1. Crisis services are required core services IAC 331.397 Chapter 24

2. The Need for Crisis Services in Iowa
25% of Iowans will have a diagnosable mental illness over the course of a year
6% of the population has a serious mental illness
Suicide is the second leading cause of death for Iowa 15 to 24 year olds, and 25 to 44 year olds.
Over an 8 years period of time 1,568 people committed suicide in rural counties of Iowa, versus 1,382 in the state’s urban parts.
Interesting statistic 1,568 people committed suicide in rural communities vs. 1,382 in Urban

3. Community Participation in Development of Crisis Plan
Met 3 times with community
Met 3 times with providers
Met with the Regional Advisory Committee
Three Regional Governing Board members participated in planning
We had several meetings discussing the crisis services that are needed throughout the region.

4. Crisis Services Defined in the Code
Crisis screening
Assessment requirements  
Twenty-three-hour crisis observation and holding
Twenty-four-hour crisis line
24 hour crisis response
Crisis stabilization residential/community based services
Mobile Crisis response
Warm line
Already have in region
Wait to see if data
demonstrates a need
Already have. Need to expand region wide
The regional advisory committee saw the importance of all services. #1 & 2 we are already funding. # 3 We are going to hold off and assess the need. So we are basically looking at #4 – 8
New Service

5. 24 Hour Crisis Line and Warm Line
24 hours per day.
screened and counseled
refer to the mobile crisis unit, other resources, or services if needed.
Warm line Peer response
Short term
Non directive support to assist the caller

6. Mobile Crisis Response. (Expansion)
Training will be provided using a nationally accredited model so the same service is provided throughout the region.
How does it work?
A call comes in.
2. Dispatch will send provider to the scene.
Assessment will be completed to determine level of care needed.
Person will be stabilized at home, transferred to a crisis bed or transported to the hospital.
Washington County Pilot
23 people received crisis services
2 went to the hospital
1 went to a detox facility 
87% were diverted from the hospital
The cost for mobile Crisis is already in the budget for Linn County and Partially funded in Dubuque.

7. Crisis Stabilization Services Residential and Community (Expansion)
Residential short term beds:
Goal is to stabilize the individual and return them to the community
Stay up to five days.
set up a place to live if needed,
set up with community support services
set up with psychiatrist and medications
Community:
Goal is to stabilize the individual in their home.
Services set up including but not limited to psychiatric, medication, counseling, peer support and linkage to ongoing services.
Start with 4 beds with the ability to expand to 8 for the region if needed.

8. Mobile Crisis Dispatch
Warm line
Crisis Line
Mobile Crisis Dispatch
Mobile Crisis staff goes to a location anywhere in the region and does the assessment
The person can call the warm line or the hotline or they can call mobile crisis directly.
Outcome 1
Resolve the Crisis $
Outcome 2
Crisis Bed or stabilize in home $$
Outcome 2
Crisis Bed or stabilize in place $$
Outcome 3
Hospitalization $$$
Outcome 3
Hospitalization $$$

9. 2014 regional costs following hospitalization
Crisis Line
This is how most of the region looks today.
In a crisis situation there is nowhere to go except to the most expensive service(s).
The person can call the warm line or the hotline or they can call mobile crisis directly.
Outcome 3
Hospitalization $$$
2014 regional costs following hospitalization
$11,719,894.

10. Additional Costs to Expand Crisis Services
Cost for
FY 2015
Warm Line
$30,880
Chat and Text
$107,354
Hotline
$130,511
Mobile Crisis Coordination
$83,089
Mobile Crisis Service
$157,175
Crisis Stabilization
3 additional beds
$246,375
Total
$755,384
Sustainability:
Decrease commitment and long term care costs.
Use the savings that comes from diversion to fund future crisis services.
10% diversion = $1,171, savings which pays for the service.
2. Medicaid will eventually fund part of the costs.
3. If necessary, drop the service. No current clients and no provider expansion.