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Can better online information for mental health crisis care help people avoid 911, ERs?

While police officers and paramedics have some training in assisting individuals struggling with mental illness, these situations are often beyond their expertise, and in many cases, taking this route for assistance can be less direct or effective and sometimes dangerous.

One of the common mental health and substance use services is the psychiatry appointment. Multiple videos made by the East Metro Crisis Alliance offer understanding of what to expect when participating in these services
One of the common mental health and substance use services is the psychiatry appointment. Multiple videos made by the East Metro Crisis Alliance offer understanding of what to expect when participating in these services
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Too often, when a person is in the midst of a mental health crisis, they or their loved ones end up calling 911 or driving to an emergency room. 

While there’s no question a mental health crisis can feel like it calls for emergency action, a coalition of health systems, law enforcement organizations, government agencies and advocacy groups known as the East Metro Crisis Alliance want people in their part of the state to know about the many other support options that can be much more helpful and appropriate than calling in emergency responders. 

To get this message across, the alliance has developed a new comprehensive website, one of the nation’s first consumer-focused online resources for people in mental health crisis. It guides users through the mental health crisis system on the east side of the Twin Cities and explains ways that they or a loved one can get the help they need in the most appropriate place. 

In many cases, people who go to ERs for mental health crises end up leaving without the services they were hoping for, said Roger Meyer, East Metro Crisis Alliance project director. He explained that ER staff are focused on assessing whether an individual in mental health crisis should be hospitalized or not, and patients with mental illness are often routed out of the hospital after waiting hours to be seen.

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“Only around 50% of the people that show up in an ER in a behavioral health emergency end up being admitted to an inpatient unit,” Meyer said. “That’s not what people were hoping for.  They don’t know what to do. They know they need help, but they don’t usually get it.” 

Roger Meyer
Roger Meyer
The same can happen when someone calls 911 for help with a loved one in mental health crisis, Meyer said. While police officers and paramedics have some training in assisting individuals struggling with mental illness, these situations are often beyond their expertise, and in many cases, taking this route for assistance can be less direct or effective and sometimes dangerous.  

Meyer doesn’t blame people for calling on traditional emergency responders in the midst of a mental health crisis. “This is a very vulnerable time,” he said, but he and his Alliance colleagues want to help people find a more direct route to the help they truly need. They hope that their site will be a clear, easy way for them to do that.

“One of the things we are always thinking about at the alliance is how to get people the right care at the right time,” Meyer said. “We don’t want people going to the ER unless they are at an ER level of need. We don’t want people calling 911 unless what they are looking for is covered by 911.” 

Joe Clubb
Joe Clubb
Joe Clubb, vice president of operations for mental health and addiction at Allina Health, said the site couldn’t come at a better time. A rising number of people experiencing mental health crisis in the state means that traditional emergency responders are feeling overwhelmed, he said, and helping people find the most appropriate assistance for their mental health concerns just might help keep the system running a bit more smoothly.

“We’ve all made some strides but none of us have been able to stay on top of this when it comes to the crushing demand for mental health care,” Clubb said. “There are many options available for people before an ER. We need more resources like this one that will help people get to where they need to go more directly.” 

Focus on regular people  

There are already plenty of online resources designed to help health care professionals understand the nuances of the mental health system and how to route patients to the care that’s best for their particular situation, but until now there have been few if any sites created with mental health care consumers in mind, Clubb said: “There really isn’t anything like this out there.” 

In Minnesota, different regions of the state all have their own mental health crisis systems, networks of social service agencies, crisis responders and even residential facilities designated to help people in crisis. But regular folks, or the very people those systems were set up to serve, generally know nothing — or, at best, very little — about how to navigate them. 

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Members of the East Metro Crisis Alliance have been aware of this gap for some time, Meyer said, and spent many meetings discussing how to demystify the system for mental health care consumers. 

“It is such a complex system,” Meyer said, “with so many resources in so many different areas.” For years, alliance members discussed different approaches, he added: “We realized there isn’t a good one-stop resource to get started in the crisis system, and as soon as you try to put together an all-inclusive resource guide, it gets overwhelming.” 

The group ultimately agreed on the idea of creating a website that people in crisis and their loved ones could turn to before reaching out to traditional emergency responders. They wanted the site to, Meyer said, “help people demystify the system and get started on the right path.” He explained that he and his colleagues wanted the site’s content to be accessible, written and designed in a style that appealed to laypeople, not health care professionals. 

Shannah Mulvihill
Shannah Mulvihill
To make sure their site would have the most accurate and helpful information, Meyer and his colleagues reached out to a number of Minnesota’s mental health leaders, including Clubb and Shannah Mulvihill, executive director and CEO of Mental Health Minnesota, a Twin Cities-based mental health advocacy and support organization. 

Mulvihill explained that Meyer asked for her help with using language that reflects the lived perspective of people with mental illness. “At Mental Health Minnesota,” she said, “we look at how people engage with the system, not through the eyes of a hospital or law enforcement lens. Roger wanted my help to see that the end product would be an easy-access place to go to for that information.”  

Mulvihill recommended that the site’s voice be welcoming and unintimidating. She said she suggested, “‘Make sure it is person-centered. Let’s not refer to people in the third person.’ The final product is focused on people’s real experiences and kept really simple.” 

The site is filled with links to resources for understanding the general crisis system, ways that users can talk directly to a mental health professional, options for making appointments for mental health care and direct connections for immediate help in a mental health crisis. 

Clubb said that developers created the site with the idea that users might often be someone who is trying to help a loved one in the midst of a mental health crisis.  

“It’s designed in large part for a situation of, ‘I need to access care for a family member or a loved one,’” he said. “Sometimes the individual in crisis is just so overwhelmed. They are struggling just to get out of bed, so they need a friend or family member to step in.” While the site could also be directly useful to a person in crisis, he said, its creators understand that other people may actually be the ones who end up searching for care and resources: “It is created to support the caregiver and support the individual who is seeking care.” 

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This consumer-focused approach makes the site especially useful, Clubb said, and sets it apart from other options. “What’s unique about this site is it’s written for loved ones, concerned people, consumers — not professionals. That’s the special sauce.” 

Another element that increases the site’s accessibility is a set of videos that were created to walk viewers through the process of using specific mental health resources. In the videos, volunteer actors (Meyer even plays a role in one) portray the experience of people as they walk through interactions with a number of mental health services, including accessing a crisis shelter bed,  making a psychiatry appointment, entering Ramsey County Detox, having an ER visit for mental health or substance use issues, or using peer support services.   

Meyer explained that his team created the videos as a way to give consumers a sense of what it might be like to access these services. “We wanted the videos to demystify and explain the experience in a one- or two-minute video because not everybody knows what is going to happen when you actually call somebody for help,” he said. “Are you going to have to share all your private information?  Will they take your vital signs? Will they ask for money? When someone doesn’t know what will happen, it can cause anxiety and they might not take action.” 

In a way, Clubb said, the videos do a better job of explaining the process than words on a screen can. “If you are a person who is not going to be pulled in through written text, the videos serve in multiple ways. They give the information you need to understand, ‘Here is what it would be like for someone who had the same struggle I’m going through. I’m not alone.’”

Meyer and his co-creators understand that mental health crises are frightening, and when one happens, it can be hard to think clearly. That’s why people so often call traditional emergency responders. With that reality in mind, Mulvihill suggested that it could be helpful for people to visit the site when they are not in the midst of a crisis, so they will already have the available resources in mind and have a better understanding of where to turn.

“You don’t know what you need until you need it,” Mulvihill said. “So why not get out in front and learn a little bit more?”