October 2013 presentation on Era of Crisis is NOW (YouTube) - http://bit.ly/Crisis-NOW The era for crisis is Now. A combination of factors, including concerns for public safety based upon recent tragedies, an enhanced focus on decreasing ER and inpatient utilization and cost savings and an emphasis on trauma informed care are creating a new prioritization of integrated crisis systems. In 2014, National Council will launch a special steering committee and host a crisis track at its Washington DC conference in May.

1. A Crisis Has No
Schedule: The Era
for Crisis is NOW
DAVID COVINGTON, LPC, MBA—
CRISIS ACCESS, LLC
crisisaccess.com

2. Aurora, Colorado

3. Polling Question #1
Virginia Tech, Columbine, Tucson, Aurora,
Newtown… We should do the following:
A.
B.
C.
D.
E.
F.
Double Mental Health System Capacity
Ban Assault Rifles Immediately
Dramatically Expand MH First Aid
Create Robust, Integrated Crisis Systems
All of the Above
None of the Above, as Tragedies Are
Unavoidable

4. 55 Years of Crisis
Services

5. First Crisis Services in US
 Edwin Shneidman

6. CIT Law Enforcement Training
 Response to shooting death of person with mental
illness by Memphis police
 Sam Cochran and Randy Dupont with NAMI
 40 hours mental health and de-escalation
 Now in 40 states and 2,000 jurisdictions

7. Joint Effort in St. Louis
 Legislative response to shooting death of family
members by person with mental illness
 Board of Directors four local CMHCs

8. Harris County MHMRA

9. Statewide Crisis & Access Line
 Single Point of Entry concept led to GCAL
 Hurricane Katrina in 2005
 Scheduling, Dashboards and Analytics

10. Crisis Response Center Tucson
 2006 community bond packages $54 million
 CPSA and University Physician’s Hospital
 Co-located Call Center, Stabilization and more

11. Phoenix’s Full Array of Services
 Peer Warm-line, Crisis Line & Mobile Crisis
 24/7 Outpatient & Co-located Residential
 Detox, Crisis Stabilization & Psych Inpatient
Above, Community Bridges

14. Colorado’s Integrated Vision
 Peer Warm Line
 Crisis Line
 Mobile Crisis Response
 24/7 Walk-In
 Crisis Stabilization
 Crisis Respite

15. Why Now? External
Forces Demanding
Better Crisis Care

16. Importance of Mental Health in
Public Safety
On gun violence, Americans now
more likely to blame mental
health system over gun laws, a
shift since 2011’s Tucson tragedy.

17. Polling Question #2
Without community based mobile crisis
services law enforcement and ERs will
hospitalize individuals:
A. The Same Amount as if Those Services
Were Available
B. Less Likely to Hospitalize
C. 2x More Likely
D. 3x More Likely

18. Investment in Mental Health
Wellness Act of 2013
“SB 82 [found] that 70% of
people taken to ERs for
psychiatric evaluation can be
stabilized and transferred to a
less intensive level of care. ”

19. California Senate Bill 82

20. The ADA & People with MI

21. Department of Justice

22. Professional
Orientation

23. Risk Assessment Standards
 John Draper

26. Polling Question #3
People have a right to suicide. We should do
everything possible to engage someone at
risk but not invasively intervene if they do
not want our help.
A.
B.
C.
D.
E.
Strongly Agree
Agree
Don’t Know
Disagree
Strongly Disagree

27. Imminent Risk
NSPL defined “Imminent Risk”:
Staff believe the person’s current risk status/actions could
lead to suicide
Staff sense an obligation/immediate pressure to take urgent
actions
Individual has both a desire and intent to die and has the
capability of carrying through

28. Emergency Intervention
NSPL provided Nine Guidelines for Active Rescue:
Active Engagement
Least Invasive Intervention
Initiation of life-saving
services for attempts in
progress
Supervisory Consultation
Active Rescue
Caller I.D.
Confirmation of Emergency
Services Contact
Procedures for Follow-Up
When Emergency Services
Contact Is Unsuccessful
Third-Party callers
Collaborative Relationships
with Local Emergency/Crisis
Services Provider

29. Engagement & Collaboration
“From the very beginning I felt like she
was an ally... It felt safe to really, really
open up to her because she accepted me
as I was, where I was. She listened to me
and she heard me. . . I felt like she was a
partner, working with me - and it felt
safe…”

30. Polling Question #4
Individuals in crisis often feel out of control
and seclusion and restraint are appropriate
treatment interventions that help reduce
anxiety and provide safety.
A.
B.
C.
D.
E.
Strongly Agree
Agree
Don’t Know
Disagree
Strongly Disagree

31. Recovery &
Trauma

32. Trauma Informed Care

33. Seclusion & Restraint
In 2000, Charles Curie won the
Harvard Innovations in American
Government Award for a
Pennsylvania state hospital
initiative that viewed seclusion and
restraint as a treatment failure
rather than an acceptable best
practice intervention.

34. Recovery Response Center

35. No Force First
1.
2.
3.
4.
5.
6.
7.
Define the use of force and coercion
as a treatment failure
Train staff in effective de-escalation
techniques
Debrief coercion and force and
include the service recipient
Perform critical incident reviews
Track and report all types of forced
interventions and provide feedback to
staff
Use active outreach, engagement and
peer support
Describe relationships as “risk
sharing”

36. Follow-up &
Chain of Care

37. Follow-Up Research
Jerome Motto’s “caring letters” found a simple
follow-up letter expressing concern following a
hospital discharge reduced suicide attempts.
 Madelyn Gould
Madelyn Gould’s follow-up calls to persons
contacting Lifeline found 54% indicated that
the calls helped significantly with keeping
them from killing themselves.
The research has demonstrated that isolation
and lack of connectedness elevate suicidality
considerably. Knowing that someone cares
helps persons feel less isolated.

38. Coordination of Care
 Richard McKeon

39. Potential of High
Tech Solutions

41. Air Traffic Control
 Single Point of
Entry and Secure
Communication and
Coordination of Care

43. National Council
Steering
Committee

45. Contact Us
National Council Crisis Steering Committee Co-Leads
david.covington@crisisaccess-co.com
suzanner@crisisnetwork.org
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crisisaccess.com