In the realm of mental health much has been done over the past few years to advance the crisis response system. Leading the charge is the state of Arizona, who has charted a remarkable course, sculpting a system with four key components that form the backbone of an effective crisis response system. Let's delve into these pillars that collectively contribute to a comprehensive and impactful system.

Pillar 1: 988: The Suicide and Crisis Lifeline

At the forefront of Arizona's crisis response system is 988 – The Suicide and Crisis Lifeline – which offers 24/7/365 access to trained crisis counselors via call/text/chat for anyone experiencing suicidal thoughts, a mental health crisis, or any other kind of emotional distress, and/or struggling with substance use. People who are worried about a loved one who may be in distress or in crisis can also use 988 to get support.

In Arizona, where Connections has operated crisis response centers for 15+ years, the crisis lifeline – operated by Solari – fields more than 10,000 calls monthly and provides immediate support and resolution for 80% of cases through telephonic crisis counseling and safety planning. A distinctive feature of Arizona's crisis line is its ability to go beyond immediate telephonic support. Dr. Margie Balfour, Connections chief clinical quality and innovation officer, shared. “If part of what helps resolve the crisis at two in the morning is to say, ‘We can get you in for an appointment tomorrow at 11:30’, they can do that for people who need more than the phone call.” This proactive approach ensures that individuals receive timely assistance, preventing crises from escalating further.

Pillar 2: Mobile crisis response teams

Mobile crisis response teams represent a dynamic and responsive element of Arizona's crisis response. Pima County, home of Connections Tucson, 16 mobile teams provide face-to-face encounters for individuals in crisis. The centralized dispatch system, akin to ride-sharing services, ensures rapid response by deploying the nearest team equipped with the necessary clinical information.

These mobile teams play a crucial role in on-the-ground intervention, resolving crises 70% of the time during face-to-face encounters. This mobile component brings mental health support directly to the community, addressing crises in real-time and minimizing the need for further escalation.

Pillar 3: Crisis response centers

For cases requiring more than immediate telephonic or mobile intervention, Arizona’s crisis facilities provide immediate access to treatment and longer term stays for individuals in crisis, offering an alternative to hospitals and emergency rooms. The goal is not just to provide a temporary respite but to initiate the path toward community-based care.

Data from the Regional Behavioral Health Authority (RHBA) indicates that 60% to 70% of individuals utilizing crisis facilities are discharged after an overnight stay, highlighting the effectiveness of this intervention in diverting individuals from more restrictive and costly settings.

At Connections Tucson crisis response center (CRC), the team serves nearly 12,000 adults and 2,400 youth annually. Services provided at the CRC include a 24/7 walk-in urgent care. Dr. Balfour shared that, “anyone can walk in new to town, needing to be connected to services, or needing a med refill and be seen.” The CRC also has a 23-hour observation unit for the highest acuity individuals who would otherwise be boarding in an emergency room, waiting for an inpatient bed somewhere.

Pillar 4: Post-Crisis Wraparound Services

Recognizing that the resolution of a crisis does not mark the end of the journey, Arizona's system extends its support into the post-crisis phase. Post-crisis wraparound services focus on continued stabilization and connection to long-term outpatient care. This comprehensive approach ensures that individuals not only navigate the immediate crisis but also receive ongoing support to sustain their stability.

Arizona's crisis response system harmonizes these four components, creating a symphony of support that addresses mental health crises comprehensively. From immediate telephonic assistance to on-the-ground face-to-face encounters, overnight stays, and sustained post-crisis care, each element plays a crucial role in orchestrating an effective and compassionate response. The four pillars of Arizona's crisis response not only provide solutions for immediate needs but also pave the way for a more resilient and supportive mental health landscape.

Source: National Advancements in Crisis Services: Defining and Refining Responder Roles