Improving community health, safety through a continuum of care

Key Takeaways

Recognizing that residents living with behavioral health conditions such as mental illness and/or substance use disorder are more likely to succeed when supported by a public health approach in lieu of the criminal legal system, county leaders across the country are spearheading efforts to develop a behavioral health continuum of care.

By directing resources to community-based and “person-centered” services, counties can better serve residents with behavioral health conditions, reduce reliance on the criminal legal system and direct valuable resources toward improving well-being and health.

Annually, counties invest more than $100 billion in community health systems — including behavioral health support — and provide services through 750 behavioral health authorities and community providers. Despite this investment, more than half of residents with a behavioral health condition report not receiving treatment within the past 12 months. Communities of color are often less likely to receive treatment because of disproportionately low levels of access to behavioral health care.

To fill this gap, counties are deploying resources that support residents before, during and after a behavioral health emergency by offering someone to call, someone to respond and somewhere to go. This coordinated system deflects and diverts people away from justice-system involvement and emergency room visits through an array of services that assist everyone.

Counties are helping community members before a behavioral health emergency by targeting resources to programs that provide prevention and early intervention services that focus on the environmental and social conditions impacting community members’ health and wellness.

County programs

In Will County, Ill., the PATH (Projects for Assistance in Transition from Homelessness) program provides services to residents experiencing housing instability and live with serious mental illness or co-occurring substance misuse. RAIZ Promotores, a mental health prevention and well-being program in

Stanislaus County, Calif., supports the Latinx/Spanish-speaking community. The community health workers live in the neighborhoods they serve and provide a bridge between community members, health care institutions and social service providers. During a behavioral health emergency, community members benefit from having someone to call, someone to respond and somewhere to go to access support, treatment and connections to services. These practices leverage the experience and expertise of trained clinicians and health professionals to de-escalate a situation without relying on first responders or law enforcement.

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NACo brief: Promoting Health and Safety Through a Behavioral Health Continuum of Care

Crisis lines provide immediate care for residents during a behavioral health emergency and an entry point to service provision. Clinicians who staff these hotlines can triage the emergency, connect the caller to community-based services and dispatch mobile crisis teams. To assist residents who call 911 for mental health support, counties are virtually or physically embedding clinicians in 911 call centers to de-escalate the call and determine next steps.

Baltimore County, M.d., Taylor County, Texas and Durham County, N.C. are among the many counties who have undertaken this practice. Similarly, counties such as Niagara County, N.Y. and Multnomah County, Ore. often offer non-911 crisis lines for community members to call 24 hours a day, seven days a week. Duchess County, N.Y. offers the HELPLINE app that can immediately connect users to phone or text support, suicide prevention tools, a resources map and mental health tips.

Starting July 16, 2022, residents in every county will have an easier way to access the existing National Suicide Prevention Lifeline via 988. This three-digit number will connect callers to trained counselors 24 hours a day, seven days a week, via text, chat or phone. No call goes unanswered and residents who call 988 from communities with behavioral health supports such as mobile crisis teams or crisis centers can receive immediate referrals to services from the 988 counselors.

Mobile crisis teams

For residents who may benefit from in-person support and connections to services, mobile crisis teams (MCTs) offer community-based, face-to-face interventions. MCTs range in composition from crisis-intervention team trained law enforcement officers to civilian-only response, with many featuring teams across professions. They provide stabilization and treatment as well as deflect individuals away from the criminal legal system and emergency room department.

Many counties dispatch law enforcement officers paired with social workers, clinicians and/or paramedics. Worcester County, Md. launched a pilot Law Enforcement Assisted Diversion (LEAD) program to embed social workers with first responders and law enforcement. Similar practices pairing behavioral health professionals with law enforcement have been implemented in El Paso County, Colo., Yakima County, Wash., Charlotte County, Fla. and Eau Claire County, Wis. In counties with rural communities, including Dane County, Wis. and Pennington County, S.D., law enforcement officers are equipped with technology such as iPads to increase community members’ access to telehealth and telepsychiatry.

Civilian-only teams

Often, calls to 911 are for a mental health crisis or low-level crime, stemming from that emergency or lack of socioeconomic resources. Civilian-only teams may be more appropriate in these cases. These groups can either be dispatched directly from 911 or law enforcement that respond to the call. In Denver and Bernalillo County, Texas, a team pairing a behavioral health clinician and paramedic can respond to crisis calls and provide early intervention. The team in Carroll County, Md. is composed of therapists and peers — individuals who are in recovery.

During a behavioral health emergency, residents may benefit from treatment at a physical location such as federally funded Certified Community Behavioral Health Clinics or crisis triage/stabilization centers. While the design and details vary, these centers often provide community members with access to out- and in-patient services, peer support networks, withdrawal management, medication adjustment, counseling, therapy and/or longer-term residential care.

Many centers offer a dedicated first responder drop-off area and accept referrals and walk-ins. Leaders in Bell County, Texas and Rowan County, N.C. are exploring the possibility of constructing centers in their counties, potentially leveraging ARPA funding.

Other counties such as Douglas County, Kan., Washington County, Utah and Beltrami County, Minn. recently broke ground on crisis centers or are preparing to open their doors. In some communities such as Pima County, Ariz., Santa Fe County, N.M. and Larimer County, Colo., voters acknowledge the need for these spaces and approved funding via taxes and bonds.

After a behavioral health emergency, community members are more likely to succeed in recovery when they have access to ongoing support and case management to help effectively respond to their underlying needs and future crises. Counties support residents during this time through programs offering peer support, connections to services and continued care. Community engagement teams in Bernalillo County, N.M. employ a recovery-focused approach to promote wellness after a crisis with the support of behavioral health peers. In Blue Earth County, Minn., the Second Step Clubhouse offers a recovery-focused, safe and stigma-free space for residents with serious and persistent mental illness to develop skills and engage in employment, education and community opportunities.

Counties play a pivotal role in improving community members’ health, safety and well-being. Developing a coordinated and collaborative system that integrates the elements of the behavioral health continuum of care can enhance these efforts. There is no one-size-fits-all approach, but county leaders can best help residents by supporting them throughout the life-cycle of their behavioral health condition as no single piece alone will resolve a problem.