1. The Evolution of Crisis Care: A Community Solution
Presented by Heather Champion and Mark Severns of Spindletop Center

2. “ER flooded with psych”
Timeline of events:
Local private hospital announced closure of behavioral health unit. Community would lose substantial number of inpatient beds.
Regulatory Issues
“ER flooded with psych”
Huge financial losses
Countdown to Crisis

3. Timeline of events: Public Sector Participants
LMHA – Spindletop Center
County officials
Law enforcement agencies
Private Sector Participants
EMS – Acadian Ambulance
Hospitals
Baptist Behavioral
Christus St. Elizabeth
The Medical Center of Southeast Texas
Jefferson County Judge holds courthouse meeting of stakeholders to brainstorm solutions.

4. LMHA letter
Pursuant to Texas Administrative Code as the local mental health authority, Spindletop Center invokes it’s power to designate all emergency departments as “suitable psychiatric facilities.”

5. Following LMHA letter, participants began to work together.
A plan was developed
Everyone had “skin in the game”
No one entity must bear the burden alone
Risk to all is too great – failure is not an option
Compromise is the key

6. Our Model of Community Crisis Intervention
Spindletop catchment
Chambers County
Hardin County
Jefferson County
Orange County
Divided into 2 zones
North Zone
South Zone
Five hospitals rotating on-call psychiatric response within emergency department
Law enforcement and County officials divert to on-call ER
LMHA embeds crisis interventionists in ER
Our Model of Community Crisis Intervention

7. 5 original hospitals eventually reduced to 3 largest hospital emergency departments
Increased MCOT staff, added 12-hr shifts, meshed MCOT with MH Deputy team
Struggles to incorporate tele-health and make it work
Complex HR requirements for new contract staff in emergency departments
EMS – voluntary patient’s right to choose
Personalities, personalities, personalities!
Lessons Learned

8. Lessons Learned Allows on-call hospital to “ramp up” resources
Addition of crisis intervention specialists in ER at no cost to hospitals
Improved communication among participants
Expedited placement for inpatient needs
Better diversion of inappropriate hospital admissions to alternative resources w/in community
Lower recidivism rate
Law enforcement better educated on MH needs
Lessons Learned

9. Is it still working?
Law Enforcement
LMHA ER
In the first year of our collaborative model, 1,256 unique individuals were served.
Baptist Behavioral Hospital has been able to remain open.
By incorporating LMHA staff in the ER, we have also increased awareness of outpatient alternatives to hospitalization.

10. How have we evolved? Crisis Stabilization Unit State beds
10 new beds for diversion from inpatient
Generous in-kind donation from Baptist
State beds
9 state funded beds under LMHA authority
Housed within Medical Center of SETX
MH Deputy Team and MCOT merged
PSA addressing synthetic marijuana epidemic
Task Force to address “super utilizers”
How have we evolved?

11. With great power comes great responsibility
Moving into the Future
Tracking data including trends in volume, type of crisis, disposition
Utilizing the data to identify preventive measures and better solutions
Sharing data across systems
Pooling resources to create a regional psychiatric crisis center
With great power comes great responsibility

12. Can we do that too? Identify Partners Brainstorm
Don’t leave anyone out
Public & Private entities
It doesn’t hurt to ask
Get the “authorities” involved
LMHA/LIDDA
County officials
Law enforcement
Be open to all possible solutions
Don’t be afraid to fail…or to succeed
Keep communicating, even when it hurts
Get in their face, literally
Build upon the uniqueness of your community
Can we do that too?