Behavioral health leaders came together at the 2023 Alaska State of Reform Conference last month to discuss the results of the implementation of the 988 suicide and crisis lifeline and the state’s plans for crisis stabilization centers.
In October 2020, the US government passed the National Suicide Hotline Designation Act. Anyone facing a mental health crisis can call or text 988 to reach the suicide and crisis lifeline.
Leah Van Kirk, the healthcare policy advisor in the Office of the Commissioner at the Alaska Department of Health, spoke about Alaska’s unique position when it comes to mental health and suicide rates, and why a crisis line is so important for Alaskans.
“We are oftentimes more than double the US rate for suicide. In 2021, the leading cause of death in our state for 15-24 year olds was suicide.”
— Van Kirk
However, the suicide rate decreased in 2022, Van Kirk said. She explained the impact that 988 had, citing that during the first year of its implementation, the Alaska crisis call center answered more than 24,000 calls. A majority of those calls, 70%, actually came through the pre-established Alaska careline number, whereas 30% of the calls were made through 988.
“We expected to see a decrease in calls to the 800 number and an increase to those 988 calls, but what our data is actually showing for the first year is we’ve seen an increase in both,” Van Kirk said. “So that has been an unintended outcome—really making sure we’re increasing communications about the availability of our crisis call center.”
A successful crisis call center should have three main components, Van Kirk said: someone to talk to (the call center), a crisis team (such as first responders or EMTs), and a place to go (a crisis center). These components would allow patients to get the same continuum of care that they would receive if they were experiencing a physical problem.
Van Kirk mentioned that technological advancements are important for crisis centers as well, because a strong technological system “allows us to connect people to outpatient services; to food banks, if that’s what they need; to housing resources; to childcare resources. Because we know that is what most of our callers are needing.”
Samantha Gunes, the administrator of the behavioral services division at Southcentral Foundation (SCF), began her discussion speaking on the importance of modeling a crisis center differently from the emergency room—a place, she said, that has fluorescent lights, loud noises, and not enough staff trained to handle a mental health crisis. She said this is an environment that is generally more stressful for patients experiencing a mental health crisis.
Instead, she argued that crisis centers need to focus on providing a comfortable, patient-first space for people to go and receive care for their mental health.
“This model really creates a safe, trauma-informed environment that is meant to provide evidence-based care to people experiencing a crisis. The staff are all trained specifically with different expertise to provide interventions and support for people and rapidly stabilize and then transition people to the lowest level of care possible.”
— Gunes
SCF, which aims to serve Alaska native peoples and works closely with the tribal healthcare system, has plans for a crisis center that more closely aligns with that trauma-informed care model.
“Originally we had planned to open [SCF’s] crisis stabilization unit within the walls of the Alaska Native Medical Center,” Gunes said.
At the last minute, Gunes said they decided it would be better for the community to construct a new building with more space; it will have a 16-recliner crisis stabilization unit, a 16-bed residential unit, and detox care.
Lauren Anderson, senior manager of clinic operations at Providence Medical Center, spoke about another crisis center going up in Alaska that Providence began constructing in August of this year. She said the center will have 12 chairs and they intend to open a residential unit with 12 beds.
“We are set to continue the construction process over the next year and we intend to open in August of 2024,” Anderson said.
Rick Ellsasser, MD, the medical director of the Behavioral Urgent Response Team at SCF, discussed the importance of remembering rural communities when thinking about behavioral health.
“We have a lot of resources in Anchorage, but we have a big state and small, little communities.”
— Ellsasser
He said that in Alaska, they need to be “figuring out how we’re going to be able to model these things and scale down to take some of [the mental health services] to our rural communities.”
Sandrine Pirard, MD, PhD, MPH, the west regional chief medical officer of Carelon Behavioral Health, concluded the panel with a discussion overviewing crisis solutions. She said that the ideal crisis system must have a combination of community support, clinical best practices, continuum of care, and strong finances.
Pirard focused on the importance of finance, and said that the ideal financial system would use braided funding, which uses different funding sources that “come into one centralized place.”
Crisis systems must “make sure that there is financing that makes it sustainable,” Pirard said. This would allow a crisis center to take in any patient, regardless of their financial situation.