Health Update

Communities in Crisis: Local Responses to Behavioral Health Challenges

By Jonah Frohlich, Managing Director, Manatt Health | Deborah Bachrach, Partner, Manatt Health | Christopher Cantrell, Manager, Manatt Health | Alixandra Gould, Consultant, Manatt Health

Editor’s Note:  On October 26, the President formally declared a public health emergency to address drug addiction and opioid abuse. The declaration does not include any additional federal funding, but does allow public health agencies to re-allocate existing resources to respond to the crisis. Earlier this year, the President’s Commission on Combating Drug Addiction advanced recommendations to combat the opioid crisis by eliminating the Institutions for Mental Disease exclusion within the Medicaid program, creating federal incentives to enhance access to medication-assisted treatment, enforcing the Mental Health Parity and Addiction Equity Act, and increasing first responder access to Naloxone.

As the opioid and mental health crises continue to gain national attention, local leaders are stepping up to implement programs to address the prevalence and impact of untreated serious mental illness (SMI) and substance use disorders (SUD). In a new report supported by the Robert Wood Johnson Foundation, Manatt Health explores how cities and counties have launched local initiatives to address the human and economic impact of untreated SMI and SUD. The report provides detailed profiles of 13 local programs, as well as a comprehensive taxonomy that categorizes program elements and features. It describes efforts that train law enforcement officials and other first responders in de-escalation tactics; deliver therapeutic treatment in jails; and create criminal justice diversion programs that direct individuals away from incarceration and toward treatment, housing, and therapeutic and social support services. Highlights from the report are summarized below. Click here to download a free copy of the executive summary, full report and taxonomy.

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Substance Use Disorders and Mental Illness: A Dual Challenge

The dual challenge of America’s growing opioid epidemic and SMI is having a devastating impact on communities nationwide. Nearly 10 million adults have SMI, and 20 million have an SUD. Drug overdoses alone now top annual death rates from car crashes and gun violence. Despite the massive need for treatment and recovery services, gaps in care are alarming. Nearly nine in 10 people with a substance use disorder (88 percent) and more than one in three people with serious mental illness (35 percent) did not receive treatment for their conditions.

While national and state initiatives are vital, it is local communities that experience the human and economic costs of untreated SMI and SUD firsthand. Untreated SMI and SUD contribute to rising rates of incarceration, homelessness and use of emergency services, straining local criminal justice systems, law enforcement, first responders, and community and public health resources.

These epidemics have a particularly daunting impact on rural communities, where the rate of opioid-related overdose deaths is 45 percent higher than in metro-area counties. Smaller cities and counties have a lower tax base and fewer resources, including behavioral healthcare providers, at their disposal, resulting in more limited access to care and treatment for SMI and SUD populations relative to urban centers.

Communities Respond

Cities and counties are responding by designing, funding and launching local initiatives to alleviate the human and economic devastation of untreated SMI and SUD in their communities. Manatt Health’s review of local initiatives found that successful efforts typically coordinate law enforcement, criminal justice, public health, healthcare and social service resources to improve access to and deliver a broad spectrum of treatment, recovery, health and social services for people with untreated SMI and SUD.

Common Elements of Successful Programs

While local approaches vary in how they address the needs and impact of individuals with SUD and SMI, successful efforts are marked by factors including:

  • Collaboration and alignment between city and county agencies and community-based health and social service providers;
  • Access to health and social service benefits, including health insurance and social security, treatment and recovery services, housing, transportation, and other social supports;
  • Care coordination and management, using case workers and counselors to develop individualized care and transition plans to help clients navigate and access public and private services;
  • Community engagement and advocacy to overcome the stigma of SMI and SUD, and to mobilize and coordinate public and private resources; and
  • Sustainable financing that leverages federal, state, local and philanthropic funding streams.

Bright Spot: Jail and Emergency Department Diversion in Texas

Officials in Bexar County, Texas, reduced rates of incarceration, recidivism and avoidable use of emergency response services by individuals with SUD. The county established a “Restoration Center” to assist with detoxification, sobering, outpatient treatment and in-house recovery. Combined with crisis intervention team training, the program and its associated jail diversion program diverted more than 17,000 people from jails and emergency departments, saving Bexar County taxpayers more than $10 million a year.

Bright Spot: Safe Stations in New Hampshire

Officials in Manchester, New Hampshire, launched Safe Stations to reduce drug addiction and opioid-related overdoses by connecting people with treatment at fire stations. While not directly attributed to the program, as of early 2017, suspected overdose rates in Manchester decreased 44 percent, and the suspected fatality rate dropped 53 percent compared with 2016. Administration of overdose treatment medication by the fire department decreased, and local police reported that Safe Stations gave them greater freedom to focus resources on criminal investigations.

Looking Ahead: Evaluating and Spreading Interventions

The authors report that many local programs targeting untreated SUD and SMI are not well understood beyond their communities. There is a significant need for thorough evaluation and widespread dissemination of successful local approaches. Specifically, more research is needed to understand what approaches communities can most readily and effectively adopt to address the impact of untreated SMI and SUD. More evidence will allow city and county leaders to make better informed decisions about investing in programs that improve the well-being of individuals with untreated SMI and SUD and help mitigate the impact they have on local communities.

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