Nashville’s pilot mental health response team has kept 70% of callers out of the ER
NASHVILLE, Tenn. (WKRN) — With suicide rates hitting an all-time high in the U.S. last year, and many people experiencing some sort of mental health crisis, emergency rooms have become flooded with people waiting for psychiatric treatment.
About a year ago, Michael Randolph, with Nashville’s Mental Health Cooperative, said the city was taking around 120 to 130 non-violent mental health patients to the hospital in an ambulance each week.
The calls from people in crisis have not slowed, but since last February, the city has seen a noticeable impact from a program still in its pilot phase called “Responders Engaged And Committed to Help,” or “REACH.”
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According to Randolph, the REACH team, which consists of two paramedics from the Nashville Fire Department and two masters-level mental health professionals, has been able to keep anywhere from 65% to 70% of callers out of the emergency room, depending on the month.
“So, people in a mental health crisis are not sitting in an emergency room waiting or getting a bill, or having to delay treatment,” said Randolph, who serves as REACH’s program manager. “We’re getting them treatment quicker and more efficiently.”
Nearly 75% of calls have involved suicidal ideation
Since its launch on February 14, 2023, the mental health crisis response team has responded to a total of around 460 calls for service in which 911 dispatchers determined that the situation was a non-violent mental health crisis.
A large portion of those calls have been “more acute or serious mental health crises” than Randolph said was initially expected, with nearly 75% of calls involving someone experiencing thoughts of suicide, but very few have required a police presence.
“We try not to involve police unless it’s absolutely necessary on a REACH call,” Randolph said. “Sometimes both have been dispatched and they kind of decide who does it. Sometimes PD has called for REACH because they’re like, ‘This is really not a police matter’.”
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Before REACH’s launch, Randolph said there was a “great need and want” from the community to have a non-law enforcement response to mental health crises, different from the city’s Partners in Care program, which sends mental health professionals to calls alongside police.
In some cases, the two mental health crisis teams have worked together because Randolph said, “the situations can be very dynamic and change very quickly,” but for the most part, not having a police presence can offer a less “scary situation” for some callers.
“And we walk with them until we can connect them to the next level of care, whether that is, we do a safety plan or set them up with resources at home, or we transport them ourselves to our crisis treatment center, or an emergency room, or a psychiatric facility,” Randolph said.
‘Our outcomes have been really good’
According to Randolph, having a mental health professional on scene helps “streamline care,” whereas it may have taken callers longer to get help beforehand — especially those waiting in an emergency room.
After suicidal ideation, Randolph said the next most common crisis callers are experiencing is either some type of psychosis or auditory or visual hallucinations.
The average response time for the REACH team is about 18 to 20 minutes, with calls sometimes taking a few hours to be resolved. But as Randolph explained, that lengthy time on scene is not only considered a positive result of the program but is encouraged.
“You’re really wanting to build that relationship with that person. We empower our teams to sit out there and get to know them and build that relationship and take their time,” he said. “And our outcomes have been really good.”
In a few cases, Randolph said some patients have had to be taken to a hospital because “it’s an acute crisis that needs some sort of medical treatment or medical clearance.”
However, of the callers that have been diverted from the emergency room, about 25% of them are able to stay at home — the most ideal outcome — and another 25% have received care at the Mental Health Cooperative’s crisis treatment center.
The rest are often being taken to a shelter or doctor’s appointment. According to Randolph, a high percentage of the non-violent mental health patients that the REACH team is helping are also experiencing homelessness, not unlike the demographic in a similar program out of Denver.
Early signs of success lead to talks of expansion
A number of Nashville’s mental health programs have been modeled off of programs in Denver like the Support Team Assisted Response (STAR) program, which began sending mental health professionals on calls for service in June 2020.
The STAR program was dubbed a success six months into the pilot, and Randolph said Nashville, which is of a similar size to Denver, seems to be trending along the same path, with REACH seemingly taking “a lot of pressure off the rest of the healthcare system.”
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It was initially the success of REACH’s counterpart, Partners in Care, that led officials to begin exploring other ways to address mental health in the city. Launched nearly two years beforehand, Partners in Care will be available in every police precinct by May 2024.
“Every crisis is different, like every person is different,” Randolph said. “Really in Nashville, as a system of care, we feel like we need a variety of programs to address the mental health crisis here and help a lot of different people in a lot of different situations.”
As officials learn more during the pilot phase of the REACH program, and with there already being signs of success, Randolph said there have been talks of what expansion could look like.
In September of last year, Nashville Mayor Freddie O’Connell said, “I’m eager to see us move beyond pilot phase based on data because the data right now is showing that they’re having the intended effect.”
A decision will be made on whether to permanently implement the REACH program by June 2024, when the pilot comes to an end. Ideally, Randolph said it would be expanded through a tiered system in order to gradually train more mental health clinicians and paramedics.
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“I think this whole city is really excited to help people and hopefully alleviate that fear of ‘My family or myself is in crisis, I have to call for help,’ by having great programs to answer those calls,” Randolph said. “So, I hope everyone out there feels a little less afraid to call for help because we are developing really great ways to answer those calls for help.”
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