Every person in crisis, and their families, should receive a humane response that treats them with dignity and connects them to appropriate and timely care.
Every day, Northeast Ohioans are struggling to get the help they need. Rates of depression, suicide, anxiety and overdose are on the rise. Nearly half of adults who experience mental illness do not receive treatment. Social isolation, despair and chronic stress often culminate and exceed one’s ability to cope and lead to a state of crisis. Historically, law enforcement, hospitals and jails have been and remain the safety nets for people experiencing behavioral health crises, and not enough resources are available.
Therefore, as a core foundation of its services, the St. Vincent Charity Health Campus initiative seeks to help enhance access and address the symptoms of trauma by creating a new coordinated response to crisis in the community and enhancing access to services that support long-term recovery.
Specifically, we will expand the mental health and addiction crisis continuum of care by partnering with community entities and developing a Crisis & Recovery Services pilot. Through the pilot, we can appropriately address all age ranges and acuity levels, especially lower acuity needs, which are not being met based on research conducted in greater Cleveland and across Northeast Ohio.
As Voiced By Residents
The St. Vincent Charity Health Campus (Health Campus) partnered with MASS Design Group—a global design collective dedicated to delivering architecture that promotes justice, human dignity and design for healing—to undertake an extensive community engagement process. We employed a process of early listening and engagement embedded in local context, guided by local partners and leaders, and deeply informed by the lived experiences of local residents.
Collectively, the team conducted hundreds of instances of:
- Dialogue: Engaging in specific conversations with individuals and organizations about pre-determined topics. Dialogues included question and answer sessions, workshops, facilitated conversations and events.
- Listening & Observation: Getting to know local context and community through observation, photography, sketching, mapping, and participating in local meetings and events.
- Lived Experience: Recording authentic narratives and emotions related to the experiences of local residents and businesses. Activities included those done asynchronously.
Community engagement demonstrated there is vast need for support in coping with trauma and violence, especially in underserved neighborhoods. Residents elevated behavioral health as a long-standing and significantly under-addressed need. Over the last two years, the ongoing COVID-19 pandemic has exponentially increased the rate and exacerbated the severity of mental illness due to social isolation, increased anxiety and lack of access to care. There is a lack of awareness of services available; as well as a lack of awareness of what is covered by health insurance.
Stigma creates additional barriers to receiving behavioral health care, and people suffering from mental illness may also receive a lower standard of health care because they aren’t taken seriously in traditional health care settings, exacerbating issues of comorbidity. Society continues to define people by their mental illness—this includes health care providers. Participants in resident focus groups described experiences where they had been judged or their opinions dismissed because of who they were. Community organizations and residents voiced a general desire to integrate behavioral health into other health and social services; and vice versa, to integrate other services into behavioral health.
As Voiced By Providers
Behavioral health care providers across Northeast Ohio agree.
The St. Vincent Charity Health Campus engaged a market research firm to learn about needs and perceptions among mental health and addiction care providers within the local continuum of care. The firm completed focused interviews with 13 senior executives across health systems, agencies, insurance companies and consumer/policy advocates.
The executives were unanimous that:
- The current system is highly fragmented and there is great need for the kind of coordinated effort the St. Vincent Charity Health Campus is proposing with our Crisis & Recovery Services pilot.
- This is an unmet need, giving it a 10 out of 10 rating, with 10 being most significant.
- Providers are beyond capacity to serve the current crisis and recovery needs they are experiencing.
- Providers are eager to partner in this pilot.
- The Sisters of Charity Health System and its ministries are recognized and appreciated leaders in behavioral health.
In addition, the market research firm engaged experienced frontline staff from public and private hospitals and community behavioral health agencies in several focus groups.
Themes expressed included:
- Cuyahoga County’s behavioral health infrastructure is most threatened by poor communication and coordination, as well as lack of parity between medical and behavioral health.
- There is no one avenue for behavioral health agencies to come together.
- Coordination of care is a major benefit of the pilot.
- Providing support for individuals leaving emergency departments and helping guide them to their next steps in recovery would alleviate a major problem in the current system of care.
- Offering crisis and recovery services would increase capacity to serve people in need.
- Minority and/or marginalized communities are impacted significantly by services not being sensitive to their needs (e.g., a shortage of bilingual therapists, supports for LGBTQ youth, Medication Assisted Treatment for youth 18 and under).
Better Cost, Better Care, Better Health
The vision of the Health Campus Crisis & Recovery Services pilot is for people to have access to a visible, accessible and responsive crisis and recovery continuum of care in Cleveland and Cuyahoga County. Our services and supports will be person-centered, quality driven and focused on ensuring individuals are stabilized and thriving in the community.
The most effective system of care for
behavioral health crises combines a
coordinated call system (air traffic
control), an appropriate mobile crisis
response and safe crisis receiving
centers. Developed by Crisis Now and
Recovery International, a global leader
in the design of crisis delivery systems,
the model demonstrates:
- 6x improvement in clinical response
fit to the crisis
- $37 million in cost savings for local hospitals and emergency departments
- $260 million in reduced potential spend by a state psychiatric hospital
- Equivalent time-savings of 37 full-time police officers and 5 full-time fire department personnel
Studies cited by the Substance Abuse and Mental Health Services Administration (SAMHSA) have shown that crisis stabilization and mobile crisis response services result in:
- 65% less cost than standard hospital care when respite services are used.
- 211 v. 665 an average cost of $211 per day vs. $665 per day for hospitalization.
- 79% reduction in costs associated with inpatient hospitalization in a period of six months post-acute crisis.
- 23% lower costs when compared to regular police intervention.
- $2.16 return of dollars for every dollar invested.
And, the National Association of State Mental Health Program Directors published a study in 2020 showing that in settings with a crisis response call center, mobile response, specialized facilities and adequate follow-up care:
- 80% of crises were resolved on the phone
- 71% of crises were resolved in the field
- 68% discharged back to the community from a crisis facility
- 85% remained stable in the community with adequate follow-up care
The evidence is clear.
During times of behavioral health crises, people need someone to speak to, someone to provide assistance on scene and/or a place they can go to obtain help.
Models with these components:
- Decrease the use of jails, law enforcement, emergency departments, first responders and hospitals.
- Result in better care provided in the least restrictive and lowest cost setting.
Pilot Goals & Programming Overview
Expanding the Crisis Continuum of Care
In year one, our initial efforts will focus on crisis outreach, prevention and management efforts to assist individuals
who are struggling when they are most vulnerable.
Fundraising efforts will focus on building capacity to provide virtual and community-based services, while building core relationships and coordinating a response for mental health and substance use crises. In years two and three, our efforts will focus on growing the pilot team and expanding our service delivery model.
Our pilot will employ licensed professionals, peers and specially trained staff who will outreach to local emergency rooms, including the St. Vincent Charity Medical Center Psychiatric Emergency Department, to provide follow-along support and treatment linkages for those who are vulnerable and in need. They will also outreach to criminal justice and other critical-time service entities.
Our newly developed crisis outreach team will demonstrate core competence in crisis intervention, de-escalation, triage, assessment, care coordination and evidence-based psychotherapy-based interventions. They will be trauma-informed, adept at working with community partners and person-centered in their approach, while also creating community-care plans.
The chief aim of our expanding crisis services:
- Link individuals to services
- Improve engagement in care pre/post crisis
- Establish a pipeline for referrals and future expansion
Expanding Longer-Term Recovery Supports
Our expanded recovery services professionals will offer ongoing, time-unlimited, recovery-oriented services to people who are experiencing serious and persistent mental illness, co-occurring addictions, trauma and medical complexities.
Individuals served by this team will be at risk of re-hospitalization, more complex and require more treatment than a traditional outpatient clinic can offer. Our recovery team’s approach will be evidenced-based and family/person-centered with treatments tailored to an individual’s needs. Services will be remote capable, aimed at helping people bridge to outpatient settings and provide people the requisite skills needed to realize personal goals.
The key supports and services offered will be screening and assessment of need; individual and group therapy; peer support; case management and care coordination, including linkage to primary care; and open door or drop-in availability for those unsure of their needs.
- Help individuals attain their self-determined goals and roles
- Improve engagement and retention in care
- Create personalized pathways for recovery and healing
The Health Campus Crisis & Recovery Services pilot will serve individuals diagnosed with a serious mental illness (SMI) and/or substance use disorder (SUD) in need of crisis response and long-term recovery support.
- Crisis response efforts will target individuals discharging from critical-time service entities (e.g., hospital settings, criminal justice facing entities, homeless shelters, etc.).
- As for recovery services, the target will be individuals seen by our crisis team that require additional support beyond what a conventional outpatient clinic can provide them.
The Crisis & Recovery Services pilot will provide support to an average of 14 individuals per day in year one, and that volume will increase over time. Visits will be community-based, mobile, on-site and virtual in nature. Our aim is to engage people in their natural settings as often as possible.
Location and Space
The Crisis & Recovery Services pilot will be located within the Sisters of Charity Health System campus at East 22nd Street and Community College Avenue in downtown Cleveland. We will perform the administrative and clinical functions to begin program and pilot operations out of this space, which will be approximately 6,200 square feet at pilot maturation.
Crisis & Recovery Services will be one of many programs and partners on the St. Vincent Charity Health Campus. In its totality, the Health Campus seeks to promote healing, equity and opportunity… building upon a holistic understanding of community health deeply informed by local residents, partners and community leaders.
The vision is for people to have access to a visible, accessible and responsive crisis and recovery continuum of care in Cleveland and Cuyahoga County.
Our services and supports will be person-centered, quality driven and focused on ensuring individuals are stabilized and thriving in the community.
The Crisis & Recovery Services pilot is well positioned for success.
It is anticipated that the pilot and operations will be operational by Fall 2022.
Journey for Person Served
By offering a more robust, integrated and seamless crisis and recovery continuum, the Health Campus Crisis & Recovery Services pilot will provide the right care at the right time, consistent coordination for care transitions and support that addresses social determinants of health. This model is intended to reduce the need for costly, intensive levels of care and allow individuals to live healthier, more productive and meaningful lives. Expanded recovery services will support individuals until they can independently access and utilize primary care and community resources.
The End Result
After our 3-year pilot we expect to offer a 20,000 square foot fully operational Crisis & Recovery Services Center that will provide both crisis response (24 hours) and recovery services. Through this pilot, the Health Campus will establish a framework and core set of services that ultimately become a central hub for those in need, where individuals are seamlessly linked to behavioral and physical health services, regardless of their entry point.
At our center, we will uniquely offer crisis services to a wide range of acuity levels/ages, and care delivery will be based on the Crisis Now Fusion Model. The setting will be home-like, and services will be peer-driven with clinician support that will follow SAMHSA best-practice guidelines. Our outpatient recovery services will be ongoing and time-unlimited, and serve adults, youth and families who are experiencing serious and persistent mental illness, co-occurring addictions, trauma and medical complexities.