Two Steps Forward, 3 Steps Back

A policy quirk in one of Georgia’s 159 counties apparently didn’t allow 6’6” 20-year-old Sam to be taken voluntarily in an ambulance to a mental health crisis center, despite efforts by counselor Wendy Martinez Farmer to set up a bed at the center after driving to Sam’s family home when his mom called asking for help for a kid who had lost control.  Turns out due to county law Sam had to first go to the hospital ER where he got tazed, afraid he would be poisoned by a needle. This policy – and the one earlier in our column here about requiring pre-approval for mobile crisis – seem to be remnants of a system in transition, like the typewriter that sits on my desk, next to my laptop. For Wendy, who works with Carelon and has helped set up several of call centers for the 988 mental health system including a Spanish speaking one in New Mexico, the hotline is one way to help people like Sam.  She told me that the vast majority using the text and chat 988 service are under 25 and 80% of them confirmed recent suicidal thoughts. Surprising to me, about 80% of these calls/texts and chats are “resolved” but there is not great data on how well referrals are working for those needing it and Wendy admits “resolving” the crisis is often all they can do – “it’s an actual intervention – which is underappreciated” but it’s not a long-term solution for that patient.  That’s why the 988 counselor does, in fact, set up appointments ideally for the next day for people who need it, but this is increasingly difficult and there is not great information on whether the individuals get to the appointments, let alone crisis centers same day or inpatient treatment in emergencies.   A lot of people still call into 911 but only some of those responders are trained and knowledgeable enough to transition the person over to 988.  Georgia is by no means the exception. In Louisiana, there’s been progress led largely by non profits providing treatment to those with substance use disorders or severe mental illness and “mobile units” are now more prevalent to avoid hospitals. But in Louisiana, at least one health insurer for Medicaid patients requires pre-authorization before these units can be dispatched, according to Randal Gomez-Simon, the VP for Business Development at Woodlake Addiction Recovery Center. “It’s causing people to end up calling 911 and then end up in hospitals,” she told us. Like any new system, these things should improve.  In Houston a 911 and 988 crisis center colocates responders and is having better results. I suppose these quirks will work themselves out so kids like Sam and their families can have a better outcome.