With co-author – Dr. Michael Hogan
We are in a rare time when national action to improve mental health services seems possible—even likely. However, the downside of this positive opportunity is that reforms that emerge may be more defined by what can be agreed upon—and probably, inexpensive—rather than what is needed. We write to propose a limited but exceedingly important policy initiative that has already been advanced.
But first, a little background:
- In our view, it’s essential that reform addresses real problems. Creating new national roles (e.g. Assistant Secretary of DHHS for Mental Health) and supporting actions that have already occurred (such as Medicaid’s targeted and limited support for weakening the IMD exclusion) do not count as actions worthy of “the mental health crisis.”
- We believe that a central problem in mental health care is that the US has no national approach or investment in crisis care. While the suicide rate in America continues to rise, the federal government (SAMHSA) spends less than $10M annually to support the effective but under-resourced National Suicide Prevention Lifeline. Yet crisis care is pivotal. Crisis lines and crisis systems are on the front lines of suicide prevention, with proven effectiveness but an inadequate infrastructure. With better support in the face of rising call volume, the Lifeline’s network could become a stronger public health safety net for communities across the country. And good crisis care assures that people get what they need and prefer, at a time when they desperately need it. It speeds access and reduces overreliance on institutional care when it is not needed.
- We were privileged to co-chair the Crisis Care Task Force of the National Action Alliance for Suicide Prevention. The Task Force included many of the nation’s leaders in delivering excellent and responsive crisis care—despite the lack of federal support. The Task Force’s Report analyzes the problem and makes the case for change. The report is at http://crisisnow.com.
- To date, modest investments to improve crisis care are almost completely missing from the national debate. One exception is the strong provisions for crisis care in the CCBHC demonstration project—recognizing that CCBHC crisis services would be embedded within funded demonstration projects, and not regional or statewide in scope. A second (modest) proposal in the President’s 2017 budget is for $10M in the SAMHSA budget to improve crisis care. This is a good but insufficient start, and because of politics it is unlikely to get a fair hearing.
What strong proposal to improve suicide prevention and crisis care is on the table? Hundreds of advocates with the American Foundation for Suicide Prevention made improved crisis care a core aspect of their national Advocacy Forum just a month ago. Their specific proposal, following recommendations of the Crisis Task Force, is the investment of $55M annually to strengthen crisis lines answering Lifeline calls in all the states. The AFSP action can be viewed on their advocacy page at: http://bit.ly/SupportMHReform.
We urge your personal and organizational support for this investment, which is small enough to be feasible but big enough to be transformational. This request is aligned with policy initiatives (e.g. recent investments in the VA to improve the Veteran’s Crisis Line, and the Crisis Task Force) well-focused on real problems in care, and complimentary to other reform efforts such as those you support, rather than competitive.
We view this policy action as one effort that the often-fractured mental health community can get behind. An investment in crisis lines—preferable housed within comprehensive crisis centers that facilitate access to care, deploy mobile crisis teams and operate crisis residential alternatives—would be the first national leadership in this most urgent sphere of action.
Please contact us if you have questions, concerns or suggestions. We need Crisis Care Now!
David W. Covington, LPC, MBA Michael F. Hogan, PhD