Department of Mental Health and Substance Abuse Services
E. Douglas Varney, Commissioner

Office of Crisis Services and Sucide Prevention

Planning

Being proactive and having things in order during a crisis is the best way to get through any of life’s challenges, and this is no different when it comes to a mental health crisis. Having a prior directive that people can follow can make a mental health crisis more manageable and may even avert the event by enabling close friends or family members to see the early warning signs. Learning to create your own Wellness Recovery Action Plan can help you plan for and prevent future mental health crises. The Recovery Within Reach Web site has more information on WRAP. Click here for WRAP . Another option is this link to the SAMHSA website that has information on developing your own crisis plan. Taking the time to do this when you are feeling well can make all the difference. http://mentalhealth.samhsa.gov/publications/allpubs/sma-3720/crisis.asp

The link below is to the page for the “Declaration for Mental Health Treatment.” It also has links to a Q & A brochure and a downloadable form for filling out a legal directive on what kind of treatment you want to receive in the event you are unable to make informed decisions about your mental health treatment due to a mental illness.
http://tn.gov/mental/recovery/oca5.html

Crisis Definitions and Goals

Crisis services include 24-hour, seven days a week, toll-free telephone hotline services, mobile crisis services, crisis stabilization units, crisis respite beds, medically monitored crisis detoxification units, mandatory pre-screening agent services and peer support services. Peer support specialists work with crisis specialists to assist adults in alleviating and stabilizing crises and to promote the recovery process. The goals of crisis services include:

• Promoting the safety and emotional stability of individuals with mental illness or emotional crises;
   
  
• Minimizing further deterioration of individuals with mental illness or emotional crises;
   
  
• Assisting individuals in developing and/or enhancing better coping skills and a natural support system;
   
  
• Helping individuals with mental illness or emotional crises obtain ongoing care and treatment; and
   
  
• Encouraging services in the least restrictive setting that is clinically appropriate to meet the individual’s needs.  
  

A mental health crisis is an intensive behavioral, emotional, substance use, or psychiatric situation which, if left untreated, could result in an emergency situation, and the placement of the person in a more restrictive, less clinically appropriate setting, including, but not limited to, inpatient hospitalization or at the very least, significantly reduced levels of functioning in primary activities of daily living. 

Telephone Triage

Mental health crisis services are initiated following telephone or walk-in triage assessment. Occasionally, following telephone triage, it is determined that a face-to-face assessment is required in the community at the location of the individual in crisis. A triage screening determines the seriousness of the crisis situation and determines the appropriate intervention needed to alleviate or stabilize the crisis. The triage screening can be completed on the phone or face-to-face for those who utilize the walk-in triage center (see Walk-In Triage Center information below). The triage screening also helps to determine the individual’s current status such as:

• If there is a behavioral health provider treating the individual;
   
  
• The existence or availability of a support system;
   
  
• The existence or availability of a treatment plan; and
   
  
• If a face-to-face crisis assessment or other services are needed.
  

Crisis Services Intervention

An intervention is a face-to-face, short-term, intensive mental health service that occurs during a mental health crisis or mental health emergency to help the person cope with immediate stressors, identify and utilize available resources and strengths, and begin to return to the person’s usual level of functioning. At the time of intervention, the needs of the individual are assessed, including the need for active, supportive listening, the need for referrals to additional services or treatment or the need for emergency hospitalization.
 
Mandatory Pre-screening Agent (MPA)

Tennessee law requires a face-to-face evaluation, known as pre-screening, of each individual in crisis to assess eligibility for emergency involuntary admission to a Regional Mental Health Institute and to determine whether all available, less drastic, alternative services and supports are unsuitable to meet the individual’s needs. If a MPA is unavailable within two hours, a MD or Ph.D. with health service provider designation may provide this pre-screening in consultation with the mobile crisis team.

Crisis Respite

A voluntary service that offers 24 hour, seven days a week support with behavioral health treatment, including medication management and illness management and recovery services, with a focus on short-term stabilization (up to two days) to adults 18 years of age or older. The purpose is to separate the person from the stressor or environment that contributed to the crisis. Trained crisis respite staff members typically provide crisis respite; however, others who are deemed appropriate by crisis staff members may render respite services.

Crisis Stabilization Unit (CSU)

A voluntary service that offers 24 hour, seven days a week intensive, short-term stabilization (up to 96 hours) and behavioral health treatment for those persons 18 years of age and older whose behavior health condition does not meet the criteria for involuntary commitment to a psychiatric hospital or other treatment resource.

CSU WAIVER

Walk-In Triage Center

A non-hospital, facility-based service affiliated with each of the Crisis Stabilization Units that offers 24 hour, seven days a week behavioral health treatment to adults 18 years of age and older by providing assessment and evaluation, early intervention, prevention, stabilization, referral, and follow-up services for individuals seeking assistance in obtaining appropriate behavioral health services or linkage of services to achieve and/or improve his/her prior level of functioning following a crisis situation.

Crisis Stabilization Services

Crisis stabilization services are short-term supervised care services accessed to prevent further increase in symptoms of a behavioral health illness or to prevent acute hospitalization. Crisis stabilization services are more intensive than regular crisis respite services in that they require more secure environments, highly trained staff, and have typically longer stays. Crisis stabilization services should include availability and utilization of the following types of services on a short-term basis as appropriate:

• Individual and/or family counseling and support;
   
  
• Medication management and administration;
   
  
• Stress management counseling;
   
  
• Individualized treatment plan development that empowers the consumer;
   
  
• Mental illness/substance abuse awareness/education; and
   
  
• Identification and development of natural support systems.
  

Follow-up Services

Follow-up services can be telephone calls or face-to-face assessments between crisis staff and the individual following crisis intervention, respite or stabilization to ensure the safety of the individual until treatment is scheduled or treatment begins and/or the crisis is alleviated and/or stabilized. Follow-up services can include crisis services staff contacting the individual only one time or can include several contacts per day for several days, as deemed appropriate by crisis staff.