Crisis Access Points exceeded expectations in the first year of a state program designed to ease the burden on first responders, said Lauren Bruce, Compass Health Network’s senior director of crisis stabilization.
The hotspots, formerly called crisis stabilization centers, are places where people experiencing a behavioral health crisis can access care without having to go to an emergency room or encounter law enforcement.
“They did really great. It was a really wonderful project,” said Bruce. “We had a rough idea of what we were getting into when we first started. It’s evolved and transformed and it’s really fantastic.”
Starting from somewhere
Until recently, law enforcement’s only choice was to transport someone experiencing a crisis to a hospital or jail, especially on weekends or after hours.
Institutions are not always the most appropriate destinations for patients, according to Compass Health Network staff. But access points are places where patients can get the care they need. They are not “drop off” sites. The points are designed to connect patients with case specialists and mental health professionals if needed.
Expanding existing access points, which were mostly localized public/private partnerships, Missouri Gov. Mike Parson included about $15 million in his 2021-22 budget to create six new access points and maintain five existing sites (such as the Center for Assessment and Triage in Kansas City, Springfield’s Burrell Behavioral Crisis Center, and Joplin’s Ozark Center). Seven actually opened in 2022.
The hotspots are meant to be places where people experiencing crisis can be diverted instead of ending up in emergency rooms or involved with law enforcement. Clients are connected to case managers who are responsible for ensuring that clients receive follow-up care.
One of the new access points is in Jefferson City.
The Jefferson City facility, which occupies the bottom floor of Compass Health’s office, has four “slots” — recliners where patients can rest or sleep. Access points are mandated to support clients for only 23 hours. Behavioral health clinicians can triage patients arriving at access points. Entering patients can shower, eat something and wash their clothes.
Patients can get new (for them) clothes.
“You never know – sometimes a hot shower and a pair of sweatpants is the best way to get your day back on track,” Bruce said. “We have a lot of people – they can come in. Take a hot shower. Dress comfortably. Return to the block and exit. Then we can start to tackle whatever the problem is.”
A year of care
In its first year in Jefferson City, the access point served people in 984 encounters, according to Bruce.
Of those, 740 of the encounters were unique customers, she continued.
Debra Walker, director of public affairs for the Missouri Department of Mental Health, said there were 19,708 referrals in the state in 2022.
Of these, the top referral sources are: client or self-referral, emergency department or hospitals, family or friend, outpatient behavioral health treatment, law enforcement, local or community organizations, outpatient treatment, community behavioral health unit, and EMS or fire services.
“Law enforcement is our second highest referral in the (Jefferson City) area, which is great,” Bruce said.
She added that partnering with law enforcement is essential to getting clients the resources they need in a timely manner. Also, if law enforcement knows how to divert people who are in crisis to the access points, it frees up a lot of their time.
“We have an interesting data point — what is this costing the system for people coming directly to us?” she asked. “About $3.6 million has been diverted from this (legal and health) system. If you call 911 with a behavioral health crisis and they send EMS and law enforcement, there are costs associated with that. The emergency room – there are costs associated with that.”
Although the state did not provide specific data on the reasons for referrals to access points, Walker listed seven leaders: mental health crisis, substance-induced crisis, co-occurring substance-induced crisis and mental health condition, acute intoxication, suicide, suicidal harmful and dangerous to others.
Bruce said the people’s conditions featured in Compass are of interest to behavioral health professionals. She said 470 (of the local encounters) were strict mental health crises and 293 were co-occurring disorders.
“A lot of people in Missouri struggle with mental health,” she said. “The substance abuse is still there.”
Paying the bills
More than 500 clients who came to the access point in the first year were Medicaid recipients, Bruce said. She said 230 had no insurance when they arrived.
“We helped them get access to Medicaid while they were here,” she said. “The Medicaid expansion was wonderful — we were able to get 200 people to access Medicaid or the marketplace.”
The insurance status for customers using the access points across the country was as follows (there is duplication, so the total exceeds 100 percent):
Medicaid, 29.4 percent.
Uninsured, 24.2 percent.
Veterans Administration, 21.3 percent.
Private insurance, 20.7 percent.
Unknown, 15.4 percent.
Both Medicaid and Medicare, 3.2 percent.
Medicare, 3.1 percent.
Others, 2.7 percent.
Lauren Moyer, vice president of clinical innovation at Compass Health Network, said customers have shared their success stories with the provider.
Moyer said an elderly woman who had struggled with addiction for years and had recently been evicted ended up at an access point. The woman had a history of relapses, police contacts, emergency room visits, and substance use disorder care. But she never received follow-up care from a case manager.
“Once she arrived at (Compass), she was able to enter residential substance use treatment and was then placed on a life support situation with continued follow-up care by a case manager,” Moyer said. “Living alone was not healthy for her recovery and she was so grateful to have a supportive place to call home. She is now eight weeks sober and loving her sober living situation.”
She said another client — a man who had recently been released from prison — was afraid he would hit the streets, abuse substances again and die.
He asked for help but did not want to stay for treatment.
The man returned and entered outpatient treatment, used a crisis access point several times (when struggling with triggers and hunger), and participated in outpatient treatment for a substance use disorder.
He got a job, got a place to live and reconciled with his fiancee.