Ongoing initiatives and ways to strengthen Arizona’s crisis response and stabilization services were a topic of discussion at the 2023 Arizona State of Reform Health Policy Conference. Panelists spoke about the importance of diverting law enforcement response away from reports of those experiencing mental health distress, and addressing the housing crisis.
“While we’re very robust and rich in crisis service delivery in Arizona, we still have some things to work on. Let us not shy away from areas where we have some mobility,” said Robin Trush, principal at Health Management Associates, who moderated the panel.
Andrew Erwin, president of Solari Crisis & Human Services, a nonprofit focused on crisis stabilization in Tempe, explained how the nonprofit has placed a tremendous focus on limiting law enforcement interventions through transferring certain 911 calls to a crisis line. Solari Crisis now receives calls from Phoenix, Mason, Chandler, Tempe, and Gilbert police departments, and the Maricopa County Sheriff’s Office.
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“We’re getting around 3,000 calls or more every single month—90 percent of those calls were resulting in the dispatch of either fire or police when those calls were being handled only by 911. Essentially, what we’ve done is we’ve gone and given them a third option.”
In addition to having police and fire options, individuals calling 911 can now click a button to be directed towards crisis counselors, Erwin said. As a result, Solari Crisis is able to stabilize 50 percent of the individuals who call 911, while the remaining 50 percent are stabilized within the community, creating massive savings in resources.
“Less than one percent of people are going into a higher level of care—jail—based on this emergency system,” Erwin said.
Erwin believes in partnerships with law enforcement to respond and dispatch, but also thinks there should be a hardline separation between law enforcement and the behavioral health crisis system.
“One of the biggest things we’re seeing in Maricopa County is housing issues, so we’ve seen a 30 percent increase in crisis calls to the crisis line for housing just in the past year—and there was a 30 percent increase the year before that.”
Educating the public on the interconnectivity of social determinants of health and behavioral health will be an important area of focus going forward, Erwin said. He explained that the housing crisis across the nation has become so bad that individuals are choosing to call 911 and 988 to receive support. Erwin said Solari Crisis receives about 750 calls per month for housing-related needs.
Another key issue is the growing fentanyl crisis, evidence of which is being seen in crisis phone calls.
“We’re having people die on the phone with our staff,” Erwin said. “They are overdosing in that moment, so this is something we hadn’t seen before. Obviously, substance use has always had a role in our crisis calls, but fentanyl—in terms of the acuity and the volume—we are seeing precipitously jump.”
Gene Cavallo, senior vice president of behavioral health services at Valleywise Health, said Valleywise has increased the number of individuals seeking assistance, but issues remain.
“Our medical system is not going to be capable of providing what everyone needs right when they need it. We’ve got to have prioritization.”
Cavallo added that an important aspect of the crisis stabilization system is involuntarily enrollment for an evaluation or treatment, but that this should be the last resort. He finds it interesting that a majority of individuals receiving involuntary evaluations also tend to have lower socioeconomic status. He said it seems as though those lower socioeconomic statuses are used as pathways to provide care when care may otherwise be inaccessible, due to financial and housing insecurity, for example.
Erwin agreed with Cavallo that a willingness to invest in initiatives that reduce poverty would help with improving crisis stabilization within the state.