Pierce County provides leadership in creating a regional behavioral health system that is coordinated and complete by identifying gaps in service, forging partnerships, driving innovation, providing accountability and paying for vital services appropriate for county government.
In 2016 the Pierce County Council commissioned a report to assess behavioral health care gaps in the county. The report urged the formation of a central coordinating body to provide regional coordination of behavioral health services because they saw that after integration what was once a unified system would be fragmented between 5 separate payers. In the absence of a single entity like the former BHO to coordinate regional behavioral health care, the report recommended that the Integration and Oversight Board (IOB) and Elevate Health partner to fulfill this role.
Since then, Pierce County has worked diligently with residents, first responders, service providers and other local agencies to fill gaps in services throughout the behavioral health system.
MCIRT. Pierce County launched the Mobile Community Intervention Response Team (MCIRT) in 2017 in response to the growing behavioral health crisis in our region. The program’s end goal is to serve law enforcement and first responders by engaging high-utilizers of the crisis system in therapeutic interventions to avoid involving emergency services if possible. MCIRT teams (made up of a mental health professional, a psych ARNP with the ability to prescribe medications, a case manager, and an outreach peer specialist) meet clients where they are to design client specific interventions to address individual needs. MCIRT works with these clients until stabilized and follows them for an additional 90 days post-intervention to monitor for any further contact with emergency personnel. Though currently only available in a handful of Pierce County localities, the county’s Behavioral Health Program is working on expanding MCIRT service areas to make it available to the entire county.
MOCT. The Mobile Outreach Crisis Team (MOCT) is managed by MultiCare and partly funded by Pierce County. MOCT provides crisis outreach services, including face-to-face evaluations. Members of the MOCT team provide initial assessments to determine if the individual in crisis will accept a less restrictive alternative to hospitalization. If the individual appears to meet involuntary detainment criteria (danger to self, danger to others, gravely disabled), the MOCT will refer to the Designated Mental Health Professional (DMHP) or refer to the Emergency Department.
Crisis Recovery Center. Pierce County’s first Crisis Recovery Center in Fife was built several years ago to provide law enforcement, EMTs, and families a place, other than an ED or jail, to bring those suffering from mental health crises to receive immediate and appropriate care. The decision to build another Crisis Recovery Center in East Pierce County was based on feedback from first responders and behavioral health providers voicing a need not only for more bed availability in the county but in a location much closer to the locus of a majority of 911 calls. In response to this need the county committed to building the new facility to be operated by a private company. This facility is expected to improve crisis care services to those suffering severe mental illness and substance use disorder as well as save thousands of hours of EMS and law enforcement time which can be devoted to far more appropriate public safety and medical emergencies. This facility is planned to open sometime in the Spring of 2020.
Beacon and the Crisis System. Each of the 9 regions in WA state is responsible, through a mix of federal, state and local funds, for funding behavioral health crisis services and services for the uninsured. Most regions directly fund and provide these services themselves, but Pierce is 1 of 3 regions who contracts with a behavioral health administrative organization (Beacon), while still retaining the right of first refusal at the yearly contract renewal. And though the county does contract with Beacon, we are still responsible to make sure the community receives the required services and one way we do this is by sitting on the Behavioral Health Advisory Board, a group convened by Beacon to advise on the yearly spending plan for the federal SABG and MHBG. The county also works closely with Beacon by participating on the Crisis Collaborative. This meeting is focused mainly on the crisis system in Pierce County and is concerned with identifying and addressing gaps as well as setting policies and best practices for the providers.
Designated Crisis Responder. Another service the BH-ASO is tasked with funding is the Designated Crisis Responders (DCR). These are mental health professionals appointed by the county or other local authority authorized to evaluate and determine if a person presents a harm to self/others/property or is gravely disabled or is at imminent risk of being so due to a mental health or substance use disorder. If they are found to meet these criteria, the individual can be involuntarily detained on the authority of a DCR through the Involuntary Treatment Act (ITA). Though the county is the entity with the authority to designate DCRs, Pierce County has authorized MultiCare Behavioral Health to be the provider responsible for training and hiring DCRs, while still retaining ultimate authority over that process. Because of this responsibility, part of the work the county has been doing with Beacon has been assessing the work of the DCRs, the efficiency of the system and the use of ITAs in our region. In collaborating with Beacon on these many projects, the county aims to create a behavioral health system that is focused more on prevention and reduces the need for crisis and emergency services.
Assisted Outpatient Treatment. Pierce County is piloting a program catching fire in other states. Assisted Outpatient Treatment (AOT) involves court intervention for mentally ill patients in an involuntary, outpatient program who are at high risk of devolving to the point of needing inpatient services. Frequently, these patients are well known to the treatment community and are in and out of inpatient care. The patients appear regularly before a judge to review patient compliance with the treatment plan. The “black robe effect” can be powerful in helping the patient focus on treatment. AOT began in 2018 and has been very successful. In other states where it has been in use longer, AOT has saved millions I health care costs and reduces involuntary inpatient treatment. The Special Counsel is working with Judge Blinn, the current AOT judge, to make adjustments and grow the program.
Elevate Health. Elevate Health is a non-profit entity charged with transforming healthcare in Pierce County, both physical and behavioral, through the Medicaid Transformation Waiver. As a partnering provider with Elevate Health, the county received funds to support and further behavioral health integration in our region, a goal we are accomplishing through several of the above-mentioned initiatives, particularly through the work of the IOB. Through the creation of another Crisis Recovery Center, the county is not only supporting behavioral health expansion, but is working to reduce emergency room utilization and influencing the physical healthcare system as well.
One Pierce. In conjunction with its parent entity, Elevate Health, One Pierce was formed to provide regional funding to sustain the work of Elevate Health, care coordination, a regional data lake, etc., and to fund projects that further its whole person health care objective. For example, it is well known that integrated health care can go only so far unless patients have stable affordable and supportive housing. Currently, One Pierce, the County and others are exploring a housing project to help fill this gap. The Senior Counsel is on the One Pierce board.