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Community Crisis Response

About one in five adults in Contra Costa County are struggling with behavioral health issues. A complex and decentralized system of intervention and treatment programs often means people experiencing a behavioral health crisis cannot access the care they need when they need it.

Calling 911 can feel like the only option for families and caregivers when behavior escalates beyond what they can manage. In reality, there are limited options currently available when faced with responding to mental health crises in our county.

In Fall 2020, we brought together a multi-disciplinary, county-wide team with diverse experiences and created an initial framework to develop a system where anyone in Contra Costa County can access timely and appropriate behavioral health crisis services anywhere, at anytime.

Over the past months, the team of community stakeholders has worked together to understand exactly what happens when someone experiences a mental health crisis – and most importantly, to identify the barriers that prevent us from providing compassionate care and easy access to effective behavioral health services for all.

At the request of mayor’s from throughout the county, Contra Costa Health Director Anna Roth gave a brief overview of Behavioral Health Crisis Response services to the Mayor’s Conference in September 2020. They asked that the county lead an effort to explore how to improve and expand these services in our county.

Identifying a common goal through Value Stream Mapping

In November 2020, Contra Costa Health Service hosted a Value Stream Mapping event where a diverse group of stakeholders worked together to develop a common aim for behavioral health crisis response in our county. The aim statement is: Anyone in Contra Costa County can access timely and appropriate behavioral health services anywhere, anytime.

The value stream team mapped both the current state of behavioral health crisis response as well as an outline for the desired future state. The process included data analysis, listening to those with lived experiences, observing current processes and evaluating available services. Out of these efforts, the team prioritized four topics for future rapid improvement events:

  • Single number to call for behavioral health crisis
  • Mobile crisis 24/7 response
  • Non-police mobile crisis team composition
  • Alternate destination

Opportunities for rapid improvement

Rapid Improvement Event #1

CCHS hosted the first of three Rapid Improvement Events in March 2020. The team effort focused on three goals:

  • Single number for people to call to access services
  • Creating a streamlined triage assessment tool
  • A non-police mobile crisis response team available within forty-five minutes
  • Some of the ideas tested during the week included: soliciting community member responses on who they would call during a mental health crisis; applying mental health crisis scenarios with a city police department to determine whether a nonpolice mobile crisis team would be deployed over the police; and using a mental health first mobile crisis response when appropriate. The suggested priority of “mobile crisis 24/7 response” was incorporated into the “single number to call for behavioral health crisis” and “non-police mobile crisis team composition” which are both expected to be available 24 hours per day, seven days a week.

The week concluded with the following recommendations from the team:

  • Develop a 24/7 Centralized Crisis Call Center Hub (virtual)
  • Create 4 regional county Crisis Teams to be deployed by the Hub
  • Empower law enforcement dispatch with a standardized, clear county wide protocol to utilize the mental health crisis response team
  • Offer a clear alternative to 911 for mental health and substance use crises
  • Establish a review process that includes, law enforcement, behavioral health, emergency medical services, families for how we are doing, identify and explore possible improvements
  • Establish training program for mental health, law enforcement, emergency medical services – all call takers and crisis responders

Rapid Improvement Event #2

The second of three Rapid Improvement Events in April 2020 reported out on the process of testing and developing solutions.

Testing was completed on the following:

  1. The response time was reduced by having a dedicated call taker and transit time was decreased by deploying regional teams
  2. Adding triage questions to a triage decision tree to get a triage protocol results in a clear map of how we do things, more standardized process and more consistent outcomes, transparency and accountability
  3. For individuals experiencing a behavioral health crisis, waiting for law enforcement can lead to a delay in the appropriate behavioral health responses and treatment. Next steps include piloting an option of having an EMT as team member, further refinement of triage assessment, pilot use of crisis support worker (mental health specialist)
  4. Psychiatric Emergency Services (PES) is the only option available to support those experiencing a mental health crisis 24/7. Explore options like a peer-operated respite center, a sobering center, crisis stabilization unit, crisis residential facilities

Rapid Improvement Event #3

On Monday, June 7, we kicked off the third, week-long improvement event. The initiative is a partnership between cities from across the county and Contra Costa Health Services focused on looking closely at our behavioral health crisis response services and developing and testing improvements. The team reported on plans to launch a small pilot project within the next month.

You are invited to watch the public report out with the results of the week’s work testing strategies to address community needs. Details on how to watch the video are posted above.

Existing Resources
Rapid Improvement Event #3
Rapid Improvement Event #2
Rapid Improvement Event #1
Value Stream Mapping

  • Statistics

    • Behavioral health issues are widespread
      • About one in five adults are currently experiencing behavioral health issues
      • About 13% of all EMS calls address mental health issues
      • There are between 10,000 and 11,000 involuntary psychiatric holds (5150s) in our county each year

  • Existing Resources

    • CCHS provides a variety of behavioral health services. A limited number provide crisis response, however none provide emergent response like 911.
      • Crisis Intervention Training (CIT)
      • Homeless Services (H3 & HCH)
      • Alcohol & Other Drug Services
      • Medical and Psychiatric Emergency Services
      • Behavioral Health Crisis Teams
    • Existing crisis response resources serve a small number of residents
      • Mental Health Evaluation Team (MHET) serves 293 people annually at a cost of $2 million
        • Designed to reduce law enforcement repeat calls for service and violent encounters, reduce visits to Psychiatric Emergency Services, increase community and police safety, and increase appropriate use of mental health services.
      • Mobile Crisis Team (MCRT) takes about 1,600 calls per year at a cost of $2 million, serves adults only
        • MCRT is designed to have mental health providers respond in the field to de-escalate crisis, provide stabilization, and prevent psychiatric hospitalization. If the situation cannot be de-escalated in the field, the MCRT will assess for 5150 criteria and, if criteria are met, the Mental Health Clinical Specialist can initiate a 72-hour 5150 involuntary hold.
        • In addition to responding in the community to the immediate situation that led to calling the MCRT, the team provides a 30-day period of follow up during which they focus on linking individuals to a variety of services to help them stabilize and prevent ongoing crisis experiences.
      • Mobile Response Team (MRT) receives about 1,000 calls from youth each year, budget is $2.2 million
    • MRT provides risk/safety assessments, crisis intervention, follow up services, collaboration with existing treatment team members and linkage for youth in their natural settings. The CCC MRT aims to provide same day services and/or services as close to 24 hours of immediate crisis.
    • We have researched models from other communities
      • Regardless of what model we choose, the key to success is alignment with our cities and community partners across the county.

  • Rapid Improvement Event #3

  • Rapid Improvement Event #2

  • Rapid Improvement Event #1

  • Value Stream Mapping