1 December 8, 2015 Crista M. Taylor, LCSW-C Director, Information, Planning and Development Adrienne Breidenstine, MSW Director of Opioid Overdose Prevention and Treatment Strengthening Baltimore City’s Behavioral Health System

Who is BHSB? Established by Baltimore City to perform the governmental function of managing Baltimore City’s behavioral health system Serves as the local behavioral health authority for Baltimore City 2

What is a Behavioral Health System? The system of care that addresses emotional health and well-being and provides services for individuals with substance use and/or mental health disorders 3

Areas of Work BHSB works to – Improve access to a full range of quality behavioral health services – Advocate for innovative approaches to prevention, early intervention, treatment and recovery – Improve quality in service delivery – Promote public education 4

Impact of the Work 5 Individuals Families Communities Housing Mental Illness Trauma Physical Illness Poverty Substance Use Employment Jail/Prison Schools

A Public Health Crisis 6

National Overdose Deaths Number of Deaths from Prescription Drugs

National Overdose Deaths Number of Deaths from Heroin

Baltimore City & Maryland Number of Overdose Deaths

Who is At-Risk of an Overdose Any person who: Is known to be using drugs or has a history of substance use Has previously overdosed Receives opioids for acute or chronic medical conditions: respiratory, renal, hepatic Receives treatment for a substance use disorder

Opioid Overdose Prevention Improve the entire behavioral health system: – Promote public education – Promote best practices & standards of care – Improve access to services & treatment

Public Education 12

What We Are Doing – Public Education Overdose Education & Naloxone Distribution As of October 2015:  477 trainings  6,699 people trained  4,457 naloxone kits distributed

What We Are Doing – Best Practices Prevent Opioid Misuse & Abuse Prescription take back boxes Expand Access to Naloxone Standing Orders Physician Prescribing Practices Opioid Treatment Programs Develop a Trauma Responsive System Healing circles Learning community Social marketing campaign and website Training clinicians

What We Are Doing – Access Improving access points in the system Buprenorphine – Mobile induction – Expanding to mental health clinics Crisis Information and Referral line – Expanded to 24/7 coverage – Integrated with the city’s crisis hotline – Ready access to residential crisis and detox – Warm handoff and follow up

What We Are Doing – Access Improving access points in the system Law Enforcement Assisted Diversion (LEAD) Program – Pilot model adopted by a select group of cities – Establishes criteria for police officers to identify eligible substance users – Divert to an intake facility that connects them to necessary services rather than to central booking for arrest Planning group Seeking funding

What We Are Doing – Access Enhancing the crisis response system – A comprehensive crisis response system is the backbone of any successful behavioral health system – Serves as a primary access point – A good crisis system: Integrated - substance use and mental health Reduces harm including death Reduces overall costs Trauma informed Works closely with police and EMS

Stabilization Center Community-Based, 24/7 voluntary care for adults who are intoxicated – alcohol and drugs Safe place to sober and get connected to services Average length of stay - 4 to 6 hours Referral Options: – Alternative transport option for EMS – Direct referral from ED – Developing protocol for others to refer – police, homeless outreach workers, etc. Will integrate data across systems – EDs, crisis teams, EMS

Stabilization Center 3.6 million secured from the State Legislature for capital improvements Location – site identified; partnership with a local FQHC Protocol approved for alternative transport for EMS Developing protocols for center operations Planning for data infrastructure Actively looking for operating costs first aid – A bed in which to sleep – Medical monitoring (including withdrawal scores and vital signs) – Hydration and electrolyte replacement – Food, clothing and showers – Screening, brief intervention, and referral to treatment for substance use, mental health and physical health disorders – Case management for up to 30 days after a visit to ensure linkage to needed services, including behavioral health treatment, shelter, income, insurance, health care, etc. – Average length of stay of 6 to 10 hours

We Need More Treatment on Demand for both Mental Illness and Substance Use – 24/7 mobile crisis response – 24/7 walk-in “urgent care center” – More detox – More residential supports – More peer support – More case management

Questions Crista Taylor Adrienne Breidenstine 21