Through a partnership with the Oklahoma Department of Mental Health and Substance Abuse Services, HunterCare is deploying telehealth technology to all Certified Community Behavioral Health Clinics in Oklahoma. 

Under a funding mandate from Oklahoma Senate Bill 7, the state's Department of Mental Health and Substance Abuse distributed more than 30,000 iPads statewide from the MyCare Technologies, the behavioral health division of HunterCare, as a mental health resource. 

One key component to this new initiative: Law enforcement officials often face challenges transporting individuals in mental health crises to the nearest facility for assessment. So the legislative funding facilitated the provision of MyCare iPads to Oklahoma police as well as Certified Community Behavioral Health Clinics. The results have been encouraging.

THE PROBLEM

Police officers serving Oklahoma communities routinely would encounter individuals experiencing possible mental health issues and would have to choose one of two courses of action: either take them into custody and incarcerate them or take them to the local emergency room to have the individual evaluated by a mental health professional.

"With most ERs lacking in-house behavioral health professionals, typically our agency would be contacted by hospital staff, and we would have our on-call licensed therapist go to the emergency room to conduct a full evaluation," explained Larry Smith, CEO of Grand Mental Health.

"This process resulted in police officers having to wait with the individual experiencing mental health crisis in the ER for our arrival and remain there with them until a decision was made as to where the person would be admitted for treatment – or be released and taken back to the place they were first picked up," he added.

Waiting for the final deposition of the individual could take several hours and then transporting the person to where they needed to go could take several more hours, leaving police officers frustrated and unable to fulfill their roles in protecting the community.

Beyond the misappropriation of time for law enforcement, often those in need of treatment would be waiting for hours in high-intensity ER room environments, which would often exacerbate their trauma, Smith noted.

"By 2015 this process involved more than 1,100 situations where an individual was taken to an emergency room for evaluation and then transported to an inpatient treatment hospital, sometimes several hours from where they were picked up and from the communities where they and their families lived," he said.

"We believed the number of individuals being admitted to inpatient hospitals or incarcerated could be reduced if police officers had a suitable alternative to the local emergency room or jail for those experiencing behavioral health issues," he added.

PROPOSAL

The first part of the solution to the problem was to design a facility where police officers could bring an individual experiencing mental health crisis and be assured they would receive the care they need without the officer's supervision.

Not only would this be best for the individual, but it would allow law enforcement to return to serving their communities as quickly as possible. However, if the facility evaluated the individual and they did not meet the requirements to be held against their will, the drive to the facility was a wasted trip. The facility was only part of the solution.

"We knew the best-case scenario would be for our trained behavioral health professionals to be able to do a mental health evaluation on-site at the point the police officer first engaged with the individual experiencing mental health crisis," Smith explained. "What we needed was a therapist in every police car to do an evaluation of any person suspected of being a danger to themself or to others.

"Of course, it is cost prohibitive to have a therapist in every police and sheriff car in our communities," he continued. "This would be about 900 total vehicles needing a 24/7 therapist."

The teams knew the solution had to be efficient and cost-effective, too.

"We knew the solution had to work in such a way that police officers would find it easy to use and trustworthy 24/7, providing instant access to a therapist that was awake and helpful in determining what was needed to get appropriate services for the person they were dealing with," Smith said. "Our hypothesis was if we could accomplish all this, we could avoid sending individuals to emergency rooms for nonphysical emergencies and that, as a result, everyone would win.

"So, we asked the question, 'What if the therapist was able to be contacted by a police officer in real time through video technology, and evaluation of the individual in need could be conducted through video conferencing?'" he continued. "It would have to be quick and easy for the officer and the individual to use, and the video could not be choppy, and the voice would have to be clear."

The size of the screen would need to be bigger than a cell phone to get a good idea of what is happening, and the connectivity would have to be 100% all the time.

"After reviewing what needed to happen, it was clear this was not something that was going to be solved without a lot of creativity and testing in a live environment," Smith noted. "We had to get a sheriff's department to work with us on how best the technology would work and what they would be willing to use it for.

"We started with a simple process and an easy way for a police officer to contact our facility where a 24/7 therapist would answer the video request and complete a mental health evaluation," he added.

MEETING THE CHALLENGE

The Craig County Sheriff's Department agreed to allow Grand Mental Health to place a custom iPad in their vehicles to be used when they came upon an individual needing to be evaluated for mental health services. All the officers had to do was touch a single button on the iPad and it would be answered by a Grand therapist working at one of Grand's 24/7 behavioral health Urgent Recovery Centers.

"We quickly learned the officers not only liked using the iPad but the individuals being helped liked using them as well," Smith related. "The amount of time the officer spent trying to get the person in need the right help was reduced, and the number of people sent to an inpatient unit or jail was further reduced.

"We soon introduced the iPads to all police officers in the seven northeastern Oklahoma counties we served, and our relationship with the police greatly improved," he continued. "Moreso, the access to services the individuals needed was immediate and helpful."

Grand later realized that its police officers come upon intense crisis situations and are themselves traumatized daily. To address this, Grand added a second button to the iPad so a police officer who just experienced a traumatic episode could touch this button and talk to a therapist for de-escalation. No record for the police officer to be concerned about.

RESULTS

Since beginning the iPad program, there has been a 93.1% reduction in inpatient hospitalizations for mental health crises from 2015 – 2021, resulting in cost savings of more than $62 million to federal and state governments.

"We've now expanded services to 12 rural counties across north central and northeast Oklahoma and every law enforcement vehicle in these 12 counties is outfitted with our Grand iPad," Smith reported. "But that's only the beginning, every Grand client receives an iPad for continued access to services. We now have Grand iPads in more than 10,000 clients' homes to receive services when and where they want them.

"As a result, we've increased the total number of adult clients served by 362% between 2015 to 2023," he continued. "We've also recently expanded into Tulsa County and are working with local law enforcement there to further our reach and access. We expect to double our current footprint with the entry into Tulsa County."

ADVICE FOR OTHERS

At the end of the day, mental health is a dynamic industry filled with many complex challenges. It requires combining the very best staff with pioneering thought, emerging technology and outcome-based services to solve the problems of the day, Smith advised.

"If a solution doesn't exist, we will work relentlessly to create one," he said. "My advice to other healthcare providers is to think outside the box and never settle for the status quo.

"The mental health crisis in our country has reached pandemic status," he continued. "It is our responsibility to break the stigma of mental health treatment through targeted education of our community partners and to increase access to outcome-driven, data-informed mental health treatment by using the latest technology and service advancements."

Smith encourages his fellow providers, along with federal, state and local officials, to see mental health treatment not as an individual's problem or responsibility but as a community's problem and responsibility.

"It will take all of us to make a difference," he concluded. "I welcome the opportunity to collaborate with any agency who might benefit from our first-hand experiences and successes."

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Email him: bsiwicki@himss.org
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