As the days grow ever shorter and the cold begins to deepen, our attention turns to Thanksgiving, the holidays, and warm and happy events with our families and good friends. Yet, we also must keep those who are much less fortunate in our thoughts at this time of year. Especially, those with major health conditions, many of whom are homeless, deserve a very special corner in our hearts. My comments today address one of these groups.
Incarceration of those with mental health, substance use, and, more recently, ID/DD conditions has grown dramatically during the past decade. Tonight, just a few days before Thanksgiving, our city and county jails will house about 731,000 persons. Fully one quarter will have mental health conditions; about half, substance use conditions; and up to one-tenth, ID/DD conditions. Many of these people are homeless. This pattern reflects the tattered nature of our current health and human services systems. The tragedy is that virtually all of these people need care, not incarceration.
Intuitively, we know that if we are to change this unfortunate situation, we will need to intercept and divert these people before they arrive at the door of the jail. Part of the solution will involve improving our county care coordination systems. Another will involve implementing good county crisis response systems. A key element of the latter will be the creation of community-based sites that can provide short-term services to a broad range of persons with behavioral health and ID/DD conditions who are at risk of incarceration.
Easy access to care
We currently use several terms to describe such service sites. We variously call them restoration centers, sobering centers, diversion centers or simply outreach centers. What they share in common are several defining service characteristics:
- They offer very easy access to care;
- They have inviting settings for care (sometimes even recovery-centric rooms);
- They provide urgently needed care;
- Their services are very short-term;
- They offer a combination of peer and professional services; and
- They bridge to longer-term behavioral health and ID/DD services in the community.
In sum, they offer excellent outreach and care activation services. Thus, they are very akin to more traditional community urgent care centers.
Importantly, a person can drop in for care without an appointment; a family member, friend, or peer can bring someone for care; local police or EMT personnel can bring someone for care in lieu of transporting them to the city or county jail. Hours of operation always extend beyond the traditional business day, and frequently include a 24-hour cycle. Thus, such programs offer a very easily accessible alternative to incarceration.
Although there is as yet no common template for these emerging urgent care centers for behavioral health outreach and care activation, a common pattern is beginning to appear. One can best appreciate how they operate by visiting several of them.
I am delighted to report that such service sites now are operating in places as diverse as Los Angeles; Portland, Ore.; and San Antonio, Texas, among others. Anecdotal evidence and hard data both suggest that such centers can have a very significant role in decreasing inappropriate incarcerations.
Equally as important, their easy drop in approach can play a pivotal role in decreasing behavioral health and ID/DD emergencies in the community, including suicide attempts.