1. CRISIS SERVICES FOR SUBSTANCE USE DISORDERS KEN BACHRACH, PH.D., CLINICAL DIRECTOR TARZANA TREATMENT CENTERS KBACHRACH@TARZANATC.ORG

2. What are SUD Crises?  Acute intoxication or withdrawal that could lead to serious medial complications (e.g., seizures)  Individuals with both SUD and serious mental health symptoms, who may or may not meet criteria for 5150 admissions  Homeless individuals with severe SUDs and often co-occurring mental health disorders  Individuals who are arrested by law enforcement due to their SUD behavior for whom there is no other placement than jail  Individuals who meet criteria for 5170 admissions

3. 5170. When any person is a danger to others, or to himself, or gravely disabled as a result of inebriation, a peace officer, member of the attending staff, as defined by regulation, of an evaluation facility designated by the county, or other person designated by the county may, upon reasonable cause, take, or cause to be taken, the person into civil protective custody and place him in a facility designated by the county and approved by the State Department of Alcohol and Drug Abuse as a facility for 72-hour treatment and evaluation of inebriates. 5176. The Board of Supervisors in each County must adopt a resolution stating that suitable facilities exist within the County for the care and treatment of inebriates and persons impaired with chronic alcoholism, and designate the facilities to be used for 72-hour treatment and evaluation. 5170 Admissions

4. Sample Cases  A family member presents with a patient who is highly agitated, fidgety, has pressured speech and reports using methamphetamine. The family member reports he cannot control the patient and is seeking help.  An individual is intoxicated on alcohol and states he is homeless and has no where to go. He has bruises from a recent fight and fall and reports multiple medical issues. The police pick him up.  A heroin user presents as very lethargic and indicates that he is tired of using and “wants to give up” on life. Further inquiry reveals many depressive symptoms.

5. Services Needed for Patients with SUD Crises  Inpatient/Residential Detox  Withdrawal management  Psychiatric stabilization  Residential Rehabilitation  Engagement, Stabilization, Relapse Prevention, Recovery Services  Medication Assisted Treatment  Stabilization and relapse prevention- alcohol and opiates  Discharge Planning for next level of care

6. What is Needed  Treatment on Demand  Expanded Admitting Hours to include evenings and weekends  Resources  More staff to address expanded hours  Parity with rates provided in the mental health system  Housing following crisis services  Transportation  Ongoing coordination of mental health and primary care services – behavioral health homes

7. Integrated Services and Care Coordination SUD Services Detoxification Residential Rehabilitation Partial Hospitalizatio n/Day Treatment IOP / Outpatien t Maintenanc e/MAT Housing Mental Health Acute Psych Hospital/S tabilizatio n Intensive Outpatien t Outpatien t Housing Primary Care 5 General Clinics 2 Specialty HIV HIV Services Medical Clinics Preventio n & Testing Case Manageme nt Jail In- Reach Mental Health SUD Services Home Health Care Housing IT/EHR/ AVATAR Integrate d Treatment Plan Care Coordination Electronic Prescribin g Telemedici ne Assessment / Case Management Community Assessment Service Centers Case Management in Hospital EDs Tarzana Treatment Centers’ Integrated Continuum of Care

8. Cost-Effectiveness  Many individuals are only open to SUD services when in a crisis  Historically only 1 in 10 patients with SUDs are in treatment at any one time  The cost of ER visits, hospitalizations, crime, incarceration and lost productivity are much more than the cost of treatment

9. NEED TO PREVENT TO CYCLE OF CRISIS SERVICES  Most SUD patients get fragmented care  They show up in Emergency Departments, Hospitals or are arrested and detained by law enforcement  There is no integration of care with mental health and primary care  There is little sharing of health information through Health Information Exchanges (HIEs) and Electronic Health Records (EHRs)  These patients need Behavioral Health Homes

10. Recommendations  Make sure there is the full continuum of care for SUD services, including inpatient/residential detox and MAT services  Have providers who can provide “enhanced” and integrated services for individuals with SUD and MH needs  Integrate or at least coordinate primary medical care into behavioral health services  Increase the supply of housing for individuals leaving crisis services  Distribute these services across the County and State and identify holes in the delivery system

11. Recommendations  Contract across counties to share limited resources (e.g., TTC has contracts with Ventura, San Bernardino, and Riverside Counties)  Provide resources for 5170 holds  Reimburse for transportation services  Use tele-health for crisis assessments, when possible  Fund SUD services adequately in order to provide quality care, so it has at least parity with services provided in the mental health system

12. Thank You!