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1
MOBILE CRISIS
Presentation to Joint Legislative Oversight Committee
on Mental Health, Developmental Disabilitiesand Substance Abuse Services
Beth Melcher, PhDAssistant Secretary for MH/DD/SA Development
Department of Health and Human Services
December 8, 2010
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Mobile Crisis Team
Service Definition approved in 2006 First state appropriation in 2008 Funded by state funds and Medicaid fee for service Critical component in crisis service array Available 24/7/365Available 24/7/365 Meet the individual where they are Meet the individual where they are –– as close to a as close to a
persons home as possiblepersons home as possible Goal is to avoid Emergency Room or Inpatient Goal is to avoid Emergency Room or Inpatient
admissionadmission Currently 41 Teams covering all countiesCurrently 41 Teams covering all counties
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North Carolina RegionalMobile Crisis Teams
Western Region Central Region Eastern Region
Eastpointe
Anson
Ashe
Avery
Beaufort
Bertie
Bladen
Brunswick
Burke
Cabarrus
Caldwell
Carteret
Catawba Chatham
CherokeeClay
Cleveland
Columbus
Craven
Currituck
Gaston
Gates
Graham
Granville
Guilford
Halifax
HarnettHenderson
Hertford
Jackson
Jones
LeeLincoln
Macon
Madison
Montgomery
Moore
Nash
Northampton
Onslow
Pamlico
Pender
Pitt
Polk
Randolph
Robeson
Rowan
Rutherford
StokesSurry
Swain
Union
Vance
Wake
Warren
Watauga Wilkes
Wilson
Yadkin
Yancey
Piedmont
SoutheasternRegional Southeastern
Center
CenterPointCrossroads OPC
East Carolina Behavioral HealthPathways
Buncombe
Mecklenburg
Orange
Transylvania
Person
Cumberland
Haywood
New Hanover
Durham
Iredell
Johnston
DuplinSampson
Wayne Lenoir
Dare
Hyde
Martin TyrrellWashington
Camden
PerquimansPasquotank
Chowan
Edgecombe
Greene
The Beacon Center
Forsyth Franklin
HokeRichmond
McDowell
MitchellAlexander
Alleghany
Mental Health Partners Sandhills Center
RockinghamCaswell
Alamance
Davidson
Stanly
Davie
Five County
Scotland
Smoky Mountain Center
Western Highlands Network
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Mobile Crisis Funding
Recurring state allocations $5.7 million
Medicaid fee for service $3.1 million
IPRS $3.6 million
Non-allocated non-UCR funds $3.8 millionCost per episode of care approximately $552
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Mobile Crisis Team Staffing
Psychiatrist availability Substance Abuse staff (CCS,CSAC,CCAS) QP who is a Nurse, CSW, or Psychologist QP or AP with experience in Developmental
Disabilities Other team members may be non-licensed
qualified professionals and paraprofessionals
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Accessing Mobile Crisis
Crisis Call to LME STR Direct Call From
Law Enforcement Magistrates Behavioral health providers Non-behavioral health providers Emergency Room
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Mobile Crisis Activities Provide support to decrease crisis and allow individual to
remain in their home Crisis Assessment (including assessment of appropriate
setting for continued care of patient based on risk factors for danger to self or others
Recommendations for behavioral management of disruptive behavior
Coordinate with police Crisis Intervention Teams Help locating an inpatient psychiatric bed if needed Coordinate services required to discharge an individual
from an Emergency Room to community based service Facilitate referrals to crisis stabilization resources, or
other community intervention services or supports Brief Treatment/Intervention Development of a Crisis Plan
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Response Location Individual’s home Schools Magistrate’s offices Urgent care centers Group homes Consumer’s Home Medical/primary care offices Emergency departments Police stations, jails, and other community
sites
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Mobile Crisis: 15,184 Total Referralsfrom January to June 2010
16%
10%
21%
2%4%
33%
2%1%
4%
2% 1%3%
0%
5%
10%
15%
20%
25%
30%
35%
Self
Family/ S
uppo
rt Sys
temLM
E STR/ Cris
is Lin
e
First R
espond
er/ Clin
ical H
ome
Other P
rovide
r Age
ncy
Hospit
al Emerg
ency D
epart
ment
Schoo
l
Social
Service
s Depa
rtmen
tLa
w Enfo
rcemen
tJu
stice
Sys
temOthe
r Pub
lic Age
ncyOthe
r/ Unk
nown
Referral Source
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Results of Mobile Crisis Interventions 15,110 episodes of service Jan15,110 episodes of service Jan--June, 2010June, 2010 Increase from 13,335 episodes of service over the Increase from 13,335 episodes of service over the
previous 6 monthsprevious 6 months 77% of dispositions were to community and 23% to 77% of dispositions were to community and 23% to
an inpatient settingan inpatient setting Dispositions to Emergency Department decreased Dispositions to Emergency Department decreased
from 5% to 4% from the previous 6 monthsfrom 5% to 4% from the previous 6 months Dispositions to Facility Based Crisis increased to 6% Dispositions to Facility Based Crisis increased to 6%
from 5% over the previous 6 monthsfrom 5% over the previous 6 months Dispositions to Hospital inpatient setting decreased Dispositions to Hospital inpatient setting decreased
from 31% to 23%from 31% to 23%
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Mobile Crisis: 15,110 Total Dispositionfrom January to June 2010
36%
5%4%
6%
4%
21%
2%1%
2%
19%
0%
5%
10%
15%
20%
25%
30%
35%
40%
CurrentSetting
AlternativeNaturalSupport
Referral toMedical/
EmergencyDepartment
Facility-Based Crisis
CommunityDetox
CommunityHospital
(psych unit)
StatePsychiatric
Hospital
State ADATC Jail orDetention
OtherDisposition
Disposition
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Questions?