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Crisis centers key piece to behvioral health system, report says

The Daily World - 2/3/2024

Options for treating mental health and substance use problems in Grays Harbor County have grown in the last few years, with the Quinault Wellness Center in Aberdeen and Summit Pacific's walk-in mental health clinic in Elma.

But first responders who intervene with a person in the middle of an acute mental health crisis have little option for immediately delivering the patient to a facility where they would no longer be at risk to themselves or others.

"Let's say I call 911 for a mental crisis," said Mike McNickle, director of Grays Harbor County Public Health. "There's only two places to go: ED (emergency department) or jail. If I haven't broken the law, I'm going to the ED."

Both of those facilities are already strained, and, health officials agree, neither is the best place for someone in serious mental crisis. A report from the county health department recommends providing new facilities to stabilize people in crisis, the next step toward the long-range goal of reaching a complete system of mental health care in Grays Harbor — though the path for that next step is still uncertain.

The health department published its Crisis Triage and Stabilization Center Feasibility Study in December 2023, and has since talked with area hospitals and behavioral health service providers about the potential of creating two new types of crisis units: emPATH, a unit intended to deliver a calm, therapeutic setting; and a behavioral health urgent care center to be co-located with a hospital.

The report's lead author was Allie Franklin, a consultant with Health Management Associates, and former crisis clinic executive and member of a legislative advisory committee on behavioral health. Franklin told the Grays Harbor County Board of Commissioners on Tuesday that a local crisis clinic would see about five people per night.

"If those five people were getting the care that they needed and the support that they needed, might you begin to see a reduction in the number of people who are going into your jails, who are going into the emergency departments, who are cycling in and out of those things, and might you begin to see some relief in your community around (behavioral health) crisis," Franklin said.

In February 2023 county commissioners allocated just over $1 million in treatment sales tax funding for behavioral health treatment initiatives. Nearly all of it helped Summit Pacific Medical Center open a walk-in mental health clinic in Elma. Another $100,000 paid HMA to produce the crisis clinic assessment.

But the county won't pay for a new crisis clinic. McNickle has consulted with the county's hospitals, Summit Pacific and Harbor Regional Health, and Great Rivers Behavioral Health Administrative Services Organization, which funds the behavioral health crisis network in five counties in Southwest Washington.

Great Rivers Chief Executive Director Trinidad Medina said the bulk of that network is a trio of services: a telephone crisis line, mobile crisis response, and Designated Crisis Responders, which dispatch to a crisis if a person could be a risk to themselves or others. He said the organization has "available funding for limited treatment services," and doesn't have the ability to fund an entire center but is contributing feedback on Public Health's studies.

Co-locating those units to medical centers is important for two reasons, Franklin said. Free-standing clinics can't take patients without a medical clearance, meaning first responders must take people in crisis to hospitals for a process that can sometimes take all day. According to Franklin, this has resulted in strain on Designated Crisis Responders, who are often called to ensure the person is safe while they wait for a physical.

An emPATH or behavioral urgent care unit would act as a diversion from the emergency department for people to get treated right away.

"An emPATH unit is a lot nicer place to wait than strapped to a gurney, restrained, because the facility isn't safe for you to be not restrained, and waiting for that bed," Franklin said. "And it can take a long time to find a bed. Versus, I can be wandering around in a living room environment with some recliners and nice people who talk to me."

Summit Pacific on Wednesday celebrated the start of construction on a $60 million expansion project that will add 30,000 square feet, 10 acute care beds and six emergency room spaces to its campus. The expansion does not include an emPATH or behavioral health urgent care, said CEO Josh Martin.

According to Martin, those models rely on a high volume of patients, which makes them more sustainable in urban areas.

"We see a lot of mental health, but to have a specific designated emPATH or urgent care or separate intake, you'd have to have significant volume," he said.

He added, "It's a great concept, I just haven't seen a rural community pilot it yet."

The emPATH model was developed in 2016 and has since been used in a handful of states, but an operating unit does not yet exist in Washington.

In an email, Harbor Regional Health spokesperson Christpher Majors said the hospital sees the benefit the unit could have, but HRH is "taking a cautious approach to evaluate its financial feasibility and impact. Further exploration and discussions are needed to fully grasp the operational demands and staffing requirements of an EmPATH unit, especially considering the extreme national shortage of highly specialized clinical staff."

According to Franklin, data taken from within Grays Harbor County for Medicaid patients shows about 23 for every 1,000 patients visited the emergency room for mental health reasons in 2019, a figure that steadily rose from 2016. Franklin said post-pandemic data was not available, but that the trend of increased mental health related visits rose nationwide. HMA's modeling estimates 1,200 patients annually would use behavioral health urgent care in Grays Harbor County.

HMA's report states that crisis units located within medical centers are sometimes more financially feasible than free-standing centers, because medical centers can collect certain insurance fees than a lone clinic could not.

Franklin also recommended against a free-standing crisis center given that the county won't be able to utilize the facility it owns on 8th street in Hoquiam for the foreseeable future. The county used $377,000 federal funds to convert the building into a quarantine facility when the pandemic hit, and now won't be able to change the 6,000 square-foot building into another use without paying back the grant money.

To compliment a potential emPATH unit, Franklin told commissioners, "you need a low-barrier, high-support shelter. You don't want your empath unit to become your de facto shelter," with people experiencing psychiatric emergencies solely due to cold weather, Franklin said.

McNickle acknowledged the many pieces that still need to come together to complete the county's system of behavioral health care. He's still looking for grants that might help facilitate a crisis center.

"It doesn't have to be all of it, all at once," he said. "It took us a long time to get to the crisis, it's going to take a long time to get out of it. We have an approach; we have an outline of how to get there."

Contact reporter Clayton Franke at 406-552-3917 or clayton.franke@thedailyworld.com.