wiley

Stay up to date with Mental Health Weekly

  • Learn about the latest trends in the field
  • Hear from leading clinical practitioners and field leaders
  • Stay up to date with regulatory and policy changes
  • Glean strategies for delivering quality services
  • Get expert advice on budget issues
Order with discount code MHW5 and SAVE 50%! SUBSCRIBE NOW!

Other Products of Interest

Alcoholism and Drug Abuse Weekly
an indispensable resource for managers and directors in addiction treatment centers, federal and state policy makers, researchers, and healthcare consultants. Read More
Child and Adolescent Psycho-
pharmacology Update

Stay current with the most successful approaches to treating common childhood disorders. This newsletter covers the latest research findings, off-label prescribing practices, case reports, adverse events, and more to keep you informed. Read More
2/12/2015 12:00 AM

The founders of the first free national crisis counseling service delivered through text messaging knew that young people needed a better medium for reaching out for help when they had a mental health–related problem. Yet even they were surprised at the demand that surfaced almost immediately after the Crisis Text Line was initially launched with teens in Chicago and El Paso, Texas, in 2013.

The founders of the first free national crisis counseling service delivered through text messaging knew that young people needed a better medium for reaching out for help when they had a mental health–related problem. Yet even they were surprised at the demand that surfaced almost immediately after the Crisis Text Line was initially launched with teens in Chicago and El Paso, Texas, in 2013.

“Within four months, we were getting texts from all over the country,” Baylee Greenberg, the Crisis Text Line’s director of operations, told MHW. “We’re doing no marketing, and we’re exchanging about 15,000 messages a day.”

For its innovative use of technology in mental health, the New York City–based Crisis Text Line was named a 2014 Community Innovation Award winner by Connect 4 Mental Health, an initiative to encourage innovative approaches to improve the lives of people with serious mental illness.

Origins

The idea for the Crisis Text Line originated out of DoSomething.org, a youth platform for social change. Administrators were finding an increasing volume of texts of a serious nature, Greenberg explained. Someone might text, “I can’t hold a jeans drive; I’m struggling with my homework.” But then another person would text, “I can’t get involved; my boyfriend’s pressuring me.” At the most serious end of the spectrum, one girl texted to DoSomething that she was being sexually assaulted, Greenberg said.

These types of messages demonstrated that youths in trouble will likely turn to texting over other forms of communication. Greenberg cited several reasons for this:

  • Texting is “just what young people do,” she said. “So this is meeting them where they are.”
  • Texting offers privacy. “You don’t have to be seen talking to someone at your locker, or observed going into a therapist’s office,” Greenberg said.
  • Texting is more factual than phone conversation, where pauses and superfluous language can muddle the message. “By the third text message, we know the exact issue at hand,” Greenberg said.

Founders of the Crisis Text Line launched the initiative by telling 4,000 DoSomething.org participants in Chicago and El Paso that the service was available, and it didn’t take long for the effort to go national.

Crisis counselors

A group of paid and volunteer crisis counselors form the backbone of the effort; the Crisis Text Line is designed to have a texter engage with a crisis counselor within five minutes of sending an initial text. Greenberg explained that the effort started with organizers contracting with crisis response organizations, but it sees volunteer counselors as its emphasis for the future.

The initiative uses a 34-hour training course that can be completed online. Around 250 crisis counselors have been trained so far, but the Crisis Text Line hopes to have 2,000 counselors in place by the end of this year (more information about the volunteer effort can be found at www.crisistextline.org/volunteer).

Greenberg said the opportunity to serve as a crisis counselor attracts a variety of individuals, from students pursuing an M.S.W. to military veterans looking for another way in which they can save lives. She believes the characteristics that make for a good crisis counselor are empathy, good decision-making, and the ability to learn a new skill and execute it.

“We don’t accept everybody who applies,” Greenberg said. “You’re talking to young people about heavy subjects.”

Topics of texts

The Crisis Text Line is designed for use by teens, but no one is asked for any identifying information, so it is possible that younger children use the free service as well. Greenberg said that around 20 percent of the texts that come in address depression. Another 10 percent each focus on self-harm and suicide.

For most texters, the task for the counselor becomes one of “moving them from a hot moment of crisis to a cool calm,” Greenberg said. “The texter usually just wants someone to speak to in the moment.” In more serious cases, the crisis counselor’s active listening and guided questions may uncover cases of imminent risk (the system also prioritizes response to any texts that use specific words such as “cut,” “hurt” or “kill”).

For the most serious cases in which it is believed that the teen has the plan and the means to cause grave harm, the Crisis Text Line will initiate an active rescue, in which a check of the texter’s cellphone area code (this predicts the location of teens in about 94 percent of cases) will then lead to a call to local police. The service averages about 1.25 active rescues a day, Greenberg said.

Program data

Crisis Text Line leaders do not at this point have data on the extent to which texters pursue specialty mental health services subsequent to receiving the crisis counseling. Greenberg said they do know that if a person is texting the line frequently, that probably means the service is inadequate to meet that person’s specific needs.

A school or a bathroom tends to be the most common location from which a text is sent to the crisis line. Greenberg said the initiative has a great deal more data, in areas such as the most active days of the week for texts and the busiest locations for certain topics. It has decided to make this data public via the website www.crisistrends.org.

“This data could be powerful for local governments,” she said. “A school administrator could say, ‘Texts about bullying in my district are most common on Tuesday mornings. I’m going to put an extra teacher in the halls on Tuesdays.’”

The Crisis Text Line’s program costs are covered by funding from a handful of large foundations. Greenberg says organizers are hoping to make the effort self-sustainable within a few years, partly by offering corporations an opportunity to pay to have their employees engage in the volunteer effort.

10/23/2014 12:00 AM

The world continues to move faster for mental health treatment organizations as reimbursement mechanisms change and providers are pushed to integrate services with general health, and the CEO of Harbor Corporation in northwest Ohio likens the situation to “changing the engines of a 747 in flight.” This means mental health treatment organization employees need more diverse clinical and business training than ever, but face greater time pressures for achieving this, Harbor CEO John Sheehan explains.

The world continues to move faster for mental health treatment organizations as reimbursement mechanisms change and providers are pushed to integrate services with general health, and the CEO of Harbor Corporation in northwest Ohio likens the situation to “changing the engines of a 747 in flight.” This means mental health treatment organization employees need more diverse clinical and business training than ever, but face greater time pressures for achieving this, Harbor CEO John Sheehan explains.

“The work happens faster now — patients are not in treatment as long as they once were,” Sheehan told MHW. As a result, productivity concerns predominate for clinicians, and the idea of sending a treatment team to an out-of-town training conference for several days quickly takes on the appearance of an unaffordable luxury.

This has made the concept of blended learning, combining online training with live sessions as needed, more attractive to mental health organizations in recent years. Harbor Corporation in July formally entered into an agreement with Cary, N.C.–based Relias Learning under which it now uses the online training company’s learning management system to assign training and to develop curricula on important subjects.

“One of the great things about e-learning is that if a staff member’s client cancels [an appointment], they can go in at that time,” Tracy Sokoloski, Harbor’s director of human resources, told MHW. “Also, we can use the system to track [employees’ training progress] and to run reports.”

Multiple needs

Sheehan says the historically disparate funding mechanisms for behavioral health and the rest of medicine have kept the mental health community “on an island” isolated from health care. But now the emphasis has turned to chronic disease management, seeking to improve outcomes while reducing costs. Harbor responded to the change this year in part by forming a joint operating company with ProMedica, which has the same level of experience on the inpatient mental health side in the Toledo area that Harbor has achieved in outpatient services.

This development and others could eventually fuel a doubling of Harbor’s staff (it currently has around 650 employees), and it already is creating more complex training needs in the organization. For one, the merging organizations are accredited by separate national entities, making accreditation-related topics even more of a focus. Confidentiality provisions also have become a prominent training topic, as Harbor’s client base exhibits a greater prevalence of comorbid substance use problems.

In today’s fast-changing clinical and business environment, “We’re constantly in an innovation state,” Sheehan said. To understand how best to manage reimbursement and establish a financial model that is sustainable, staff training becomes a critical component, he said.

Having an arrangement with a training organization that serves as an exclusive partner with the National Council for Behavioral Health allows Harbor to respond to the diverse training needs and learning styles of its staff, Sheehan indicates.

“Physicians are scientists, clinicians are a little more on the feeling side and nurses are somewhere in the middle,” he said. “For us to develop a curriculum on our own would be challenging. The experts understand these needs.”

Sokoloski believes the Relias learning management system’s ability to track employees’ training progress and to conduct pre- and post-testing exercises greatly benefits her organization. “We need to determine ‘Are we delivering what we need?’” she said.

Sheehan says an organization could lose a bit of the human interaction element as it moves to more online training, but there are ways to compensate for that with online forums and other features.

Sheehan considers the investment in training to be a critical marker of his organization’s long-term viability. “Some reports estimate that up to 40 percent of mental health centers could eventually be out of business,” he said. “A lot of disruptive things are happening. The ones that will make it are those that are progressively looking at what they need to survive.”

Broader training needs

Kristi McClure, L.C.S.W., senior product manager for health and human services at Relias, told MHW that clinical and management staff in mental health organizations now need a broader scope of knowledge. “It’s not as much ‘I work with just this population’ anymore. Now it’s ‘I need to treat the whole person,’” McClure said.

Relias’ learning management system and content libraries offer mental health organization employees regular access to self-paced courses on key clinical and management topics. McClure says the technology has come a long way since the days when the Health Insurance Portability and Accountability Act (HIPAA) training she received as a social worker a decade ago took the form of a giant text file. “Now it is interactive and involved,” she said of online learning.

Users of the Relias system also can manage any live trainings they conduct themselves or through another outside source via the Relias learning management system.

McClure said some of the clinical topics that are proving very timely in training right now include primary care integration and trauma-informed care. On the management side, she is hearing a great deal about leadership issues as longtime executives leave organizations, forcing these companies to take a close look at promoting from within and easing employees’ transition from a clinical peer role to that of a supervisor.

Relias made news of its own on the business front last week, as the European media group Bertelsmann SE & Co. (which includes book publisher Penguin Random House among its holdings) announced that it had reached a deal to acquire Relias from private equity firm Vista Equity Partners.

10/2/2014 12:00 AM

Despite financial investments in its behavioral health system, New Mexico lacks a “comprehensive grasp” of its finances and has done a poor job of providing services for consumers with mental health and substance abuse issues, according to a scathing report released Sept. 24 by the state’s Legislative Finance Committee.

Despite financial investments in its behavioral health system, New Mexico lacks a “comprehensive grasp” of its finances and has done a poor job of providing services for consumers with mental health and substance abuse issues, according to a scathing report released Sept. 24 by the state’s Legislative Finance Committee.

The state does not know how it spends an estimated $209 million on adult behavioral health, whether it’s funding effective services, whether services are located in high-need areas or whether services are producing expected results, according to the new report. Estimates are that the state only spends 11 percent of its limited funding on proven and effective programs for adults, even though past studies have recommended greater spending on these services.

According to the report, “LFC Results First: Evidence-Based Behavioral Health Programs to Improve Outcomes for Adults,” New Mexico has been plagued with a number of problems regarding its behavioral health system.

Last June, state officials released an audit alleging that 15 of the state’s largest behavioral health organizations had engaged in mismanagement and widespread overbilling of federal and state government money (see MHW, July 15, Sept. 16, 2013). Five Arizona agencies were subsequently brought in to manage services for consumers with serious mental illness.

For adults, New Mexico leads the nation in alcohol-related death rates and is ranked among the worst in the nation in drug overdose–related death rates, suicide rates and serious mental illness rates. These persistent challenges in behavioral health outcomes, along with gaps in services, have substantial consequences in costs to consumers and taxpayers, including increased criminal activity, increased use of the health care system, property loss, decreased labor market earnings and preventable deaths, the report stated.

Behavioral health outcomes

Behavioral health outcomes in New Mexico continue to rank among the worst in the nation, the report stated. About two in 10 New Mexico adults suffer from mental illness and one in 10 suffers from mental illness. Serious negative outcomes include:

  • The percentage of New Mexicans with a mental illness is higher than most states, and the percentage with a serious mental illness is among the highest in the nation.
  • From 2008–2012, about 63,000 adults, or 4.3 percent of the adult population in New Mexico, had serious thoughts of suicide in the previous year.
  • The suicide rate has consistently been among the highest in the nation.
  • The alcohol-related death rate has been the highest in the country since 1997.

Adult mental health issues range from stress, anxiety and depression to more serious functional impairment and life-threatening situations such as serious mental illness and suicide, the report stated. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) reports 19.6 percent (300,000) of New Mexicans 18 or older have a mental illness.

This figure is above the national percentage of 18.2 percent. SAMHSA also reports 4.72 percent (72,000) of New Mexicans 18 or older have had a serious mental illness in the past year, up from 3.4 percent in 2008. This figure is well above the national percentage of 3.97 percent and ranks among the highest in the nation, according to the report.

Limited EBPs

The report noted that evidence-based practices (EBPs) for the treatment of mental illness and substance abuse disorder are limited and oversight of program fidelity is lax for many programs. Such programs as assertive community treatment, cognitive behavioral therapy and illness management and recovery are available.

Other EBPs, including collaborative care management for depression and depression with comorbid medical conditions, and primary care behavioral health co-located in community-based and integrated care settings, may be buried in generic individual therapy codes and specific treatment interventions and cannot be identified, the report stated.

The analysis also emphasized “the need for a system of care which is planned and designed coherently, managed and led effectively, and owned and guided by those who benefit from and contribute to the system’s existence and success.”

Additionally, the report recommended that the state:

  • Develop and use common reporting system requirements;
  • Develop a common set of core services across funding streams;
  • Require or provide incentives for adherence to evidence-based practices; and
  • Create statewide behavioral health research and development capacity.

HSD responds

“The Legislative Finance Committee report adds to the conversation about ways to improve behavioral health outcomes in New Mexico,” Matt Kennicott, spokesperson for the New Mexico Human Services Department, told MHW. “As has been the case over the past several years, we will continue to support the use of evidence-based practices in behavioral health. But this is only one part of the conversation.”

Kennicott added, “We also need to improve access to behavioral health services broadly by focusing on individuals in a holistic manner through integrated care in Centennial Care (our new Medicaid program), addressing behavioral health workforce shortages and streamlining the regulatory structure.”

He noted that HSD has taken important steps to improving access. “This is evident by the increase in the number of behavioral health consumers that were seen in FY14 — an increase of 30.8 percent over last fiscal year to more than 114,000 individuals served,” Kennicott said.

Meanwhile, HSD officials announced Oct. 1 that the department’s Behavioral Health Services Division has been awarded a suicide prevention grant from SAMHSA to help prevent suicide and suicide attempts among working-age adults from 25 to 64 years old, and to reduce the overall suicide rate and number of suicides in New Mexico. The grant totals $1.4 million over three years, with the state receiving $470,000 each year.

System issues

The state’s behavioral health system "has never been top notch," especially in light of the Medicaid fraud allegations in 2013, Rep. Elizabeth “Liz” Thomson (D), chair of the Behavioral Health Subcommittee, told MHW.

“It’s really disturbing and disheartening that only 11 percent of our behavioral dollars is being used on evidence-based treatment,” said Thomson. “We can’t say with one-hundred percent certainty that more funding isn’t being used [for these treatments]. We want to see better traction and more [emphasis] on evidence-based practices.”

Additionally, the way the state conducts its Medicaid billing, it’s impossible, she said, to determine whether evidence-based treatments are being used. “The billing codes need to be changed in order to dig down and see what therapies are being used,” she said.

The subcommittee, meanwhile, is working on recommendations for addressing challenges in the behavioral health system, including the lack of providers and homelessness, Thomson said. “The legislative council charged us with coming up with a plan,” Thomson said. “The problem is New Mexico is a poor state and a very rural state.” The subcommittee will take their recommendations to the full legislative subcommittee in late November or early December, she added. “We recognize that what we come up with will not [necessarily] fix the system,” said Thomson.

Bottom Line…

The state legislature’s Behavioral Health Subcommittee is preparing recommendations to release in another month on repairing New Mexico’s behavioral health system.

From the Field
9/26/2013 12:00 AM
FromtheField
8/7/2013 12:00 AM
In Case
7/11/2013 12:00 AM
  • LOGIN HERE

    Username: Password:
  • Content Directory

    MHW subscribers can now log in to browse all articles online!
    Browse Content
    Free Content
  • Free E-Alerts

    Sign up to receive exclusive content and special offers in the areas that interest you.
    Send
  • Subscription Formats

  • Meet the Editor

    Valarie Canady
    Managing Editor

    Valerie Canady, managing editor of Mental Health Weekly, knows the mental health field inside and out. She uncovers the essential stories and gets the scoop directly from leaders and advocates in the field.
Copyright © 2000-2013 by John Wiley & Sons, Inc. or related companies. All rights reserved.