At least 17 times in a three-month period starting in May, Longview police officers transported a person experiencing a mental health episode to a hospital ER. On average, each trip took 17 hours, according to police Chief Mike Bishop. That’s almost 300 hours in which at least one officer waited in an ER until the person was seen by a health care professional and could be referred to a treatment center.
“There’s times when we have multiple individuals in some time of crisis that we end up sitting at the hospital, so we could have one, two or three officers at a time sitting with a patient,” Bishop said.
That commitment is one of multiple burdens that mental health events place on public safety, emergency response and criminal justice systems in Gregg County and the Longview area. A coalition of at least 16 governmental, health and social agencies have teamed to create a solution they hope eases that load.
The Gregg County Collaborative Wellness Center is the product of several years of meetings between the mental health, social services and first responder communities.
Starting in October, the collaborative will open a wellness assessment center on Sixth Street between Longview’s two medical centers — Christus Good Shepherd and Longview Regional.
The facility will be staffed with mental health professionals 24 hours a day, giving Longview police, firefighters and EMTs as well as Gregg County sheriff’s deputies a place to take patients for treatment in a mental health crisis rather than clogged hospital emergency rooms.
“Our whole approach is that we want to create an environment where we can expedite and move people that have a mental health crisis to a community after-hours clinic,” said Dr. Stanley Williams, director of strategic initiatives for Community Healthcore.
Community Healthcore is the mental health authority for Gregg and several other East Texas counties and has been a lead agency for the Gregg County Collaborative.
The Houston-based Episcopal Health Foundation gave $850,000 to get the assessment center operational, but there have been significant contributions from Gregg County, the Christus Foundation, Longview hospitals and the federal Substance Abuse and Mental Health Services Administration, Williams said.
Also involved in the collaborative are the city of Longview, Texas Health and Human Services, UT-Health Northeast, Special Health Resources, Hiway 80 Rescue Mission, the Hogg Foundation for Mental Health, United Healthcare and others.
“How this is going to help us,” Bishop said, “is when we have these situations, we’ll be able to take them there to Community Healthcore and start the evaluation process to see what the patient needs at the time … and it frees up the officer to where they don’t have to sit at the emergency room.”
Officials say the collaborative might be a first for a rural area in the state, and while there are similar collaborative efforts for mental health in Houston, Austin and other areas, Gregg County is likely the first to use mobile app technology designed to make mental health assessments more streamlined and efficient.
“This is just the outgrowth of years of us trying to figure out a better way and a faster way to get treatment to the mentally ill,” Gregg County Judge Bill Stoudt said.
How it will work
In Texas, a person with a mental health situation must see a physician face to face to get a medical clearance in order to enter a mental health crisis center, which generally means that law enforcement officers or EMTs take the patient to a hospital, Williams said.
Sometimes, the patient simply is depressed and needs to talk to someone, he said, but there is no other place particularly after 5 p.m. or on weekends in which he or she can be seen by medical personnel and have lab tests performed.
“They’re going to the emergency room to get all of that. It’s very costly,” Williams said.
He believes that diverting patients to the Gregg County Collaborative Wellness Center, where appropriate, will improve safety for first responders, hospitals and community members — not only because it allows officers to return to public safety and other law enforcement duties, but also because the approach might change local culture and decrease mental health crisis events.
When dispatched to a call that involves a possible mental health crisis, the officer or EMT will determine if the situation poses immediate danger to physical health or if the situation is criminal in nature.
If no immediate danger is present, the first responder communicates with a medical professional to get a referral to the Gregg County Collaborative Wellness Center — a communication made easier by Pulsara.
Pulsara is a mobile app that provides real-time communication between healthcare entities. The collaborative’s use of the app will be unique in that it usually isn’t used by an officer or EMT looking to get a medical clearance for a mental health patient, Williams said.
“This is the first time that (Pulsara) would do a mental health platform on top of their medical approach,” he said, “so it’s pretty innovative in their thinking.”
A similar collaborative in Austin involves mental health counselors riding along with police officers to assess patients on scene.
Because Gregg County doesn’t have a budget to pay for ride-along counselors, Williams said, the Pulsara app will use telecommunications to connect officers and EMTs in real time with hospital medical staff and assessment center counselors.
Williams said the app also is compliant with federal health privacy laws. A first responder can record video of the patient’s behavior to show doctors and counselors, but the video is blacked out to other users.
“Sometimes folks that have a mental illness, they may present one thing in a crisis at that time, but by the time they get to the hospital, they may have calmed down,” he said, “so this gives the police officer or first responder the ability to present exactly what’s happening.
“A lot of thought went into it, so that’s a unique aspect of this that nobody is doing,” he said of the collaborative’s use of the app.
Patients who get a referral and pose no physical or criminal dangers will be taken directly to the collaborative wellness center.
If serious health or criminal danger is present, the person will be taken to an emergency room or to jail, but those facilities will be notified during transport so mental health support and instructions arrive faster.
If the person is taken to the hospital, the emergency room department also has real-time communication with the collaborative wellness center. If the subject goes to the Gregg County Jail, he or she can receive a behavioral health evaluation by Community Healthcore staff working inside the jail.
“There’s no question that we’re considered more of a rural area, but our problems are the same. We just don’t have as many as an urban area does,” Stoudt said, “but our problems are exactly the same — getting them into treatment, getting them to mental health facilities faster than later (and) getting them on their prescriptions faster than later, and it’s probably unique for a rural area to have this program in place.”
Stakeholders are focusing on social determinants of health, which are environmental conditions in which people live, learn, work, play, worship and age. These conditions affect a wide range of health, functioning and quality-of-life outcomes and risk, he said.
According to the Substance Abuse and Mental Health Services Administration of the Center for Mental Health Services, “Because only a portion of real-life crises may actually result in serious harm to self or others, a response that is activated only when physical safety becomes an issue is often too little, too late or no help at all in addressing the root of the crisis. And a response that does not meaningfully address the actual issues underlying a crisis may do more harm than good.”
It often leads to hospital stays lasting two to three months if not longer for some mentally ill patients before they are discharged, only to return less than a month later, Williams said. But it’s a cycle that can be avoided.
“Research has found that when a person presents a lot of times with mental health issues, (social determinants) are the undercurrent issues that are going on that aren’t being dealt with,” he said, “so, if you don’t deal with those issues, then you have a situation where people recycle and go back into the hospital.”
To reduce hospital re-admissions, Community Healthcore wants to target specific social determinants commonly found among seriously mentally ill patients.
Those determinants include unemployment, homelessness, a lack of transportation or access to health care insurance and primary care services, substance use, low health literacy and unsafe social environments.
“Remember (psychologist Abraham) Maslow’s basic needs, where you have to take care of food, safety, security and all of those things like that? Well, this is the same thing,” Williams said.
“If we don’t begin to address these issues, then the trajectory of their illness gets worse because we’ve never dealt with these things like this — social isolation (or) people not having the greatest relationships with their family and friends because they don’t feel empowered,” he said.
Stakeholders involved in the collaborative want to analyze the program’s outcomes for two reasons — to find areas for improvement and also to affect cultural change in Gregg County’s approach to dealing with mental health issues, officials said.
“After it’s been in existence for a month, we might have to tweak it,” Stoudt said. “The bottom line is we’ve got this grant money to kind of get this program started and see if it will make a difference.”
The Parkland Center for Clinical Innovation is a Dallas-based collaborative team of data scientists and healthcare professionals who use data and social determinants of health to better support under-served communities, and it has agreed to help with data analysis, Williams said.
Episcopal Health’s grant is funding business intelligence software, usage of the Pulsara app, mental health crisis staffing, evaluation and reporting including the center’s involvement.
“We’re going to look at the value of preventing people from going into the hospital that meet the criteria,” Williams said.
The Gregg County Collaborative Wellness Center is “just another piece” in local efforts over a long period to improve how officials handle mental health patients in a way to lessen the financial, manpower and other burdens on jails, hospitals and other facilities, Stoudt said. In the past, those meetings led the county to contract with Community Healthcore to provide 24-hour mental health staffing inside the Gregg County Jail.
Williams said officials in the Waco area has taken notice and are trying to replicate the collaborative wellness center model before Gregg County’s center has even opened.
“If any county sits on its hands and doesn’t start moving on its own initiatives, it will really start falling behind the curve in mental health treatment,” Stoudt said, “because if you’re waiting for the state or the federal government to come up with a solution, that’s not going to happen. That’s what I’m convinced of.
“It’s truly a local issue that the local people are going to have to figure out a way to do it and do as much as they can to move them into a facility, find a facility and screen out the ones that (don’t have) mental health (issues) but are a drug addict and just looking for drugs,” he said, “because we have that, too.”