Deescalating behavioral health emergencies

Behavioral health emergencies trending upward

Most individuals use their available resources to successfully treat their behavioral health needs.¹ However, behavioral health emergencies have reached record numbers. Suicides climbed from 29,350 in 2000 to 45,979 in 2020, and drug overdoses rose to a record 107,000 in 2021.² 32.8% of US adults experienced behavioral health issues in 2021, compared to 8.5% prior to 2020.³

The numbers extend beyond adults. From 2019 to 2020, behavioral health related ED visits increased 24% in youth aged 5-11, and 31% in youth aged 12-17.⁴

Additionally, the U.S. is currently experiencing a shortage of behavioral healthcare professionals. Within the next few years, the country will be short between 14,280 and 31,109 psychiatrists, further overextending psychologists and social workers.⁵

These factors have accelerated the need to expand behavioral health services for individuals in crisis.

Crisis centers helping to fill the gap

Congress launched the dialing code, ‘988,’ in 2020 as a first step towards transforming the crisis care system in the United States. 988 is made up of an extensive network of hundreds of local and state funded crisis centers across the United States.

988 centers – and crisis centers built on the 988 model – are staffed by crisis specialists answering calls, texts, and chats from individuals in distress, seeking support.

Carelon Behavioral Health operates crisis contact centers with on-staff crisis specialists and clinicians in three states: New Hampshire, Massachusetts, and Kansas, helping to fill this need. The centers are open to anyone needing care. Specialists respond to calls, texts and chats regardless of individuals’ health insurance status.
 

How the crisis centers operate

When an individual contacts a Carelon crisis center, the crisis specialists’ priority is to first engage the person and then to make a safety assessment. “Crisis Specialists triage the person in terms of what their crisis is and what type of support they need in the moment; allowing the individual to define their own crisis and their own support needs,” says Dr. Linda Henderson-Smith, Senior Product Director, Carelon Behavioral Health. “Specialists can then actively engage and listen. We work collaboratively with the individual on resolving their crisis, we make referrals, and engage with partners on problem solving. We also help dispatch mobile crisis response teams to visit individuals onsite, if needed.”

If someone is about to self-harm or harm someone else, crisis specialists can connect the individual to emergency services, though such occurrences are rare. “We resolve a significant number of crises on the phone, or through text or chat,” notes Dr. Henderson-Smith.

She emphasizes that Carelon Behavioral Health makes it a priority to staff the crisis centers with diverse, culturally competent, and culturally humble specialists. “We hire staff that look like those in the community, speaking the same languages. For example, some specialists who work in our center speak Spanish as their first language. They serve individuals who feel most comfortable speaking Spanish.”

Peer support is also a significant part of the crisis contact center’s capabilities. Peers provide follow up for people who have utilized the crisis contact centers and shown a clinical need. “Peers typically follow up with individuals a few times after they have contacted the crisis centers, though there is no set timeframe,” she adds.
 

Differences in state programs

While the programs in New Hampshire, Massachusetts and Kansas operate similarly, a few key differences set them apart.

In New Hampshire and in Kansas, the contact centers can refer an individual to mobile crisis. Someone from the mobile crisis team can then visit the individual in person.

Kansas’s crisis contact center, which has existed prior to the 988 rollout, works directly with child welfare, consisting of mostly foster youth.

New Hampshire’s crisis contact center is a Suicide and Crisis Lifeline Center. It answers 988 calls that come from New Hampshire, as well as calls to a dedicated crisis number.

While Massachusetts’s center is not a Suicide and Crisis Lifeline Center, it operates as both an access and crisis line.
 

How Carelon Behavioral Health’s centers make a difference

Dr. Henderson-Smith observes, “When people are overwhelmed and in crisis, they can manage those situations more effectively just by having someone to talk to. With the support our contact centers provide, individuals in crisis are less likely to experience further escalations.”

Another significant differentiator is Carelon Behavioral Health’s role in operating the centers, and how it improves access. “Our staff are actually in it, as well as doing the follow ups, working with segments of the population that have historically struggled with access. For example, our texts and chats are especially helpful to teens, since that is how teens prefer to communicate.”

Furthermore, the crisis lines help keep people out of EDs, since individuals have the option of responders coming to them, if needed. “When people are in the ED for hours, they often get more tired and frustrated. These factors can lead to people experiencing escalations, or no longer wanting to address their crisis. Neither outcome is positive. However, when people contact the crisis lines, they can usually avoid that scenario,” emphasizes Dr. Henderson-Smith.

Overall, Carelon Behavioral Health’s crisis contact centers help people when they are in crisis and struggling with nowhere to turn. “People are overwhelmed right now, and that’s normal. Oftentimes we are not okay with not being okay, and we’ve got to learn how to deal with that,” Dr. Henderson-Smith concludes.