UnityPoint Health Robert Young Center – UnityPoint Health Crisis Behavioral Health Services

Overview

In January 2016, UnityPoint Health’s Robert Young Center for Community Mental Health was awarded a contract from the Eastern Iowa Mental Health/Disability Services Region to develop, implement and manage crisis behavioral health services for the 300,000 residents of five counties in eastern Iowa. The contract was re-awarded in 2017.

As a comprehensive community mental health center, the Robert Young Center (RYC) is integrated within UnityPoint Health – Trinity. This model provides bi-directional integration of primary and behavioral health care services as well as a crisis intervention system fully embedded within the emergency departments (EDs), leading to better clinical outcomes at less expense for the patient.

RYC offers a full continuum of behavioral health services for adults and children, including outpatient and inpatient psychiatric services, partial hospitalization, care coordination and substance abuse treatment services. Crisis intervention services are offered 24/7 for people experiencing psychiatric emergencies or those under the influence of alcohol or drugs. For those individuals with severe and persistent mental illness, RYC offers a Community Support Program utilizing the clubhouse model as well as providing supported and supervised housing and supported employment services.

Because of the size of the geographic area to be covered, the next step was to establish a 24-hour crisis line for the five-county region, as well as telehealth systems in EDs throughout the region.

“While emergency departments can handle some cases of patients in psychiatric crisis, they can’t always handle all of them,” says Dennis Duke, president, Robert Young Center. “With our telehealth system, those patients can get a behavioral health evaluation from a trained caregiver who can help them get appropriate services.”

The program also embedded behavioral health care coordinators in those EDs to ensure that those patients do make contact with the recommended services.

“We need to make sure people aren’t falling through the cracks,” Duke says. “With this initiative, we’re making sure that behavioral health patients are receiving quality care and that we’re maximizing existing resources.”

For the county that does not have a hospital within its borders, a mobile crisis component was deployed.

Impact

Following are some of the results the various efforts have seen:

• In the first year of its implementation, the hotline served 965 people in crisis.
• Caregivers have provided nearly 1,700 behavioral health crisis evaluations.
• In the first 16 months of the program 56 percent of clients were reconnected with community services, for an estimated cost savings of $4.2 million.
• The mobile crisis center is estimated to have saved the region more than $55,000 in its first year.
• In less than a year following implementation, the rate of patients who had to be transferred out of the region decreased to 9 percent of all people admitted.
• The region’s rate of attendance for referred behavioral health services has increased 96 percent, compared with 77 percent for the nation overall.

Lessons Learned
“There’s often a belief that there’s not enough resources, but what we have found is that we have to coordinate services better,” Duke says. “We can’t assume that everyone knows what everyone else does. We need to make a concerted effort to coordinate services, communicate with law enforcement, understand the protocols between law enforcement and behavioral health providers, and bring together stakeholders to serve the community better.”

Also, he adds that care coordination is critical: “Just because you’re able to provide evaluation and disposition, you still need make sure you’re connecting that person to appropriate resources, and don’t assume they’re going to follow up without reminders.”

Future Goals

“As we continue, we want to put services in places where people are presenting,” Duke says. “We want to make sure that we can be even more responsive.”

To that end, the organization plans to expand the mobile crisis program and work more closely with transitional housing agencies, emergency services, law enforcement, and the judicial system to ensure that they’re all working together rather than in silos.

“In Iowa, two people can go to the courthouse with evidence to request that an individual they believe to be in crisis be admitted to a hospital for a psychiatric evaluation via a civil commitment,” Duke explains. “But as many as 70 percent don’t require admission – they need community-based services. So by working with law enforcement to send licensed individuals to conduct an evaluation first, we can ensure that people are getting the services they really need and that inpatient beds are being used appropriately and effectively.”

Additionally, the organization is committed to investing further in and expanding the telehealth initiative to increase the reach of its behavioral health services.

Contact: Dennis Duke
President, Robert Young Center for Community Mental Health
Telephone: 309-779-2043
Email: dennis.duke@unitypoint.org