Crisis Services: Building a Better System of Care

 

We are working to develop an unbroken system of care that connects people from the point of their mental health crisis to the level of care that's right for them. 

The need for change

Our current system is sometimes inadequate to meet the needs of Wisconsinites experiencing a mental health crisis.

Why is the current system sometimes inadequate? We have a patchwork system made up of elements designed for other purposes that doesn't have the capacity to treat the most vulnerable in our communities. 

Imagine two types of bad days involving emergencies that could happen to anyone. First, a person crashes their car or experiences chest pain. There's a system built to respond immediately to these public safety and medical emergencies. The law enforcement officers, emergency medical technicians, and hospital staff who may respond to these situations are trained to provide appropriate support and care. Second, a person who wants to die is taking steps to attempt suicide. The same emergency system that responds to the car crash or chest pain also responds to this situation. However, this emergency system doesn’t have the capacity to handle all types of emergencies and wasn’t designed for mental health emergencies.    

The need for targeted services to respond to medical and public safety emergencies is recognized by all communities. However, in many communities people experiencing a mental health crisis often receive a response that is not specific to their unique needs and may even be harmful to them, even if the emergency responders are well-intentioned. In the example above regarding someone planning to attempt suicide, it is likely that the individual or someone who cares about them may call 911. The 911 call center typically dispatches law enforcement who may take the person to a medical emergency room or jail or leave them to remain in the community with no assessment, treatment, or support. None of these options are ideal. 

The only solution to delivering mental health crisis care worthy of our communities is to build a structure specifically for mental health crisis emergencies that is on par with medical and public safety emergencies. 

Our areas of focus

In Wisconsin, tribal and county health and human services agencies have first line responsibility for responding to mental health crisis situations. This work often involves local law enforcement, mental health and substance use providers, medical emergency rooms, and county, state, and private psychiatric hospitals. 

We are leading an effort involving the major stakeholders in Wisconsin's system of care for mental health crisis situations to dramatically improve the experience for someone with a mental health crisis. By integrating the core elements of Crisis Now, the national framework for best practices for mental health crisis care, we can replace the patchwork fabric of our current system and develop a true safety net that can serve everyone, everywhere, and every time. In the process, we can reallocate misplaced financial resources to places where they can have deep community impact. There are three components of the Crisis Now model.

  • Someone to talk to. The someone to talk to component focuses on high tech regional or statewide call centers, which are call, text, or chat lines staffed by specialists who answer every time and direct people to the level of care they need. These programs use technology for real-time coordination across a system of care. 
  • Someone to respond. The someone to respond component focuses on 24/7 mobile crisis teams, which are non-law enforcement teams that work in the streets meeting people where they are and for the majority resolving their situation right then. This lessens the burden on law enforcement and eliminates the anxiety people feel when a uniformed officer knocks on their door.
  • A place to go. The place to go component focuses on crisis stabilization programs, which are facilities offering immediate specialized treatment for people who need support and observation regardless of their level need. With facilities like this available, when law enforcement is involved, they no longer need to decide between a medical emergency room or jail. This no wrong door approach reduces the time needed to handle these cases allowing law enforcement to focus on supporting public safety, a role they are uniquely trained to do. Medical emergency rooms can also focus on the people they're trained to serve.

Visit the Crisis Now website to learn more about the Crisis Now model

Our guiding principles and practices

The essential principles and practices of the Crisis Now model are guiding our work to transform Wisconsin's system of care for mental health crisis situations. The principles and practices of a modern system of care for mental health crisis situations include:

  • Promoting hope and recovery.
  • Providing services and supports in ways that do not blame or re-traumatize a person in need.
  • Ensuring the safety and security of staff providing services and supports and the people receiving services and supports.
  • Involving peers or people who have experienced mental health crisis situations trained to support others.
  • Implementing the Zero Suicide framework or suicide safe care practices to prevent suicides.
  • Collaborating with law enforcement, 911 centers, and emergency medical services.

 

Improvements and investments

We have long recognized the need to strengthen Wisconsin's system of care for mental health crisis situations. With this system facing rising demand in recent years, we have focused considerable energy toward ensuring the right services and supports are available to people experiencing mental health crisis at the right time. 

Trainings for mental health and substance use providers, law enforcement, and other partners on topics related to our guiding principles and practices are one piece of this work. 

The bulk of our work has been focused on aligning Wisconsin's system of care with the key components of the Crisis Now model. Recent actions are listed below.

Someone to talk to

  • A statewide call center affiliated with the National Suicide Prevention Lifeline was established in 2020. Wisconsin residents who contact the National Suicide Prevention Lifeline are now much more likely to connect by phone with a Wisconsin-based counselor with knowledge of the services and supports available across the state for people experiencing a mental health crisis situation.
  • A 988 Planning Coalition was established in 2021 to develop Wisconsin's plan for 988, the new national calling code for the National Suicide Prevention Lifeline that is expected to launch in July 2022. This group has been discussing issues related to technology, communication, and data sharing among state call centers that will handle calls to 988.
  • Warmlines operated by Wisconsin's peer-run respites began taking calls in phases starting in 2015. Warmlines are a resource for people before their situation becomes a mental health crisis. They are staffed by peers or people who have been in distress trained to use their personal experiences to support others experiencing similar issues. 

Someone to respond

  • Modifications to the Medicaid crisis intervention benefit took effect in 2020 giving county mental health crisis response programs qualified to seek Medicaid reimbursement for their services funding to sustain and expand services, including mobile crisis teams.
  • State funding for crisis intervention team training for law enforcement officers was first allocated in 2014. Crisis intervention team training is designed to improve the outcomes of law enforcement interactions with people experiencing a mental health crisis.

A place to go

  • Wisconsin's first peer-run respite opened in 2015. There are now five peer-run respites in Wisconsin. Peer-run respites can help people avoid a mental health crisis situation.
  • The youth crisis stabilization facility type was established in Wisconsin in 2019. Certified youth crisis stabilization facilities are located in Milwaukee and Wausau.

Federal funding to support transformation efforts

We are setting aside about $20 million of funding from our share of the American Rescue Plan Act over the next four years to support efforts to transform Wisconsin's system of care for mental health crisis situations. Learn more about our plan for the supplemental funding we've received through the Community Mental Health Services Block Grant and Substance Abuse Prevention and Treatment Block Grant

 

 


Crisis Services Workgroup

County and tribal health and human services staff are part of the Crisis Services Workgroup we formed in 2019 to look for areas of opportunity in the state's system of care for mental health crisis situations.

Based on a review of data and best practices, the priorities of the Crisis Services Workgroup include:

  • Creating regional telehealth prescribing for crisis programs.
  • Improving access to screening and assessment for people with substance use disorders in a crisis situation and providing education for understanding billing and policy around substance use disorder resources.
  • Improving the relationship with law enforcement associations and considering the law enforcement role when authorizing emergency detentions.
  • Improving the medical clearance process.
  • Addressing inequities in the effectiveness of crisis services with a priority on racial and ethnic populations.

Subgroups are working on these priorities. The subgroups report their progress at quarterly meetings of the Crisis Services Workgroup.

Last Revised: September 13, 2021