Table Of Content

Foreword The Substance Abuse and Mental Health Services Administration (SAMHSA) is the U.S. Department of Health and Human Services agency that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities. This book is consistent with the SAMHSA mission. It is composed of the National Guidelines for Behavioral Health Crisis Care Best Practice Toolkit (National Guidelines for Crisis Care), which provides best-practice guidance to the behavioral health field and related papers on crisis services. The Toolkit reflects careful consideration of relevant clinical and health services research, review of top national program practices and replicable approaches that support best practice implementation. The topics of the papers built around the National Guidelines include: papers addressing key issues relevant to crisis services, homelessness, technology advances, substance use, legal issues impacting crisis services, financing crisis care, diverse populations, children and adolescents, rural and frontier areas, and the role of Law Enforcement. We are grateful to the writers of and contributors to these papers. This is an outstanding effort that will result in better care for individuals with mental illness and/or substance use problems. The emphasis on crisis services and community treatment is a priority for SAMHSA. We are proud to provide this book detailing crisis intervention services, best practices, and related important components of crisis services. This compendium will improve care and reduce the impact of substance abuse and mental illness in our communities. Elinore F. McCance-Katz , M.D., Ph.D. Assistant Secretary for Mental Health and Substance Use U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration Acknowledgments We extend our thanks to SAMHSA staff for their dedication and collaboration on this book consisting of this year’s technical assistance paper series focused on crisis services. We also thank Debra Pinals, M.D. for not only being the lead author of three of the papers within this technical assistance paper series, but also editing the other papers within this series. We are grateful to the writers, contributors from around the country, producers, technical researchers, and reviewers of this series. Many thanks to the lead authors - Paul Galdys, Debra Pinals, M.D., Kevin Martone, Kristin Neylon, Rebecca Boss, Robert Shaw, Sharon Hoover, and Margie Balfour – and their collaborators. Thank you also to Elizabeth Sinclair Hancq, M.P.H. for her Technical Research Assistance. Thank you to Brian Hepburn, Executive Director of NASMHPD, and his team for their collaborative efforts in developing this year’s series: David Miller, Project Director, for overseeing this important effort; Aaron Walker for his outstanding work and dedication in coordinating the development of these key resources; Nili Ezekiel for proof reading and formatting the papers; Meighan Haupt for bringing the papers together into this book format; and Kathy Parker and Greg Schmidt, who worked to ensure seamless coordination. Many thanks to Golda Pinals, for the cover art, and Eli Pinals for the cover graphics and technical design. This series is an outstanding effort that will result in better care for individuals with mental illness and/ or substance use issues. We especially are grateful to all the collaborators from around the country who provide vision in systems in mental health, developmental disabilities, and substance use services that helped inform the content of this series and who make a difference to people in crisis every day. This work was developed under Task 2.2 of NASMHPD’s Technical Assistance Coalition contract/task order, HHSS283201200021I/HHS28342003T and funded by the Center for Mental Health Services/Substance Abuse and Mental Health Services Administration of the Department of Health and Human Services through the National Association of State Mental Health Program Directors (August 2020) CONTENTS SECTION I: SAMHSA’s National Guidelines for Behavioral Health Crisis Care: Best PracticeToolkit National Guidelines for Behavioral Health Crisis Care: Best Practice Toolkit advances national guidelines in crisis care within a toolkit that supports program design, development, implementation and continuous quality improvement efforts. It is intended to help mental health authorities, agency administrators, service providers, state and local leaders think through and develop the structure of crisis systems that meet community needs. This toolkit includes distinct sections for: Defining national guidelines in crisis care; Tips for implementing care that aligns with national guidelines; and Tools to evaluate alignment of systems to national guidelines. SECTION II: Crisis Service Papers Building on SAMHSA’s National Guidelines Crisis Services: Meeting Needs, Saving Lives by Debra A. Pinals. Dr. Pinals ties in the previous series of papers on Beyond Beds, which began in 2017, with this year’s series on Beyond Beds-Crisis services. She highlights how by enhancing crisis response, community needs can be met, and lives can be saved with services that reduce suicides and opioid-related deaths, divert individuals from incarceration and unnecessary hospitalization and accurately assess and stabilize and refer individuals with mental health, substance use and other behavioral health challenges. Effective Behavioral Health Crisis Care for Individuals Experiencing Homelessness by Kevin Martone, uses the National Guidelines as a framework and explores issues that should be considered in the design and implementation of core crisis system components, with specific consideration of the needs of individuals who experience homelessness. Using Technology to Improve the Delivery of Behavioral Health Crisis Services in the U.S. by Kristin A. Neylon addresses how technology is being used by the states, and the opportunities and challenges it presents, in the delivery of each of the critical services identified in the National Guidelines. Addressing Substance Use in Behavioral Health Crisis Care: A Companion Resource to the SAMHSA Crisis Toolkit by Rebecca Boss highlights states and programs that are demonstrating success integrating substance use disorders in the core services described in the SAMHSA Crisis Toolkit – crisis call centers, mobile crisis response services, and crisis stabilization services. This report also identifies the essential principles that are crucial for effective integration, as well as practices that are more specific to people with substance use disorders that may be useful in implementing crisis services. Legal Issues in Crisis Services by Debra A Pinals addresses issues including civil commitment treatment orders, the role of guardians, restraint and seclusion, confidentiality, the criminal justice system, EMTALA, red flag laws, risk management, and how these important topics relate specifically to crisis services. This paper also discusses the COVID-19 pandemic and its potential implications for legal issues related to crisis services. Financing Mental Health Crisis Services by Robert Shaw discusses how mental health crisis services are funded in 2020. It gives an overview of the mental health crisis service system and how the service systems and individual service types are funded and how the burden of funding those services may be more broadly shared by Medicaid and private insurance. Crisis Services: Addressing Unique Needs of Diverse Populations by Debra A. Pinals discusses the considerations, challenges, and implications of treating diverse populations, including older persons and people with intellectual disabilities, in any of the varied crisis settings. Although each population is discussed in turn, this paper also considers intersectionality of diverse populations. Improving the Child and Adolescent Crisis System: Shifting from a 9-1-1 to a 9-8-8 Paradigm by Sharon Hoover discusses the vision of the National Guidelines as it applies to young people, whose behavioral health challenges can often be prevented or identified early, yet are often neglected, at a high cost to society and to the quality of life of many children and families. Strategies for the Delivery of Behavioral Health Crisis Services in Rural and Frontier Areas of the U.S. by Kristin A. Neylon discusses the challenges associated with the delivery of comprehensive behavioral health crisis services in rural areas, and recognizes the strategies and opportunities pursued by state authorities and local providers to enhance access and the availability of these important services in rural and frontier areas of the United States. Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies by Margie Balfour, reviews best practices for law enforcement (LE) crisis response, outlines the components of a comprehensive continuum of crisis care that provides alternatives to LE involvement and emergency department utilization, and provides strategies for collaboration and alignment towards common goals. Policy considerations regarding legal statutes, financing, data management, and stakeholder engagement are presented in order to assist communities interested in taking steps to build these needed solutions. Section I: SAMHSA’s National Guidelines for Behavioral Health Crisis Care: Best Practice Toolkit Back to Contents Best Practice Toolkit