A person calls 9-1-1 believing they are experiencing a medical emergency. Dispatch contacts first responders. While on scene, the Spokane Fire Department (SFD) clears the patient medically, and a specialty-trained member of the Behavioral Health Unit (BHU) completes an assessment and determines the symptoms are related to a severe panic attack. Instead of going to the hospital emergency department, the patient requests and receives immediate counseling services.
This ride-along program is a collaboration between Spokane Fire Department and Frontier Behavioral Health with support from Providence Health Care community benefit funds. The BHU responds to calls from dispatch that are coded as individuals with behavioral health needs. The unit includes a mental health clinician who is co-deployed with a paramedic. Both are trained in Motivational Interviewing as well as risk assessment and safety planning. Once it is determined that there are no acute medical needs, the BHU completes a risk assessment, provides crisis intervention and stabilization services, and links the individual with referrals to community providers and education.
Increasingly, emergency departments nationwide are being used as defacto triage sites for people with non-urgent mental health issues who have nowhere else to go. Data from the National Hospital Ambulatory Medical Care Survey shows that mental health patients rely on emergency departments (EDs) more than people with medical conditions and stay there longer before they are discharged.
Spokane Fire Department transport data for the city’s four emergency departments shows that 2,138 individuals with low-risk mental health issues occupied beds that were needed for patients with more urgent medical conditions during the first eight months of 2017.
“Our job has always been to put people in an ambulance and take them to the hospital,” says Mike Lopez, Spokane Fire Department’s integrated medical services manager. “Before the Behavioral Health Unit program started, 100 percent of the calls that came in to dispatch as mental health-related were transported to a hospital.”
In the first week of the program, the BHU responded to 11 calls and connected seven individuals to services including detox and Frontier Behavioral Health’s Mobile Community Assertive Treatment (MCAT) team. The Unit is helping get patients the right care in the right setting.
“We see health as much broader than simply physical health,” said Sara Clements-Sampson, community benefits manager for Providence Health Care. “By supporting a partnership between Frontier Behavioral Health and Spokane Fire Department we hope to allow the community to receive direct services when they are in times of crisis, and to help alleviate some of the burden on first responders who may not be experts in the mental health field.”