Though crises are often associated with those who suffer from a mental illness, they can strike anyone at any time. And, their costs can be high, ranging from devastating individual and family impacts to high costs for 24/7 intervention and stabilization services—often involving an ambulance ride to the emergency room.
Faced with the growing costs of crisis intervention for more than a million residents in the Greater Pittsburgh area, Allegheny County leaders tailored a new 24/7 crisis response solution: re:solve Crisis Network. The network is a collaboration between Allegheny County’s Department of Human Services, Community Care Behavioral Health (a local MCO), Western Psychiatric Institute, and the University of Pittsburgh Medical Center (UPMC). It offers round-the-clock, crisis intervention by telephone, mobile unit dispatch, and at a walk-in and overnight center.
But as much as re:solve Crisis Network’s stakeholder groups sought to provide a variety of accessible crisis services, they wanted them to be person-centered to reduce the stigma and fear that residents often associate with those seeking help for a mental health issue. To achieve this, consumers were involved in both the planning of network services as well as the design of the facility that houses them.
“It was pretty much built on consumer feedback,” Ellie Medved, RN, MSN, vice president for ambulatory operations at the Western Psychiatric Institute and Clinic of UPMC, says. “We had many sessions including consumers exploring what crisis is and what you would hope for in a crisis situation, and kept coming back to the basic premise that it needs to be resolved.”
From those sessions with consumers, the name of the re:solve Crisis Network was born. “We wanted to communicate a message of hope and help: ‘You can resolve a crisis,’” Medved says. “We wanted to recognize the individuality of the people we serve and their varying needs. So, while the basic premise is ‘re:solve’ (regarding solution to crisis), there are many other ways we want to think about this: ‘re:hope,’ ‘re:strength,’ ‘re:resilience.’”
The re:solve Crisis Network took this same person-centered approach to its year-long marketing campaign, implemented following the program’s launch in July 2008. The network’s message targeted any in the county who could face a mental health crisis. “Sometimes in behavioral health, you’ll see that they’ll have a photograph of a person trying to tap into an emotion—and we intentionally stayed away from that because we wanted to make [the network] something that anybody would want to use,” Medved says. “Instead, we used objects—for example, one of our core objects is a shattered plate, because we talked to a lot of folks and it meant so many different things to different people.” These images, along with re:solve Crisis Network’s contact information, appeared on buses, at bus stops, and on SmartBoards and billboards, making a name for the program and forging valuable relationships with other resources in the community, such as behavioral health providers and police.
The 138-member team at re:solve Crisis Network—crisis intervention-trained psychiatrists, counselors, crisis nurses, crisis service coordinators, and peer support staff—was established around a few essential principles: Provide care to anyone who calls, with or without a diagnosed mental illness, and enable consumers to self-define their needs.
“A lot of crisis services have a priority scale: emergent, urgent, routine, things of that nature. We decided that we were not going to have a priority scale, but that the consumer who needed the crisis service was going to define their level of need for us,” Medved says. “That’s been really successful from an anti-stigma perspective; we’re not trying to put people in a box, but letting them define better what they need.”
Once a call is made to the network, staff members will provide anything from supportive listening to crisis intervention, depending on the consumer’s level of need. If the consumer wants, a team of two staff members will visit them at home or in the community.
“We will meet anybody, anywhere,” Medved says. “If somebody calls and says, ‘I’m having a hard time, I need to speak with someone,’ or ‘I’m depressed,’ or ‘I think I’m getting sick again,’ regardless of the time of day or day of the week, we would send a mobile team out to wherever the person is.”
The network provides services regardless of the consumer’s ability to pay. “No matter who calls, regardless of age, ability to pay, or insurance type, they’re going to get the crisis service, and it’s funded by either the county or Community Care Behavioral Health,” Medved says. Once the consumer has been stabilized, re:solve Crisis Network then relies on its strong partnerships with other community resources to ensure continued care. “We do tons of community linkage and referral, and we know we’ve done a good job if we can get someone linked into a traditional behavioral health service,” Medved says. “Not everything results in a behavioral health linkage, but a lot of it does.”
Since 2008, the network has almost doubled the number of consumers it is serving, while its mobile crisis unit alone reaches 700 to 800 consumers per month.
“A lot of that results in diversions for ER visits or places that people would normally have to go to get 24/7 care, but they don’t have to,” she says. “The vast majority of people we see remain in the community and don’t need that higher level of care. So we’ve seen a reduction in that which is a great thing.”
This summer, the program will expand further, adding an engagement center for crises defined by drug and alcohol issues that will open in July.