After two years, results show boost for Alaska mental health emergency care thanks to new partnerships

Presented by Alaska Mental Health Trust Authority

Part 1 of 4

Header image: Members of the Anchorage Mobile Crisis Team on a call in Anchorage. Photo provided by Anchorage Fire Department.

A statewide initiative led by a collaboration of behavioral health care advocates, officials and providers is helping end an ineffective and costly cycle for people experiencing mental health emergencies, data shows, and its positive effects are rippling across communities.

In 2020, the Alaska Mental Health Trust Authority, in partnership with the State of Alaska, announced plans to enact a new model, Crisis Now, in the state. The model has been shown to help people experiencing behavioral health emergencies overcome existing barriers to access, stay out of jail, and minimize hospital emergency room visits while receiving better care.

Under the Crisis Now model, mental health services are provided across an entire continuum of care, from mild to acute needs, forming a safety net for individuals experiencing different levels of emergency. This includes a 24/7 crisis hotline, mobile crisis response teams, and crisis response facilities.

Crisis Now is “a framework of effective mental health crisis care, which has components that can support every community,” said Alaska Mental Health Trust Authority Chief Operating Officer Katie Baldwin-Johnson. “The model provides a person in crisis someone to talk to, someone to respond, and if needed, somewhere to go.”

In this series, readers will explore how organizations are adapting Crisis Now for Alaska to best serve residents and communities and see how these efforts are driving real-world results.

Since work began, data already indicates major benefits for Alaskans.

In the Interior community of Fairbanks, a mobile crisis team — comprised of a mental health professional and a peer support specialist — responds to behavioral health emergency calls around the clock, filling a role previously held by police or emergency responders.

The team diverted visits to emergency rooms 82% of the time in the first year of operation. Another mobile crisis team housed within the Anchorage Fire Department is reporting similar results.

In Juneau, a residential center for mental health crisis intervention, the first of its kind in Southeast Alaska, is opening in June. The Aurora Behavioral Health Center will provide 24/7 crisis care for Juneau’s youth and adults, and help curb Bartlett Regional Hospital’s growing need for mental health services, which jumped 33% from 2020 to 2021. Similar crisis stabilization services are slated to open in Anchorage, and planning for these services in other communities is underway.

And July marked the launch of 988, a national suicide and crisis lifeline, operated through Careline Alaska here in the state. Alaskans struggling with depression or thoughts of suicide can connect with a highly trained crisis counselor 24/7, by dialing 988 or toll free at 1-877-266-4357 (HELP).

These efforts are promising — and are only the beginning.

In addition to standing up new crisis response services in communities across Alaska, the passage of HB 172 in the 2022 state legislature marked another recent success.

The bill, sponsored by Governor Mike Dunleavy, streamlines mental health institutions regulations, allowing low- to no- barrier crisis stabilization centers to operate in Alaska. These centers are a key element of the Crisis Now model.

Working with the Alaska Mental Health Trust and the state Departments of Health and Family and Community Services, Alaska’s Crisis Now partners include hospitals, behavioral health providers, patient advocates, Tribal health organizations, local city and borough governments, emergency dispatch, law enforcement, and many others.

“Supporting mental health isn’t something any one organization can do on its own,” said Governor Mike Dunleavy.

The collaboration between the wide range of entities will “ensure that Alaskans can access the care and mental health support they need,” Dunleavy said.

In Alaska ‘we need more rungs on the ladder’

Alaskans experiencing mental health crises often face barriers to treatment, Baldwin-Johnson said.

Studies facilitated by the Trust and State of Alaska identified some of these challenges and “indicated our system was missing really important components in the continuum of care,” Baldwin-Johnson said.

In Alaska today, hospitals are the only place where someone can be evaluated for inpatient care, and the Alaska Psychiatric Institute is the only state operated psychiatric hospital in the state.

“We need to create more rungs on the ladder,” Baldwin-Johnson said. “At the top is the Alaska Psychiatric Institute, and at the bottom is outpatient care. We need more rungs in the middle to provide treatment and support options before resorting to highest levels of care.”

“So that’s what we’re trying to do: Provide more services that give us the opportunity to intervene at earlier levels, and at less intensive and costly levels than inpatient care,” she said.

The hope is more people will stabilize at lower levels of care. That way, the need for inpatient care will be reduced, as needs are met in a more effective and therapeutic way.

This benefits the individual in crisis, who avoids a stressful emergency room experience, and allows hospitals to provide the best level of care for all patients.

The studies also offered recommendations for Alaska’s mental health care access. Adapting the Crisis Now model for Alaska was a crucial step in improving the system, Baldwin-Johnson said.

Bringing mental health care to small communities

Crisis Now was developed by the Crisis Services Task Force of the National Action Alliance for Suicide Prevention. The model was pioneered in the State of Arizona, where it serves more than 60,000 individuals in crisis annually and is estimated to have saved millions of dollars in health care costs, all while providing better outcomes for patients and communities.

The Crisis Now model calls for aligning treatment options in each community with its unique needs, based on the input of local leaders, residents, emergency responders and mental health professionals, Baldwin-Johnson said.

Addressing crisis care in Alaska’s smaller communities is an important part of the effort. While not all communities will implement the full model, experts say having a broader resource base, such as a robust statewide crisis call center and improved coordination between local dispatchers and the Careline, will have a positive ripple effect for smaller towns. Communities across the state are exploring adaptations for improved local response and services.

“Communities will determine what will work best for their community members and will adapt the framework accordingly,” she said.

In a smaller town, a local solution may include something like designating a local safe house or building space that has additional support through the statewide program, or a behavioral health aide paired with another professional who will be able to respond in community and support a person in crisis in place, she said.

Another priority of Crisis Now is serving Alaska’s youth. The newly formed Department of Family and Community Services is one way the state is working to support and expand services for Alaska’s kids and teens.

The department works closely with the state Department of Health and Alaska Mental Health Trust Authority on a myriad of issues including support for youth in out-of-home placement and serving youth with mental health diagnoses and complex behaviors.

Most mental health services in Alaska today focus on the needs of adults, said Department of Family and Community Services Commissioner Kim Kovol, but an increasing number of children and teenagers would benefit from these services.

In 2021, suicide was the leading cause of death for youth 15-24 in Alaska; Alaska’s average rate of adolescent suicide is around four times higher than the national average.

“As the State of Alaska continues to expand community services, we need to look at ensuring these services are provided for children and youth in crisis,” Kovol said.

Building a better behavioral health system has been a long-term effort, said Alaska Department of Health Commissioner Heidi Hedberg.

“We are building upon the new crisis tools, including provider education, complex care response teams, culturally relevant care closer to home, and exploring new licensing types as we continue to improve the continuum of care for all Alaskans,” said Hedberg.

In the next three stories, readers will learn about three crucial components of Crisis Now: The creation of crisis stabilization centers, which alleviate strain on emergency responders and improve care; how mobile crisis teams are leading the forefront of mental health emergency response; and how Alaska’s suicide prevention and crisis lifeline, 988, connects callers with an Alaskan on the other line ready to listen.

NEXT: Alaska’s suicide prevention hotline and 24/7 crisis call center provide immediate care for mental health emergencies.

Read the rest of the series: Part 2 - Part 3 - Part 4

The Alaska Mental Health Trust Authority is a state corporation that administers the Alaska Mental Health Trust to improve the lives of beneficiaries. Beneficiaries of the Trust include Alaskans who experience mental illness, developmental disabilities, chronic alcohol or drug addiction, Alzheimer’s disease and related dementia, or traumatic brain injuries. Learn more at AlaskaMentalHealthTrust.org.

This story was produced by the sponsored content department of the Anchorage Daily News in collaboration with the Alaska Mental Health Trust Authority. The ADN newsroom was not involved in its production.