Missouri has lagged behind other states in funding programs and services intended to help people overcome behavioral health concerns.
Despite that, areas of the state have been creative in coming up with solutions to issues surrounding behavioral health, speakers testified Tuesday afternoon during a hearing for the Missouri House Subcommittee on Mental Health Policy and Research.
They also praised steps Missouri has taken, such as funding implementation of Crisis Stabilization Centers and expansion of behavioral health liaisons.
Alex Rankin, the Missouri Foundation for Health director of government affairs, told the committee more than 22 percent of Missourians reported mental health issues in 2018 and 2019, and more than 1 million residents experienced some sort of disorder.
Coupled with that, the state has among the highest suicide rates in the country.
The Missouri Foundation for Health is a nonprofit that formed following the conversion of Blue Cross Blue Shield of Missouri to for-profit status. The foundation, which tries to improve Missourians' health through partnerships and strategic investments, partnered with Health Forward Foundation (HFF) to assess how various stakeholders intercept in Missouri's behavioral health care system.
HFF is a Kansas City-based nonprofit that supports changes that improve the health outcomes of uninsured and under-served populations by addressing the most widespread needs of communities.
Based on the research, the Missouri Foundation for Health recommended:
The state enhance Medicaid and comprehensive coverage for adults who need crisis stabilization.
It enhance substance use disorder treatment services.
It find ways to incorporate school-based behavioral health services.
Missouri proceed with implementation of the 988 hotline.
It promote child access in primary care settings.
Rankin pointed out crisis stabilization prevents repetitive uses of emergency rooms and repetitive interactions with law enforcement.
Gov. Mike Parson included about $30 million in his fiscal year 2021-22 budget for programs aimed at creating some solutions to the mental health crisis in Missouri.
Of that revenue, $15 million is set aside to establish six new crisis stabilization centers and support five existing ones. Additionally, $8.3 million is intended to expand the Behavioral Healthcare Home Program, which integrates primary and behavioral health care for adults. And, $5.3 million is for adding 50 additional Community Health and Substance Use Disorder Liaisons to the existing 31.
The liaisons are behavioral health professionals who work with clients who have frequent interactions with law enforcement and courts. Before state funding added 50, there had been only 31 liaisons in Missouri, each assigned to regions of the state. Liaisons ask their clients to contact them before police if they have an issue. Their focus is to direct people with behavioral health issues toward services they need - and away from the justice system.
Jason Klaus, a Perry County Sheriff's Office detective and the coordinator for the Missouri Crisis Intervention Team (CIT) Council, thanked the legislators for giving CIT 50 additional liaisons.
Liaisons work with CIT-trained officers to prevent people contacted by officers from going to emergency rooms or jails.
About 30 years ago, metropolitan areas began offering CIT training to some officers. Only a few years ago, most rural counties had no officers with CIT training. Now, all but about 10 have some sort of CIT officers, whether they be in sheriff's departments or staff from other first-responders like firefighters or ambulance crews, Klaus said.
And referrals to liaisons went from about 7,000 per year to more than 16,000 last year.
The CIT Council is training more than 1,250 officers in intervention techniques each year, Klaus said.
"In Sikeston, we have six dispatchers that are taking de-escalation training," he told the committee.
That may help reduce calls for officers, he continued.
The boots on the ground want the quickest access point for services they can find, Klaus said. The additional stabilization centers might be those points of access.
"These additional units coming online are going to be so key in doing that warm hand off," he said.
He acknowledged there are gaps.
"A rural deputy in Shannon County may not have direct access to (a Crisis Stabilization Center)," Klaus said. "They are diverting to jails, or emergency rooms, or leaving them at home, and waiting for that call again."
Ten counties also have no CIT officers, he said. CIT officers are still trying to find ways to get them that training.
For example, he said, in Shannon County there is a total of only four officers, including the sheriff. So there's no way officers can take a week off for the 40 hours of training.
The council instead offered a series of one-day trainings for the officers.
"We adjust to meet those needs," he said.
Another step Missouri is taking is implementation of a universal 988 emergency number to call in case of a mental health emergency, said Lauren Moyer, Compass Health Network vice president of clinical innovation.
The number is to go online in July.
"988 is going to be that catchphrase, just like 911. So, if someone is in an urgent situation, they know to call 988," Moyer said.
There's a lot of work to be done to prepare.
Infrastructure has to be improved and systems must be integrated, she said. Missouri's suicide lifeline received 70,000 calls last year, she said. When 988 is implemented, the emergency number is expected to receive 182,000 calls per year.
Suicide has been a public health epidemic, she said.
"We saw a slight decline in deaths in 2019. A decline in deaths in 2020," Moyer said. "There was a huge uptick in ideations and hospital visits."
At the same time, veteran suicides increased.
"As a state, we are the 11th-highest (suicide rate) in the nation," she said. "We're up there as far as states with a significant suicide death rate."