Behavioral Health Crisis Center

Barbara Dahl, case management supervisor, talks about her role at the Behavioral Health Crisis Center of East Idaho on May 19. The state-funded center in Idaho Falls was Idaho’s first, followed by one in Coeur d’Alene a year later. This year, lawmakers approved funding for two more.


TWIN FALLS • People in the Magic Valley suffering from a mental health crisis will have another option to help them before the end of the year.

Three mental-health service providers applied a week ago to run the new state-funded crisis center in the Magic Valley — which, theoretically, could go anywhere in the eight-county region served by the South Central Public Health District. Most people involved in the process expect it to go in or near Twin Falls, the population center by far.

The selection committee, which consists of five local people with jobs in mental health-related fields, plans to review the applications, interview the applicants and make its choice over the next few weeks. If the committee is done with its work, the Region 5 Behavioral Health Board will ratify the choice at a July 13 meeting. Then the winner will have a few months to get everything in place before the center’s planned Dec. 1 opening.

The Legislature authorized the creation of crisis centers in 2014, modeling them on one that opened in Billings, Mont., in 2005. The state’s first, in Idaho Falls, opened in December 2014, followed by one in Coeur d’Alene a year later. In 2016, lawmakers approved $2.23 million in funding for two more — one in the Magic Valley and one in the Boise area.

What are these centers, and what sort of impact might one in the Magic Valley have?

What Do Crisis Centers Do?

People who are having a mental health crisis or struggling with drug or alcohol problems can go to the crisis center and stay there for up to a day. While there, they can talk about their problems to case managers, who can help them develop a plan, and get information about other services in the community that are available to help them longer-term.

Occasionally, people stay longer than a day. If you’re in the middle of a drug or alcohol detox and need a bit more time, for example, the crisis center might check you out after 23 hours and 59 minutes, then check you back in. The average stay in the Idaho Falls center, though, is 14 hours and 39 minutes.

“I think the crisis center has a certain niche,” said Zach Morairty, a regional Behavioral Health Board member and medical director of adult services at St. Luke’s Clinic Behavioral Health Services.

It’s not the answer for everyone, he said — some people are severely psychotic or pose a more acute danger to themselves or others, and they need to be under closer supervision.

“It doesn’t replace an emergency room or a psychiatric hospital,” he said.

Who might benefit from the crisis center? People who are struggling with anxiety or depression, for example, Morairty said. Or a person on the edge from a bad day at work or relationship problems.

Who Will Run the One in Twin Falls?

Three groups applied by the June 10 deadline: ProActive Behavioral Health, a mental health provider that has offices in Twin Falls, Gooding and Burley; Lifeways Inc., a mental health provider based in Ontario, Ore.; and 9C’s Inc., a nonprofit affiliated with Psychiatric Services Behavioral Health Clinic and Twin Falls Healthcare.

The plan had been for the Idaho Department of Health and Welfare to contract with South Central Public Health District, which would then pass the funding to the agency running the crisis center; however, it is possible Health and Welfare will choose to contract with the operator directly instead. The funding the Legislature approved will be in Health and Welfare’s hands July 1.

The law is written to provide for plenty of discretion in choosing the entity that runs a crisis center. Morairty said one of the big factors will be a good plan.

“I would want to make sure that company, entity, whatever, is financially viable,” he said.

Another thing the selection committee will look for, he said, will be awareness of mental health issues and the ability to think creatively.

“You’re going to run up against a lot of hopelessness,” he said.

How Are the Centers Funded?

By the state, for now. During the 2016 session, lawmakers approved $200,000 in one-time funding for the Twin Falls crisis center’s capital costs and $1.013 million in ongoing funding, which will be paid out as reimbursement to the agency running the crisis center and is expected to be enough for eight months of operation. Lawmakers are expected to appropriate more during the 2017 session.

Whoever runs the crisis center in Twin Falls will have to have a report ready by the end of 2018, explaining how it will wean itself off state funding over the course of the following two years, said Rene LeBlanc, South Central Public Health District director.

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How this will happen is uncharted territory, as neither of the crisis centers in Idaho Falls and Coeur d’Alene have reached this point yet; the Idaho Falls center is working on its sustainability plan, which must be finished by the end of the year. LeBlanc said 60 to 70 percent of the people using the crisis center in Coeur d’Alene have insurance, and this could end up providing a good deal of the money if the same pattern holds in Twin Falls. Other possibilities might be grant funding, or getting the counties that benefit from the crisis center’s existence to chip in.

“If it’s actually … saving money … everyone would be working hard to make sure it continues to operate,” LeBlanc said. “And if it’s already a nonprofit, they’ll be able to apply for a lot of grants.”

How Do They Affect Local Governments?

Crisis centers’ supporters hope they’ll provide relief to local law enforcement, keeping people out of jail cells who don’t need to be there; to hospitals, because some people who go to the crisis centers might end up in emergency rooms otherwise; and possibly to county and state budgets, if they lead to a reduction in the number of people getting help from county indigent programs and the state Catastrophic Health Care program to treat mental health problems.

The crisis center in Idaho Falls has saved more than 1,000 hours of law enforcement time and about $281,000 on hospital emergency room costs and $483,000 on inpatient hospitalizations in its first year, based on estimates the center prepared using average hospitalization costs and the number of patients referred by hospitals or by law enforcement.

“This has the potential to be a good thing for the Magic Valley,” LeBlanc said. “It really could do a lot toward saving the counties money.”

In Twin Falls County, for example, 36 of the 204 indigent fund claims that were approved between Oct. 1, 2015, and April 7 were for mental health issues — most of them related to “mental holds,” or instances where a person is held involuntarily because he is severely disturbed or might pose a threat to himself or others, plus a few each for suicide, schizophrenia and depression. Another 10 were for alcoholism.

County Commissioner Terry Kramer said in April that the number of mental health-related cases paid for by the indigent fund has been rising, speculating that this could be due to a mix of a growing population and increased awareness of mental health issues. Also, he said, the state has been putting a greater emphasis on improving mental health care.

Hospitalizing people who are having mental health problems, Kramer said, can be very costly.

“In the crisis center, (what) the Legislature funded was exactly for this kind of situation here,” he said. “Give them a 24-hour period, they can decompress them, get them to where they don’t have to go into a facility.”

Down the road, LeBlanc said, he might want to see smaller satellite crisis centers opened in some of the Magic Valley’s other counties, to better serve the outlying areas.


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