NYAPRS Note: Dutchess County, in upstate New York, is rolling out a very innovative 24-hour Crisis Stabilization Center that will serve as a voluntary walk-in or police drop-off for people with serious mental health or substance use related conditions. This groundbreaking initiative is aimed at offering more responsive individualized support and a reduction in avoidable hospitalizations and incarcerations.
Another central goal of the center is fostering collaboration between healthcare providers, law enforcement, and other relevant agencies. A $4.8 million bond was recently approved to renovate the county’s Mental Hygiene buildings in Poughkeepsie into the center.
The model is similar to one used in Bexar County, Texas, where implementation of Crisis Intervention Teams and development of a Crisis Stabilization Center has led to 500 empty beds in the once overcrowded county jail, as well as a reduction in mental health-related ER visits by 50%. The Dutchess approach will also be heavily informed by the pioneering work of Steve Miccio and Poughkeepsie’s PEOPLe, Inc in creating the nationally replicated Rose House peer crisis respite model.
Crisis Center Aims to Reduce ER Visits, Jail Rates
Amanda Fries Poughkeepsie Journal January 1, 2016
Karen Zirbel has always felt her verbal skills have been an important tool in her 11-year career as a City of Poughkeepsie police officer.
It was while responding to a call of a suicidal homeless man a few months ago that she saw just how beneficial these skills could be.
The man had threatened the life of some of his coworkers as well as himself. City police located him in the woods, but instead of rounding him up to take him to the local hospital, they spent time talking with him first.
“We took the extra step. I sat down…he just wanted someone to listen to him,” Zirbel said. “And a lot of times, that’s what most of it is. They just want to be heard.”
Proper communication techniques with mental health patients and substance abusers is a key component to the Crisis Intervention Training, which is one of the tools Dutchess County has instituted in an effort to overhaul how mental health and substance abuse situations are dealt with on the streets, in emergency situations and within incarceration.
Another tool will be a 24-hour Crisis Stabilization Center that will serve as a voluntary walk-in or police drop-off for individuals suffering from mental illness or substance abuse. A $4.8 million bond recently was approved to renovate the county's Mental Hygiene buildings at 230 North Road in Poughkeepsie into the center.
“People don’t want to go to MidHudson (Regional Hospital of Westchester Medical Center), so it’s a struggle to get them to go,” Zirbel said of individuals suffering from mental illness whom police encounter. “The center — if it rolls out as it’s supposed to — hopefully will be a place where people can really get help and they’ll want to go there. We’re really hoping that they’ll open the doors tomorrow.”
The goals of the center are to provide more humane treatment of mentally ill and substance abusers, while encouraging collaboration among health care providers, law enforcement and others. It aims to reduce avoidable hospital visits by 25 percent within five years. County officials have said they hope to drive down the overall jail population by instituting the center, but say they haven't set specific goals.
Roughly 70 percent of inmates in the Dutchess County Jail suffer from mental health or substance abuse issues, a figure officials said is based on snapshots taken of those incarcerated over the past seven years. The average daily inmate population has hovered around 450 for the last three years, according to county figures.
“The Crisis Stabilization Center will be a safe environment for people to come,” said Beth Alter, director of the Office of Community Services in the county’s Department of Behavioral and Community Health. “And not just an alternative to the hospital because it will be a community, user-friendly level of care that doesn’t rise to the acute hospital intervention.”
The model Dutchess County is following is similar to that in Texas.
The jail in Bexar County, Texas was cited in 2002 by the state for overcrowding. A consultant came in and estimated that the county would need an additional 1,000 beds to meet the growing incarceration rate, however Leon Evans, president and CEO of the Center for Health Care Services in San Antonio, had a different idea.
“I became painfully aware of all those being criminalized and put in jail,” Evans said of his time as the director of the Community Services Division of the Texas Department of Mental Health and Mental Retardation in San Antonio. “They’re just in this vicious revolving door, and they never get any treatment or help.”
The diversion approach began with law enforcement receiving Crisis Intervention Training. In 2003, a joint county and state partnership — a public subdivision — implemented the crisis center, Evans said.
Since the center’s implementation, they not only avoided additional beds, but now have about 500 empty beds in the Bexar County Jail, Evans said. This happened despite the population growing by more than 300,000 from 2000 to 2010, according to the U.S. Census. The new approach also has reduce those going to emergency rooms due to mental illness by 50 percent and saved money, he said.
The last component
Dutchess County officials say that while San Antonio’s approach may seem similar, the county already has programs in place that help divert individuals from the emergency room and incarceration. The center is the last component to build upon what is already implemented, providing a 24-hour place outside of an emergency room for people dealing with mental illness or substance abuse to go to.
The Mobile Crisis Intervention team started in 2012. Made up of licensed mental health professionals, the team deescalates situations involving mental health patients, officials said. Law enforcement can call on the team to assist during an incident, or the team may be sent to a location if the county receives a call on its helpline. Earlier this year — by partnering with MidHudson Regional Hospital — it was expanded into the hospital and now provides 24-hour service. The county allotted $1,042,203 in the 2016 budget for the services.
“All of these things have been built to try to give everybody some different tools to use so they just don’t have to arrest and potentially incarcerate,” said Margaret Hirst, acting commissioner of the county’s Department of Mental Hygiene. “The Crisis Stabilization Center is kind of the last component to shoring up that front end.”
The center will provide 24-hour service for individuals who want to get sober or need a respite from their home for a period of time, and connect them to the right resources to help with the situation, or crisis. It will accommodate up to 24 individuals for a 23-hour period maximum, with designated beds for psychiatric care and detox. While $250,000 has been budgeted for the center in the fourth quarter of 2016, officials said it’s still undetermined how much will be needed in the years to come.
For 25-year-old Bryan Prinz, the idea of a place for addicts to go to is perfect. Prinz is a recovering heroin addict and has been sober for 18 months. He used to live in Dutchess County. He now lives in the Town of Clermont in Columbia County with his parents.
“A lot of people don’t know where to go. They’ll call treatment facilities… eventually get the right idea on where to go,” he said. “But I think having a set place for someone to go is important. I’m totally for having a one-stop shop, it’s like a Walmart — you get everything there.”
The center will fill the void by providing assessment and triage, while also relieving the burden from local emergency departments currently providing the round-the-clock care.
The MidHudson Regional Hospital has 30,000 emergency department visits every year, Westchester Medical Center Health Network officials said. Roughly 6,000 of those visits involve behavioral health, which include mental illness and addiction. The challenge, however, is finding the beds for those who need them. MidHudson has 40 adult mental health beds, 10 adult detoxification beds and 50 beds dedicated for rehabilitation, and it’s the only facility that provides behavior health care in Dutchess County, officials said. The next closest hospital is in Kingston.
Eric Amoh, senior vice president of clinical services at the health network, said the partnership the Poughkeepsie hospital struck with Dutchess County allows the county’s mobile team to set up shop in the emergency room, providing the community connection. With the institution of the crisis center, those patients who don’t need to be at the emergency room will be diverted, he said. In turn, this would improve services for all those who come to the hospital’s emergency department for acute care.
“The emergency department is a hot spot for them,” Amoh said. “The patient could be diverted to this crisis center and within that center there would be a residential provider, a substance abuse provider… this multi-disciplinary team is much better equipped in a way that the emergency department is not set up to do.”
Many who are playing a part in the overhaul say the new approach provides better collaboration.
Steve Miccio, CEO of People Inc. — one of 30 organizations in the collaborative approach — said the challenge is that services aren’t shared well and they don’t co-locate. This new approach will change this mindset.
“It’s refreshing to see the excitement and motivation of all the different providers and county government to do something that is genuinely in the best interest of the county,” Miccio said.
For law enforcement, the collaboration is opening their eyes to organizations they may not have known much about. City of Poughkeepsie police officer Zirbel said despite often going to calls on Cannon Street, she didn't know about the Mid-Hudson Addiction Recovery Centers Inc., or MARC, on that street.
“I learned a lot about that, and it’s right here within our four square miles, which is small,” she said. “There’s a lot here.”
Dutchess County mental health officials said that rather than having each agency with its own set of rules and vision, the center and its players have a cohesive approach.
“That’s a little different in terms of service delivery than I think we have anywhere,” Hirst said. “It provides a richer service.”
Through this approach, officials hope the center will provide a 24-hour option for people who, when they decide to make the change — to get sober or go back on medication for mental illnesses — can take those first steps. Officials recognize that they may not be able to help every person since it’s a volunteer center, but they said they want to make sure the center is welcoming when they return.
“The substance user is going to have a safe place that in the moment, when they decide they want to try something different, they don’t have to wait until the world opens up at 9 a.m.,” Alter said. “We want to make sure whether you’re 15, 25, or 95, and you’re using that substance and you’re ready to talk to somebody, our door is open to you.”