As a licensed clinician deeply embedded in crisis work for decades, I have had an up-close view of how our healthcare system has evolved to address growing behavioral health needs. This firsthand experience tells me our society urgently needs comprehensive and connected crisis systems.
Our community does not currently have the same infrastructure to address behavioral health crises as we do with 911 and medical emergencies – and we need one. Behavioral health crises often result in 911 calls to law enforcement or unnecessary – and potentially costly – visits to the emergency department.
This need is driven by factors like the opioid epidemic, rising suicide rates, and challenges to accessing quality care. Effective crisis systems save lives, and the stakes have never been higher.
Care providers across the country, including my colleagues at Carelon, work every day in communities, promoting evidence-based best practices and strengthening state and local crisis systems of care to improve the patient experience and health outcomes.
Building a robust behavioral health crisis response system
There needs to be as clear and predictable a pathway for individuals having an emergency triggered by mental health, substance use disorder, or related conditions as there is for someone with a physical medical emergency. The 988 Suicide & Crisis Lifeline is a step in the right direction. Launched in July 2022, the 24-hours-a-day/7-days-a-week national network of local crisis centers provides free and confidential emotional support to people in suicidal crisis and emotional stress.
Through 988, those in need have the option to call a crisis line instead of dialing 911, so specially trained mobile response teams are able to be dispatched to address behavioral health emergencies. And rather than sending people to the ER, they can be directed to crisis stabilization programs that can provide specialized behavioral care. The goal is to meet the personalized needs of communities in a compassionate and effective way.
We recently helped a mother with a child actively threatening to harm his siblings navigate an urgent admission to a facility without calling in law enforcement or sending the child to the emergency room. She was so thankful that an already stressful situation was streamlined and less disruptive for her child in desperate need of crisis support. Someone’s first mental health care experience should not take place in the back of a police car.
Engaging a diverse group of stakeholders to meet unique community needs
My experience has taught me that you can’t build an effective crisis system in a silo. It is essential that crisis response be built on the knowledge and experience of the community it is designed to serve.
At Carelon, we hold “crisis collaboratives” to educate, train, and engage with community stakeholders such as physicians and mental health providers, community health organizations, housing and social services, law enforcement, and faith-based groups. We also include individuals who have personally dealt with and overcome a behavioral health crisis, as they have vital firsthand experience of the existing system. These collaboratives provide the opportunity to have honest conversations about the current state of crisis response in the community and discuss ways to collectively customize solutions, strengthen planning, and drive innovations for effective response.
The most successful systems are those with the strongest relationships between community stakeholders. I think about these relationships as the fibers of a community safety net. The stronger those connections are, the less likely people who need behavioral health services are going to fall through the gaps.
Not long ago, we talked with a frightened individual with a very clear and imminent plan for suicide. It took patience and building rapport, but she ultimately disclosed her location. Although we did have to involve emergency services because she needed immediate attention, our knowledge of the community and resources made all the difference when they arrived to support her because this knowledge allowed us to engage a specialty team that included a clinician.
Closing the gaps between physical and behavioral health support
The bottom line is that behavioral health should be treated as equitably as physical health. To make this a reality, Carelon integrates our expertise in both physical and behavioral health to deliver the right care at the right time to people, which ultimately improves care quality and outcomes.
I believe there is an opportunity to strengthen our crisis care system, including developing an infrastructure that better supports urgent mental health crises like a 911 for mental health. I am in a very fortunate position to work every day with individuals dedicated to improving our behavioral healthcare system. This helps ensure our patients have access to the support services they need to improve their health and well-being.
About the author: Wendy Martinez Farmer, LPC MBA, is a licensed professional counselor with over 25 years of crisis experience in the public and private sectors. Since 2020, she has served as a national crisis lead for Carelon Behavioral Health, helping to develop crisis capabilities, which include building and overseeing statewide and community crisis systems.
