An Alternative to the Hospital Emergency Room for Persons with Substance Use Disorder or Severe Mental Illness
In cities across the country, individuals with behavioral health issues routinely present at emergency departments or even worse are jailed. Such interventions rarely, if ever, change behavior or resolve a crisis.
Three-year trend data (2012-2014) generated by the Missouri Hospital Association indicates that Kansas City- area hospital emergency departments experienced over 8,000 visits per year from patients with substance use disorders (having no other life-threatening emergent medical conditions), along with over 9,000 visits per year from clients with severe mental illness. What’s more, a high percentage of these individuals had histories of repeated ED visits, some as high as 100 visits annually. The same individual may present for substance abuse disorder on one occasion and severe mental illness on another.
Such repeated visits tie up hospital ED resources that could otherwise be used for individuals in acute medical crises.
In 2013, a group of committed area stakeholders gathered to create a different option for these individuals. Throughout the next two years, this group established the Kansas City Assessment and Triage Center (KC-ATC), a public and private partnership between Kansas City stakeholders that include courts, law enforcement, hospitals, city officials and the Missouri Department of Mental Health. The objective of the KC-ATC is to divert persons with mental health and substance use disorders away from jails and area emergency rooms to a safe place where they can be assessed and stabilized, then treated at a behavioral health outpatient or residential service if necessary. Funding was secured from Ascension Health, local hospitals, the City of Kansas City and the Missouri Department of Mental Health.
In 2016, ReDiscover was chosen as the lead agency by the City of Kansas City to operate the KC-ATC. The KC-ATC, located at 2600 E. 12th St. downtown, has two units with a total of 18 slots. There are nine slots in the Sobering Unit for those currently under the influence of a substance and nine slots available in the Stabilization Unit for those with a primary mental health issue. The maximum length of stay for an individual is 23 hours. The center is open 24 hours/7 days a week.
Individuals are referred to the KC-ATC by the Kansas City Police Department or approved area hospital emergency departments. A nurse and licensed qualified mental health professional will immediately triage each individual. This includes a comprehensive behavioral health assessment, plus a shower, change of clothes and a meal/snack if needed. Individuals are able to stabilize for up to 23 hours in an observation room where they engage with a licensed social worker and case manager to determine a successful discharge plan.
Discharge functions include:
- Linking the patient back home to family or friends
- Arranging follow-up with a behavioral health provider and/or support services
- Providing bridge case management and medications
- Securing emergency housing until permanent housing is available
- Collaboratively developing a crisis plan in the event of future distress
The KC-ATC has been open almost 18 months and has received well over 4,000 referrals. Of those referrals, 70% are male, over 70% are homeless, and the majority are currently under the influence and are suffering from co-occurring issues. Some 64% of the referrals come from area hospitals and the rest from the KCPD and EMS. Among referrals, 77% were between the ages of 25 and 54 years and the average length of stay for a client is 16 hours.
While an individual is only able to stay at the KC-ATC for 23 hours or less, the larger goal at the KC-ATC is ongoing case management. ReDiscover recognizes and has thrived at providing intensive case management services to individuals who aren’t quite ready to change. At KC- ATC, individuals receive a case manager who assists them in getting connected to long-term support services. The client may work with the case manager for as little as a week or as much as three to six months, depending on the individual’s level of care needed and motivation.
This ongoing case management is what distinguishes KC-ATC from becoming another revolving door—the crucial ingredient of the success of the KC-ATC model. An equally important resource is the funding we receive from the Missouri Department of Mental Health for aftercare services. If someone is uninsured and can’t get their medication filled, the aftercare service funds are allowed to be used flexibly to cover medication costs, pay for rent or immediate supportive housing and/or assist in paying for on-going outpatient treatment services. This has also allowed us to increase engagement rates in on-going treatment as we can assist in meeting the basic needs to those referred.
The KC-ATC was also created to assist in further identifying gaps in our system of care and help to find solutions. One of those areas is quick access to case management and medication services.KC-ATC sometimes keeps individuals longer for both case management and medication services due to the wait time at local outpatient centers. This is an area in which we are continually working to improve.
The KC-ATC has seen many success stories throughout the 18 months of being open. John is one of those such individuals. John spent 10 years in and out of jail. Once he arrived at KC-ATC, he had lost connections to family and loved ones—and more importantly, he had lost all hope. John wanted to end his life. He had struggled with bipolar disorder and used drugs such as heroin to stabilize his mood swings. KC-ATC provided him medication and found a transitional housing program which he agreed to enter. His KC-ATC case manager continued to follow him and through conversations, learned that he had been a cook at one point in his life. With this information, the case manager helped the man enroll in a culinary educational program, which led him to a job as a sous chef in a Kansas City hotel making $60,000 annually—all within just seven months of his first visit to the KC-ATC. John was also connected back to his girlfriend and finally reported having hope again.
Lauren Moyer, LSCSW, LCSW, is vice president of clinical services at ReDiscover. She can be reached at email@example.com, or (816) 581-5816.