IDAHO FALLS | Soon, the Twin Falls and Boise areas will become the third and fourth places in the state to open a state-funded crisis center where people with mental health and addiction problems can stay for a day and start to get help.
The first, the Behavioral Health Crisis Center of East Idaho, has been open since December 2014 and helped more than 2,000 people in its first year. It is on track to help almost twice as many this year.
“It saves money. It saves lives,” Crisis Center Coordinator Brenda Price said.
Price said she enjoys seeing people who came in earlier, at a low point in their lives, living successfully later on. “It does get better for them.”
Before the center opened, many of its clients either ended up in jail or were hospitalized again and again.
“We need compassionate care for them, and opportunity for them to heal,” said Barbara Dahl, the center’s case management supervisor, who has been there since it opened.
The state appropriates funding for the crisis centers, and the Idaho Department of Health and Welfare contracts with an agency in the area to run it. The one in Idaho Falls is run by Bonneville County; the one in northern Idaho that opened in December is run by Kootenai Health.
As the word gets out, the number of people using the Idaho Falls center has been rising — 367 clients in the first four months of 2015, 686 in the first four months of this year.
You can stay there for up to a day, and the average client stays there for a little less than 15 hours. Price said there are some repeat visitors, many of them people who used to end up in the hospital emergency room over and over, but the majority of clients are on their first visits. Other people, she said, are discharged and then readmitted immediately — for example, someone who’s detoxing and needs a bit more time.
While the overwhelming majority of people using the crisis center are from Bonneville County — 1,230 out of 1,536 regular clients who came during the first year the crisis center was open — it also gets a fair number of visitors from surrounding counties such as Bannock, Madison and Bingham. The 2015 numbers even show five people who came from Twin Falls, Gooding and Cassia counties, people who probably would have gone to a crisis center in the Twin Falls area had there been one.
Most people who go check themselves in, although there are also many referred by law enforcement or by Eastern Idaho Regional Medical Center, the local hospital.
“We’ll take people there who are in a crisis that doesn’t necessarily meet the level of hospitalization,” said Idaho Falls Police Lt. Steve Hunt, a member of the crisis center’s board. (The board has seats set aside for law enforcement representatives.)
Hunt said these cases most often arise when someone is having suicidal thoughts but hasn’t taken any real steps toward harming himself or herself. Another common scenario, he said, is when police get called because someone appears disoriented but isn’t necessarily violent — someone wandering around talking to himself, for example. Some people call police themselves; in other cases a concerned friend or family member does.
Police don’t force people to go to the crisis center; people who are gravely disturbed or dangerous enough to be held involuntarily would be brought to the hospital’s Behavioral Health Center, not the crisis center. And while the number of people using the crisis center has gone up significantly, Hunt said the number of law enforcement referrals has dropped, perhaps because more people are aware of the center’s existence and know to go there if they think they need help.
Hunt said the crisis center has reduced the number of people with mental problems who get arrested or end up at the hospital. Also, some people are reluctant to go to the hospital due to the cost.
“The hospital is a great resource, but it is not free,” Hunt said. “An emergency room visit is expensive.”
Hunt said there were cases in the past where people who didn’t meet the criteria for admittance to the psychiatric hospital or the homeless shelter would end up in jail. Now, he said, the crisis center provides another option. There are still cases where people have to be arrested, but there are also ones — such as when someone is wandering around disoriented and may have broken a law such as public urination but is clearly acting out due to mental condition — where the crisis center is a better alternative than charging the person with a crime.
“The crisis center just gives us another (option) to deal with those kinds of problems,” he said.
When a client gets to the Idaho Falls crisis center, he presents himself to security; the center has a contract with the Bonneville County sheriff’s office, and a deputy sits at the front desk. The center also provides an “amnesty box” where people can get rid of any drug paraphernalia or illegal items they may have.
“We don’t want this to be a place where people fear coming for fear of being arrested,” Dahl said.
The client goes into a small room for an initial assessment by a nurse and, if available, a case manager. Including the case manager, when possible, in the initial assessment means a person has to tell a potentially traumatic story only once instead of repeating it again and again, Price said.
The nurse checks the person’s blood pressure and vital signs and takes any prescription medication for safekeeping, to be dispensed as prescribed while the client is there.
The center provides boxes to store people’s personal effects, which Price said ensures people aren’t pressured by other clients into lending out their possessions. It also provides clothing they can change into. When the center first opened, it had uniforms donated by the jail, but people didn’t react well to wearing those; now Price buys cheap T-shirts from Walmart to give people.
After they’re checked in, clients stay in either one of the two “comfort rooms” — small rooms for one person, for those who need isolation because, perhaps, they’re hearing voices or because they’re detoxing and need to have their vital signs checked frequently — or in one of two dormitory-style rooms with seven or eight beds in each. People who come in at night, especially, are sometimes intoxicated to the point that they need to sleep it off before getting any further help or therapy.
The center feeds the people who come in and has a selection of board games, books, movies and TV to keep people occupied. The main thing, though, is to talk to case managers who can help clients with their problems, and to get connected with mental health or addiction treatment providers who can help them after they leave the crisis center.
Some clients have family and friends who can help them when they leave; in other cases, particularly cases of severe substance abuse or chronic mental health issues, the family is burnt out or the people have chosen to isolate themselves. Some people, Dahl said, are ready to get help, while others are ambivalent or still exploring their options. Some are homeless and choose to go back to the streets.
“A plan you impose on someone won’t work if a person isn’t invested in its success,” Dahl said. “We meet people where they are.”
All kinds of problems bring people in.
Mental illness is common — often depression or suicidal thoughts. The center also deals with many people who have persistent conditions such as schizophrenia or bipolar disorder. Many people also come in looking for help with alcohol or drug problems, Price said, and many clients have both an underlying mental illness, such as depression, anxiety or past trauma, and a substance abuse problem.
The older people who come in, Price said, are more likely to be alcoholics, while the younger ones are more likely to have heroin or meth addictions. Addiction to prescription opiates is also common.
One issue the center frequently runs into with younger people, Price said, is that they are willing to try to quit other drugs but not marijuana.
The Legislature appropriated $1.5 million a year to fund the place for its first two years of operation, with the idea that it would transition to local funding after that. Eventually, whoever ends up running the crisis center in Twin Falls will have to grapple with the same question.
For Price, that time is coming up — she needs to have a sustainability plan ready by the end of the year, coming up with a source other than state money that can support at least half of the center’s cost.
“I can squeeze a nickel pretty hard, but staff costs are more than $750,000,” she said.
Price is still weighing options for the Idaho Falls facility’s funding. One that is being discussed in northern Idaho, she said, is creating a local taxing district; Price said she didn’t think that would fly in her area. Another possibility, she said, would be billing Medicaid for visits, which she said would still be cheaper than an emergency room visit.
Price said having the center saves society money. People who keep their jobs and their families together, rather than falling victim to addiction or mental illness, benefit society.
“Those are all savings to society,” she said, “but it is very difficult to quantify that.”