Collaboration keeps individuals with acute mental illness out of jail, ERs

September 15, 2018


Counselor opening water bottle for client
At the Kansas City Assessment and Triage Center, counselor technician Angel Modersohn opens a water bottle for a client who had difficulty doing so. Adults experiencing a mental health or substance abuse crisis are triaged and stabilized at the Kansas City, Mo., center. Staff then link clients to additional behavioral health care and social services.
Jill Toyoshiba/© CHA

When helping people in the throes of acute mental illness or substance abuse, community responders in Kansas City, Mo., used to feel like they were keeping a revolving door in motion — they often took individuals in crisis to the emergency room or to jail. It was only a matter of time before the same people would be back in crisis and the cycle would repeat.

To provide a more humane and comprehensive response, one that might yield better long-term outcomes, community and hospital leaders opened the Kansas City Assessment and Triage Center in the fall of 2016. Staff at the center assess clients who arrive in crisis and stabilize individuals by first meeting their basic needs, including giving them nutritious food and a safe place to sleep.

Counselor checks client's vital signs
In the Kansas City Assessment and Triage Center sobering unit, counselor technician Lois Blackmon, right, checks a client’s vital signs as another counselor technician Lon Holder, standing left, records the data. Jill Toyoshiba/© CHA

Then a person can get a psychiatric evaluation and discuss the next steps. These may include providing them with medications, and linking them with outpatient behavioral health services, substance abuse treatment, and housing options, said Lauren Moyer, the center's vice president of clinical services.

The center is open around the clock, and each shift is staffed by seven or eight people, including a nurse practitioner, nurses, social workers, case managers, discharge planners and technicians.

Clients at the center are welcomed by a social worker or professional counselor who does an initial evaluation. If someone is perceived as a danger to himself or others at that point, the center arranges for the person to be transferred to the appropriate level of care.

Clients receive a basic health assessment by a nurse; they can shower and get a change of clothes. Most nights, 16 of the center's 18 beds are occupied. The center has recliners that fold flat to become beds, with privacy walls between clients' recliners and an open view on one side of the space, so staff can maintain line of sight. Clients can stay at the triage center for up to 23 hours.

Sgt. Sean Hess
Sgt. Sean Hess Courtesy of KCPT, Kansas City PBS

Everyone is assigned a case manager. If the client needs a medication previously prescribed to them, a nearby pharmacy will fill and drop off their medications, or their case manager can take a client to a pharmacy to get a refill. If an on-site clinician determines a client needs a psychiatric medication, it can also be prescribed and filled, said program manager Stephanie Boyer.

The case manager continues to work with their client after they leave the center — helping them find a spot in a treatment program or follow-up behavioral health services.

Kelly Phillips, an outreach case manager, said some clients may choose to return to living on the streets. But many gladly accept help finding a placement in respite care, transitional housing or a sober living residence. The center offers ongoing assistance finding permanent housing.

On a recent day, she was driving to visit center clients who had completed inpatient detoxification treatment at a hospital or nonprofit behavioral health center and were living in sober homes. She was bringing clean clothes, pantry foods and towels with her. She stopped in to visit 53-year-old Timothy Newlun, who said he'd been homeless for about two years before he was brought into the triage center. Phillips had helped him find a place in a sober living home after the triage center arranged for his inpatient care. "As far as I'm concerned, Miss Kelly has saved my life," he said.

He said it took him a long time to feel worthy of assistance. "I thought people would look at me like: he's nothing." But he came to realize, "You can't be afraid to ask for help. It's what people like me need. I'm going to get my life back."

Counselor technicians Lois Blackmon and Lon Holder check on a client in a dormitory-style sleeping area. Jill Toyoshiba/© CHA

The law and mental illness
Sgt. Sean Hess, supervisor of the crisis intervention team for the Kansas City, Mo., police department, said, "The crisis center is awesome in that it gives us a front door, a place to bring someone in crisis."

Hess said police officers responding to a call involving someone who may be experiencing a mental health emergency are trained to make assessments that determine next steps, such as whether someone is safe and capable of self care.

"It's not against the law to be mentally ill," he noted.

Officers gather information from the person or from others with the person to assess if the individual in crisis poses a danger to themselves or others. The officer asks questions such as if the person has a mental health or medical diagnosis and if the person is taking medication. The officer assesses the person's mannerisms and behavior, for instance, if the person is talking nonsensically or making threats. The officer also considers aspects such as if the person has warm clothes in winter and access to food.

When an officer determines a person is in crisis and should be taken to the triage center, the officer escorts the individual into the center and fills out a crisis intervention team report about that individual. The officer usually can be back in the squad car within a few minutes.


A better option
Judge Joseph Locascio has seen many defendants struggling with substance abuse and behavioral health issues during his 16 years as a municipal court judge. He helped create Kansas City's drug court. The court offers alternatives to jail for people trying to overcome addictions. It doesn't provide an avenue for supporting those with other underlying mental or behavioral health concerns. "I quite frankly didn't know what to do about it," Locascio said.

He said he's had defendants appear in his court who don't believe they are mentally ill, and so they refuse to take medications. Some have thought they were in court as a lawyer, not as a defendant. He sees many defendants in his courtroom who have experienced abuse or other trauma, and who don't trust anyone.

Counselor technician Angel Modersohn, left, leads a newly arrived client to the sobering unit after a medical assessment. Jill Toyoshiba/© CHA

Both Hess and Locascio got involved in the creation of the triage center and its continuing work because they saw it as a way to help individuals in need of mental health care in an environment that could respond to their crisis and follow up to link them to services.

Moyer said 3,000 individuals were referred to the center in its first year of operation, from the fall of 2016 on. The referrals came from law enforcement and health care providers who determined the triage center was a more appropriate care venue than an emergency room or jail. About three-quarters of those referred were homeless. Caring for people at the center led to cost reductions for hospitals of about $3 million the first year, she said.

Moyer said that the center's work pays off in human terms too. People arrive at the center downtrodden and shamed by life circumstances. Many say they don't feel they belong in the pleasant, comfortable surroundings. Moyer said staff quickly assure them they do. "That's really our purpose," she said. "To regenerate hope in people."


Ascension supports mental health triage center

St. Louis-based Ascension contributed $20 million — $2 million a year for 10 years — to help fund the Kansas City Assessment and Triage Center. Funding came from proceeds of the 2015 sale of Carondelet Health's St. Joseph Medical Center in Kansas City, Mo., and St. Mary's Medical Center in Blue Springs, Mo., to Prime Healthcare Services. Nine other-than-Catholic area hospitals, city and state departments, a county tax and the Health Care Foundation of Greater Kansas City also provide funding. The center has an operating budget of about $3 million annually.

The center has been described as a public-private partnership between Kansas City, stakeholders and the Missouri Department of Mental Health, the Missouri Hospital Association, Ascension, the city through involvement of the municipal court and police and fire departments. Hospital partners include HCA Midwest Health, Truman Medical Center, Saint Luke's Health System, North Kansas City Hospital, Prime Healthcare and Liberty Hospital.


Copyright © 2018 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3490.

Copyright © 2018 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.