Virtual-Mobile Crisis Intervention

Program Description

In late 2016, Behavioral Health Response (BHR) launched the Virtual-Mobile Crisis Intervention (V-MCI), a program to improve Crisis Intervention services and reduce unnecessary diversions of persons in crisis to emergency departments and jails. Partnering with the St. Louis County, MO Police Department, law enforcement officers are equipped with iPads to connect in real-time with behavioral health specialists to obtain live assessments and appropriate referrals for persons in crisis. Building on its 24/7 crisis hotline infrastructure, a BHR phone clinician handles the initial call and immediately connect a member of the V-MCI team with the on-scene CIT officers to provide the support, triage and disposition planning. In addition, BHR provides follow up case management services to all persons who receive a V-MCI assessment utilizing BHR’s clinical follow up coordinators. BHR remains connected to individuals assessed via the V-MCI until the individual is linked to community based mental health services. Substantial cost savings are anticipated for behavioral health, law enforcement, courts, and hospitals, while improving the lives of those in crisis. BHR is located in St. Louis, Missouri with a 22 year history of providing telephonic, text, chat, video, follow up & mobile crisis intervention services.

Creativity

The St. Louis County Police Department CIT program is considered highly successful by the community and the regional system of care. Currently, St. Louis County CIT officers respond to approximately 5,000 calls per year with 90% of those calls resulting in the individual being transported to an ED for a mental health evaluation. While BHR’s mobile crisis team responds when requested, BHR’s response time of 1 hour is a barrier for a CIT officer who needs a much more rapid response time. Under the V-MCI program, the St. Louis County CIT officer makes a determination of appropriateness for the intervention and initiates with BHR a real time assessment, reducing an hour response time to just a few minutes. The simplicity of the program, equipping officers with iPads and connecting consumers in real time, 24/7/365, with BHR’s crisis staff and follow up case management improves timeliness and appropriateness of care.

Leadership

In 2012, Burrell Behavioral Health, under the direction of Paul Tomlison, PhD, introduced the V-MCI in conjunction with the Springfield, MO Police Department. Now known as the “Springfield model,” this was believed to be the first intervention of its kind in the nation. As the creator of the “Springfield Model,” Dr. Tomlison has worked with BHR on both the creation and evaluation of the V-MCI program. While the V-MCI program is considered a demonstration project, it is a proven successful model in southwest and Central Missouri. In 2015, Dr. Tomlison presented on the V-MCI program to the Missouri CIT program in which BHR was present and inquired about replication. Additionally, United States Senator Roy Blunt, Co-Sponsor of the Excellence in Mental Health Act, encouraged and supported BHR’s replication of the program in the St. Louis area.

Sustainability

BHR was funded by the Missouri Foundation for Health to create and implement the Virtual Mobile Crisis Intervention program. The 3 year funding award will allow BHR to assess up to 1,248 St. Louis County residents per year. Under this program, BHR has established memorandum’s of understanding with both the St. Louis County Police Department and Burrell Behavioral Health. The St. Louis County Police Department assisted in the creation of policies and procedures for the program and provided training to appropriate personnel on the use of the iPads and the purpose of the program. Burrell Behavioral Health provided best practices, processes and procedures for implementation of the V-MCI program and their grants and research staff members involved in the development of the V-MCI program will provide an annual program evaluation. At the end of 3 years, BHR intends to continue the V-MCI program utilizing the iPads purchased at program’s onset.

Replicability

Nationwide, law enforcement routinely intercept individuals exhibiting signs of an emotional distress. In many cases, individuals in crisis are diverted to inappropriate settings (emergency rooms, jails). Timely interventions most often thwart unnecessary incarcerations and hospitalizations, but it takes precious time to obtain a mobile response from mental health professionals even when crisis mobile response services are available. Also, the need for this service is high and the cost to behavioral health agencies, county or state health systems is often prohibitive. The V-MCI model BHR adapted from Burrell Behavioral Health was ready out of the box with minor process tweaks for BHR and the St. Louis County Police Department. BHR intends to collaborate with other police departments in the St. Louis Metropolitan area well as offer the real time V-MCI intervention nationwide to police departments and access crisis intervention providers.

Results/Outcomes

Currently, it is estimated that over 4,000 persons in crisis are being transported to EDs by St. Louis County CIT officers. BHR’s mobile outreach team responded to 132 CIT requests from July, 2015 to June, 2016 and diverted over 81% of those persons from the hospital. The ability to provide CIT officers with a more timely and efficient mental health evaluation is significantly reducing the number of persons being transported to the hospital. BHR anticipates providing 1,248 V-MCI assessments per year while successfully diverting 749 (60%) persons from the EDs measured by BHR and police tracking of case disposition and connecting 749 (60%) of persons receiving CIT response with ongoing community based services measured by reports and verifications that persons are successfully engaged with services. BHR also intends to reduce the number of CIT response recipients receiving multiple CIT responses from 375 (30%) within a year to under 250 (20%).