Changes in emergency department utilization associated with behavioral health crisis care adoption

Indiana University Indianapolis, Indianapolis IN

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Abstract

PROJECT SUMMARY/ABSTRACT With 1 in 8 emergency department (ED) visits involving a behavioral health crisis, mental health conditions and substance use disorders are a leading cause of preventable ED utilization. Yet, the ED is often an inappropriate and ineffective setting for behavioral health crises. Inadequate access to behavioral health providers leads individuals to seek care in the ED, even when alternate care settings may be more appropriate to meet their needs. Behavioral health crisis care (BHCC) is a potential alternative to the challenges of behavioral health ED utilization. Mental health treatment facilities may adopt a range of BHCC services. The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends comprehensive BHCC as a best practice, including the following six services: emergency psychiatric walk-ins, crisis intervention teams, onsite crisis stabilization, mobile crisis stabilization, suicide prevention, and peer support services. Despite calls to implement these evidence-based services, my previous work has found that only 6 percent of mental health treatment facilities currently offer comprehensive BHCC. Importantly, it is unclear how environmental factors such as community needs and available resources may influence the decision to adopt BHCC services. Additionally, it is unclear whether access to BHCC actually reduces behavioral health ED utilization. Thus, the objective of this study is to assess the drivers of BHCC adoption and the potential effectiveness of BHCC at reducing avoidable ED utilization. Aim 1, assess market factors associated with BHCC adoption, tests the hypotheses that mental health treatment facilities will be more likely to adopt comprehensive BHCC in 1) more munificent (resource rich) environments; 2) less dynamic (unstable) environments; and 3) less complex (intricate) environments. This aim merges a novel dataset on BHCC services with county-level data on environmental factors. Aim 2, assess the association between BHCC services and behavioral health ED visits, tests the hypothesis that BHCC adoption will be associated with a decrease in behavioral health ED visits, but not physical health ED visits. This aim will utilize a propensity score matched panel to examine changes in ED utilization associated with BHCC adoption. The proposed study is significant because it rigorously measures the impact of a promising, cost-effective model for behavioral health service delivery. This study is innovative because it extends the evidence-base for BHCC services through the use of multiple data sources and advanced methodological approaches. Furthermore, this study is needed to inform policy decisions to expedite BHCC adoption and improve access to underserved communities. Finally, by examining adoption/implementation and outcomes associated with an alternative model of care for individuals with chronic conditions and socioeconomic disadvantage, this study effectively targets the following high priority research area as defined by AHRQ: 1) Increase accessibility and affordability of health care by examining innovative market approaches to care delivery and financing; and 2) Harness data and technology to improve health care quality and patient outcomes and to provide a 360-degree view of the patient.