case study

Barriers to Access

A behavioral health crisis facility was not able to operate profitably, causing a burden on the overall cost structure of the public behavioral health system. Law enforcement and emergency departments were unhappy due to high barriers to access. Further, the over-representation of people with mental illness in jails and officer-involved fatalities has led to the development of evidence-based models of community-wide crisis response. A central component is a mental health receiving facility that provides officers an alternative with minimal turnaround time and accepts all referrals regardless of diagnosis or financial status. The prevalence of these are increasing, however, many do not have the low barriers to access outlined in the CIT model, and highly acute patients still end up in jails or emergency departments.

The CXNS Plan

  • Identify operational costs and potential funding streams
  • Develop a viable and sustainable financing model
  • Develop innovative methods to provide 24/7 operations despite national shortage of providers
  • Design a facility and program that can meet the needs of all patients who require care no matter how acute
  • Build consensus among diverse stakeholders
ASSOCIATED RISKS
  • Lawsuits and associated liabilities
  • Mentally ill people often end up in jail or EDs without adequate treatment
  • Patient violence due to high acuity of crisis
METRICS
  • Transferred 500 patients per month out of local emergency departments
  • Capacity increased from 400 to 2,000 encounters per month
  • 2-hour door-to-door dwell time for urgent psychiatric care center
  • 60-70% diversion from inpatient rate
  • Wait time for law enforcement drop-offs decreased from 2 hours to 7 minutes (compared to a 20-minute average booking time in jail)
  • Rapid transfer of custody allows officers to get back to work quicker
  • Police utilization of center increase from 25 to 700 encounters per month
  • Voluntary law enforcement commitment rate went from 0 to 200 per month
  • Reduction in job turnaround, increase in staff satisfaction
VALUE
  • Lowered barriers to access care and improved outcomes for patients
  • Kept identified “difficult” patients out of the emergency departments
  • 911 calls from facility went down
  • Reduced the number or mentally ill patients in jail
  • Provides a jail diversion solution — SMI jail population decreased by half after the receiving facility opened
FINANCIAL IMPACT
  • Maintained the same cost structure and increased revenue through 3rd party billing
  • To the criminal justice system: Inmates with mental health issues incur 2-3x higher costs than non-mentally ill inmates
  • To the mental health system: Justice-involved patients incur double the cost than those without justice involvement

Outcome

CXNS Health Strategies leadership changed the way the facility was managed by creating an emphasis on customer service and implementing hospital-like processes and staffing patterns that were safer, more efficient, and better-matched to the acuity of the patient population needs. The facility was able to improve patient outcomes, reduce the burden on law enforcement, and provide care for five times as many patients at the same cost levels.

FURTHER READING

Eliminating ED Boarding Through Creation of Center

Alternatives to Long-Term Care

Creating a Crisis Center

Facility Design

Improving Throughput and Safety in an Emergency Setting

Safety in Crisis

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