illness. Similarly, relying on law enforcement for community crisis re- sponse is an inefficient use of public safety resources. Both instances have the poten- tial to create an unnecessary reliance on involuntary psychiatric hospitalization or even, when referring to police utilization, arrest and possibly incarceration. This year, we’re proud that we are de- ploying our first crisis system of care, an approach we believe is compassionate, ef- fective, and resolution-focused. To deliver this newly minted model, we’re orienting the healthcare system toward coordina- tion, responsiveness, and efficiency. This is a huge change in the way crisis services are offered, and we know implementation of this system will take time. It is also cost ef- fective. In a study conducted of programs in Minnesota, the net benefit for mental health crisis services was around $3 million, with a savings of $2.16 for every dollar invested, while mobile crisis services in particular re- sulted in, on average, a 23% lower cost per intervention. Though the study was based the healthcare system and, in many cases, lead them to avoid the follow-up mental health services they need. How we engage a person in this critical moment not only impacts whether we resolve the immediate crisis, but also whether we are able to avert future crises. We at the Louisiana Department of Health recognized this as we began to ex- amine the need for crisis services in Lou- isiana, and implementing these services became one of our priority initiatives in the department’s fiscal year 2022 business plan. Work began by seeking feedback from those on the front lines working with indi- viduals in crisis. During this process, hos-