How a Provider-Police Collab is Expanding Virtual Mental Health Access

December 05, 2023 - Law enforcement officers play an increasingly pivotal role in connecting people with mental health conditions to healthcare services. However, amid strained resources and hospital capacity problems, law enforcement often lacks efficient strategies to help those in crisis.

An article in the journal Psychiatric Services notes that between 5 percent and 15 percent of all 911 emergency service calls are for behavioral health emergencies, often resulting in a law enforcement response. More than half (56 percent) of 2,406 senior United States law enforcement officials surveyed in 2011 said that the increase in calls related to mental health issues is due to the inability to refer people to treatment.  

Thus, as the mental health epidemic intensifies, there is an urgent need for coordinated care management involving both law enforcement and healthcare professionals.

In Baraga County, Michigan, one such partnership is underway. Last month, Baraga County Memorial Hospital and the Baraga County Sheriff's Department announced the launch of telehealth provider Avel eCare’s co-responder model.

Called Virtual Crisis Care, the model enables law enforcement officers to connect with behavioral professionals while responding to incidents involving people with mental health issues. These healthcare professionals can perform assessments and recommend a course of action. Patients who require additional services are connected to Baraga County Memorial Hospital.

The model has the potential to alleviate numerous pain points in managing the county’s mental health needs, but the organizations had to first address barriers to implementation.

UNDERSTANDING THE MODEL

Discussions about the model had been ongoing for almost a year before its launch. Baraga County Memorial Hospital worked with the Baraga County Sheriff's Department and four other law enforcement agencies in the county to implement the model. The hospital had already implemented the model in its emergency room (ER).

According to Rob Stowe, CEO of Baraga County Memorial Hospital, there aren’t many psychiatrists in Baraga County. The hospital itself does not have a credentialed psychiatrist.

“Our ER docs were finding themselves in some really difficult situations where they didn't necessarily have the expertise to know what to do next, and there really wasn't anyone for them to call,” he said in an interview with mHealthIntelligence.

The Avel eCare telehealth program allowed the hospital’s ER physicians to connect with Avel’s behavioral health clinicians for peer-to-peer consultations, enabling them to provide ER patients with mental health screenings.

Avel proposed expanding the model to include law enforcement agencies.

“The more we thought through it, it's really that same very similar screening,” said Stowe. “You're just moving that screening upstream.”

Launched on November 8, the model allows law enforcement officers in the field to use tablets or smartphone applications to connect a person who appears to be suffering from a mental health crisis to an Avel behavioral health specialist.

“So that's kind of what it looks like from our end — just responding to calls, identifying that this person isn't a criminal, but that they're having some kind of episode and then having the means to address that without removing them from their house,” said Sheriff Joe Brogan of the Baraga County Sheriff's Office, in an interview with mHealthIntelligence.

If those situations escalate, officers can bring the person into the ER for any needed services. For example, if the Avel eCare health professional suggests a medication change for the patient, that can be facilitated at the hospital, Stowe noted.

The model’s launch was made possible by funding from the Copper Shores Community Health Foundation and the Michigan Health Endowment Fund. Along with the Baraga County Sheriff's Department, the Keweenaw Bay Tribal Police Department, the Village of L'Anse Police Department, the Village of Baraga Police Department, and the Michigan State Police are involved in the collaboration.  

ADVANTAGES OF TELEMENTAL CARE IN THE FIELD

The virtual care model offers several benefits for those involved — first and foremost for the patient.

The US is facing a significant psychiatrist shortage. According to the University of Wisconsin Population Health Institute, nearly 30 percent of the US population lives in a county designated as a Mental Health Professional Shortage Area (MHPSA). Baraga County, Michigan, has one mental health provider per 750 residents.

The model allows county residents to access mental healthcare more quickly and without traveling and waiting in the ER.

“We've had behavioral patients awaiting inpatient placement north of 30 days in our ER,” Stowe said. “So, one of the big benefits for us is if this crisis can be de-escalated in the home and the person stays there, that's one fewer person that could potentially get bogged down in our ER. If we can handle that upstream, that's definitely how we want to do it.”

Helping people get access to care without coming to the ER also takes the pressure off ER clinicians, helping boost ER physician retention, he said.

This benefit extends to law enforcement officers as well.

“As law enforcement, we're not really qualified to be making decisions based on somebody's mental health,” Brogan said. “So, kind of unfair to our guys is they were tasked with making a decision and then having to live with the consequences should they make the wrong decision, which generally most guys would err on the side of caution and then bring [the person] to the hospital for an evaluation.”

Bringing a person to the hospital can also be a contentious process, potentially resulting in injuries to both the officer and civilian, he added.

The long wait time in the ER can keep an officer away from their work for hours. This could increase into days if the resident needs to be admitted to inpatient psychiatric care. Stowe said the closest facility is an eight-to ten-hour drive away, taking officers out of the field for almost two days.

Further, an assessment of the Virtual Crisis Care model, performed by researchers from the Medical College of Wisconsin, the University of Iowa, the University of South Dakota Sanford School of Medicine, and Avel eCare, found that the model helps avert unnecessary involuntary committal to a mental health facility.

The study published in JMIR Mental Health examines quantitative EHR data for 181 encounters as well as qualitative data from interviews with law enforcement in the 18 counties that adopted the model.

The telehealth behavioral health provider most commonly recommended that the person in crisis remain in place (77.9 percent) and occasionally recommended that the person be voluntarily admitted (5 percent) or involuntarily committed (14.9 percent).

Researchers found that the telehealth provider’s recommended disposition —the recommendation for the resolution of a complaint — and actual disposition were similar for cases where the patient was told to remain in place, voluntarily admitted, and involuntarily committed.

“[The model] has potentially saved individuals the stress and negative health outcomes associated with IVCs [involuntary committals], it helps law enforcement by better preparing them to serve their local communities, and it helps counties preserve resources and reallocate time and energy otherwise dedicated toward IVCs,” the researchers concluded.

OVERCOMING FUNDING HURDLES

Coordinating the various law enforcement agencies involved and ensuring the funding was in place were the most significant challenges to launching the model.

Five law enforcement agencies are involved in the model, each with its own funding cycle.

“If they went individually to Avel or someone else to figure this out, it's just a very time-consuming process to develop that contact, figure out how it's going to work,” Stowe said. “And we wanted to make this as easy as possible for folks to be a part of it.”

Additionally, the agencies are working with limited resources, making cost a major factor in launching any new program.

Thus, collaborating and contracting with Avel eCare together helped the organizations streamline the launch of the model. Further, along with the funding from Copper Shores Community Health Foundation and the Michigan Health Endowment Fund, the model operates at no cost to the hospital, law enforcement agencies, or the patient during the trial period.

Brogan took the lead in bringing the agencies together, noting that most law enforcement officers do not want to be fielding mental health crises on their own.

“That's not really what anybody gets into this profession for,” Brogan said. “But we've been tasked with walking point on the calls in the field, obviously, and you could do a survey of law enforcement officers, and there's not one of them that's going to say, yeah, those are my favorite calls. So, when we approached other law enforcement entities, the message was pretty clear: ‘Hey, I think we have a solution here that can make all our lives easier.’”

Once the trial period ends, the organizations plan to tell their story, share the trial results, and then submit funding requests to extend the model.

Stowe believes the model enables law enforcement and healthcare providers to care for their community to the best of their ability.

“I do think it's a win-win, and everyone's wanting to do the right thing for the person that's experiencing that crisis,” he said. “And that's really what it comes down to for us when we think through it — how would you rather be treated if you were in that situation? Would you much rather spend that 45 minutes and get that screening done and get to stay home? I think it just makes all the sense in the world.”