Mark Boschelli, LPCC , LADAC, ACS Terry Sine, LISW

1. Presbyterian Medical Services: Santa Fe County's Mobile Crisis Response Team and Same-Day Suicide Intervention Program Mark Boschelli, LPCC, LADAC, ACS Terry Sine, LISW

2. Components of PMS Diversion away from Emergency Room Crisis Hotline Two Teen Health Centers CSA; Santa Fe Community Guidance Center with a Clinical Assessor Mobile Crisis Response Team (MCRT)

3. Youth Suicide • In the USA 3rd leading cause of death for youth 15-24 • Estimated that nationally 500,000 youth attempt suicide each year • Suicide rates in New Mexico are 60% higher than national rates • Santa Fe County had the highest youth suicide rate in New Mexico (55.8 per 100,000 year 1997)

4. What we know 50% of all mental illness can be identified by age 14 75% of all mental illness can be identified by age 24 Suicidal ideation is best intervened quickly Schools are key

5. Continuum of Care for Youth in Santa Fe

6. Clinical Assessment • Welcoming • Rapport establishment • Assessment of dangerousness • Warm hand-off

7. Assessment Make a connection Assess lethality Establish relationship Discern ideation, intent and plan No harm agreement; strengthen life anchors Link with follow-up services with warm hand-off

8. Same Day Suicide Assessment Data 500 Suicide assessments in last 7.5 years Demographics are cross cultural; Primarily Hispanic Ages from 6 to 18 Gender split about 50/50 80% linkage to behavioral health services at PMS 10% re-linked to current providers 10% assessment only

9. Community Meetings • Polarizing event in 1993 mentally ill intoxicated man killed by law enforcement illustrated mental health needs in community • Citizens became outraged • Community Roundtables instituted by mayor involved law enforcement, professionals & advocates, led by a professional facilitator

10. Lessons Learned from CRSF Hotline + Mobile Teams 1997 - 2002 Mobile Face to Face contact is the key Hotline is effective to diffuse and support Crisis alleviation takes more work than one intervention Primary Care should be included Crisis intervention = successful linkage

11. Mobile Crisis Team Effectiveness Mental health and substance abuse consumers who were seen by a mobile outreach team were 17 percent more likely than those served by a hospital-based team to receive follow-up services (Johnson, March 2000)

12. The design of the Santa Fe crisis service would be modeled after the Mclean County Center for Human Services in Illinois which is ideally suited for small cities within a rural county. This model used four mental health counselors dispatched in a team of two to community mental health crises by a separate hotline staffed by trained volunteers. Spear, A. and Story, D.W. (1983). Crisis Intervention Unit, a Successful Pilot Program. Law and Order, June 22-25. Origins of Design

13. The emergency crisis mental health protocol elaborated by psychiatrist Joseph Zealberg.Zealberg, J. J. and Santos, A.B. (1996). Comprehensive Emergency Mental Health Care. New York: W.W. Norton and Company, Inc. Cuyahoga County, Ohio, there has been a measurable decrease of psychiatric hospitalizations of consumers served by a mobilecrisis team.Johnson, Jeffrey A., Ph.D. (March 2000). The Impact of Mobile Crises Services on Hospitalization and the Receipt of Community Mental Health Services.Cuyugoga County Community Mental Health Research Institute Research Brief, No. 3, pp. 5 – 6. Origins of Design

14. Mobile Crisis Response Team What Is MCRT? The Mobile Crisis Response Team (MCRT) is an emergency mental health program of the Santa Fe Community Guidance Center-PMS that provides on-scene evaluation, treatment and crisis intervention in the community. The MCRT specializes in providing these services to individuals who are experiencing and who need mental health treatment. In many of these situations there is a concern that, as a result of a psychiatric condition, the person may be in danger to self or others or may not be caring for self.

15. Mobile Crisis Response Team What Is MCRT?  While the goal of the MCRT is to enlist the individual’s cooperation and develop the least restrictive treatment options, the MCRT is authorized to recommend and facilitate involuntary psychiatric hospitalization and treatment when necessary. The MCRT specializes in responding to referrals from the Santa Fe County Sheriff, Fire and Rescue, Santa Fe Police and Fire Departments on cases where mental health consultation and intervention are needed.

16. Mobile Crisis Response Team What Services Does the MCRT Provide? Psychiatric Crisis- evaluation, intervention and treatment planning including hospitalization, if needed. Suicide Threat or Attempt- assessment, prevention and intervention with individuals exhibiting suicidal behavior. Substance Abuse Crisis- assessment, intervention, and treatment planning when imminent danger is the result of, or exacerbated by alcohol and drug abuse.

17. Mobile Crisis Response Team What Services Does the MCRT Provide? Domestic Disturbance- intervention and mediation of parent/child, marital and other interpersonal conflicts. Linkage to Services- follow-up case management services to the individuals to needed behavioral health services in order to establish a continuum of care which will dissipate further crisis incidents.

18. Mobile Crisis Response Team Making a Referral to MCRT:  The MCRT is located at the Santa Fe Community Guidance Center-PMS and accepts referrals from families, individuals, public agencies, and private organizations. The MCRT responds to cases in the County of Santa Fe, including the City of Santa Fe and Edgewood. MCRT is dispatched 24/7 from the Crisis Response of Santa Fe Hotline at (505) 820-6333 or 1-888-920-6333. Referrals are triaged by the CRSF Hotline according to imminence of risk to life. Priority is given to referrals from police/sheriff and other public safety agencies.

19. Mobile Crisis Response Team Who Makes Up the SFCGC Mobile Crisis Response Team? The MCRT consists of licensed mental health clinicians, dispatched by the CRSF Hotline, who are trained and credentialed to provide crisis counseling in the community and employed by Presbyterian Medical Services which is the Core Service Agency for the County of Santa Fe.

20. Mobile Crisis Response Team Who Pays for the SFCGC Mobile Crisis Response Team? MCRT is funded from a $350,000.00 grant through the County of Santa Fe. This is a four year grant renewed each year, thus PMS’ best effort must be evident in each and every mobile experience. Other funds include Medicaid and BHSD for mobile crisis services.

21. Staffing Plan of MCRT What does MCRT look like? 1.0 FTE Independently licensed therapist 8:00 AM-5:00 PM Monday – Friday Paired with masters level intern for mobile excursions One therapist + One Community Support Worker (CSW) on-call 5:00 PM-8:00 AM Monday – Friday One therapist + One CSW on-call 24 hours Saturday One therapist + One CSW on-call 24 hours Sunday

22. Staffing Plan of MCRT What does MCRT look like? All MCRT staff are already employees of PMS Credentialed with PMS and Health Insurance Agencies Privileged by PMS; able to perform specific clinical services Enter data into Electronic Health Record (EHR) Vested into the PMS model of helping behavioral health consumers in the community by working at a community health center. Agree with a continuum of service delivery via increasing community tenure and linkage to services Benefits include: enhancing skills in crisis services, awarded 20 Continuing Education Units (CEUs), on-call stipend and crisis pay for dispatch

23. MCRT response into the community: 20 minutes SFCGC @ 2690 Rodeo Park Drive West MCRT dispatched from SFCGC Monday – Friday 8:00 AM – 5:00 PM and link to First responders and Law Enforcement at the scene After-hours MCRT staff dispatched from their home and link to First Responders and Law Enforcement at the scene CRSF Hotline will log time of call MCRT will log time of dispatch and evacuation from scene into EHR

24. Partnering with First responders Working with law enforcement: The Teachable Moment Introduce self and partner Probe for any information from First Responders Review and predict what you are possibly dealing with Intervene Brief the First Responders, and add discussion of the mental illness and/or substance abuse issues being exhibited “Teachable Moment” in order to increase awareness to the First Responders on the scene how to work with an individual in a behavioral health crisis. Suggest and partner outcome with Law Enforcement and First Responders

25. MCRT 7 Months Data July 1, 2015 – Feb 1, 2016 3 Rounds of clinical training held at SFCGC resulting in 18 licensed clinicians and community support workers qualified to be on MCRT 39 presentations to shifts of Santa Fe Sherriff’s, Santa Fe County Fire, City of Santa Fe Police, Santa Fe Fire, NAMI-SF, and BHSD of NM. Article submitted to Crisis Magazine to be published by the National Council on Mental Health MCRT is now an internship host for universities in order to increase workforce development in behavioral health $23,000.00 of mobile crisis services billed to MCOs and BHSD and $4000.00 collected

26. MCRT 7 Months DATA July 1, 2015 – Feb 1, 2016 MRCT Report, December 2015                      Year to Date Total Number of Call-Outs                                  172 Of Total Call-Outs, Number Mon-Fri, 8-5             95 Number of In-House/Walk-in Crisis                      49(Alternative to ED) Phone Call Crisis                                                 12 Clients Referred/Linked for Behavioral Health Tx229

27. MCRT 7 Months Data July 1, 2015 – Feb 1, 2016 MRCT Report, December 2015                      Year to Date Number in Need of Respite Housing                19 Facilitation of Client into Hospital                       20 Number of Client Call-Outs, Contacts, Follow-ups 303 Number of Deaths of MCRT clients 0