In this interview, BHDDH’s Director of the Division of Behavioral Health, Corinna Roy, discusses the innovative behavioral health crisis intervention services provided by BH Link.
Could you start by telling us a bit about BH Link overall and some of the very important services that BH Link offers?
We had been thinking about creating this service for about five years as we knew that there was a great deal of confusion regarding how and where those experiencing behavioral health crises could access help. There are many people who are already attached to behavioral health services, but for those who are not, this could be their first crisis, they may not have a provider, and they might not know what to do or where to go in a crisis type of situation. We wanted to address this need and create a central place to provide effective behavioral health crisis intervention services that anyone could feel comfortable accessing. Our first approach was to create the Recovery Navigation Program which focused on connecting people with substance use disorders to care. This program had some funding and sustainability issues, and after it ended, we wanted to create a new approach to address both mental health and substance use disorder crises. Horizon Health Partners contracted with Community Care Alliance to manage the program, and this became BH Link.
BH Link is a 24/7 behavioral health crisis intervention center with a crisis/suicide hotline. We work with anyone age 18 or older who is experiencing a behavioral health crisis. Our primary goals are to get people directly into services if necessary and provide a trusting and safe environment where people are treated with respect and dignity. Hospitals can often be a more turbulent environment with bright lights, constant noise, and people frequently going in and out. BH Link offers a much more subdued environment.
Why do you think it was important to create this service? Why was it important to create an integrative model including both a hotline component as well as an in-person triage center component?
Based on needs assessments we had conducted, we knew that many people did not know where they could go to access behavioral health services. At the same time, we were told by hospitals that they were seeing an increase in emergency department utilization for behavioral health. We wanted to address this by diverting people experiencing behavioral health crises from emergency departments and guiding them to a more appropriate setting where they could receive linkages to treatment and access to peer support. With behavioral health, it is so important to strike while the iron is hot and help people when they are ready to accept help. We do not want to miss an opportunity to connect an individual to treatment.
We created an integrative model of services because it is much more efficient. With a 24/7 hotline, it is important to be able to direct people to a central location to receive help and then be connected to other services. Prior to moving the state’s suicide hotline into BH Link, the Rhode Island hotline had been answering 14% of incoming Rhode Island calls (hotlines from other state answered the remaining 86%) because it was only operating during regular business hours. Since moving the hotline into BH Link, 100% of calls are being answered by Rhode Island clinicians who are more knowledgeable about Rhode Island culture and referrals sources. They can also invite individuals on the line to come right into the Link.
The website talks about BH Link providing “innovative crisis intervention services”. Could you tell us a bit about these services and the ways in which they are implemented?
At BH Link, we have a number of Qualified Mental Health Professionals (QMHPs) available to provide support. We start by offering a formal clinical assessment or crisis evaluation and QMHPs then work to determine the appropriate level of care. We also have peer specialists on staff who are qualified to work with people who have substance use, mental health, or co-occurring disorders. A prescriber and access to some pharmaceuticals to address the needs of those in crisis are also available on site. In addition, we have mobile outreach professionals who work in community mental health centers throughout the state to provide expanded crisis intervention services. We provide short-term psychiatric and nursing services as well as referrals and transportation to various forms of treatment, residential services, veteran support services, and domestic violence services. In the future, we hope to offer virtual counseling and other telemedicine services.
Our Program director, Kristy Moles, comes from a background of working in the hospital system for behavioral health. She is very familiar with this work and her leadership and sensitivity to this population are critical in terms of service implementation. Our services are provided in a very calming and respectful environment. One piece of this is that security guards are not in uniform and they are trained in behavioral health. All of our staff are extremely well trained to ensure that the BH Link environment is one that provides dignity, respect, and understanding.
I imagine this work can be quite challenging. Can you speak to some of the most challenging facets of this work and how BH Link addresses these challenges?
One of the biggest challenges is that there are very high expectations for this program. We have not been seeing as many people as we initially estimated, and this tells us that we still need to work on garnering recognition of the program. In order to address this, we have developed a communications plan and are currently doing a great deal of advertising. Another challenge is that we had a difficult time finding an appropriate location for the program as many residents in potential locations were concerned about the program’s hours of operation and the potential noise from ambulances. It is important to note that the ambulances going to BH Link do not use sirens as we do not accept people who need emergency medical care. As a result of these concerns, we ended up in a more private area of East Providence which has been good for the privacy of the individual, but also geographically challenging as Rhode Islanders often do not like to travel long distances.
It has also been challenging to effect a cultural shift among first responders. We want first responders to drop people off at BH Link as much as possible, so we have been working with them to get protocols changed and raise their comfort level with dropping off at BH Link. This cultural shift is so important, but it takes time.
How does prevention fit into the work that BH Link is doing?
I think any intervention is a form of prevention. While we are technically a licensed treatment facility, the follow up work that we do is part of relapse prevention. For instance, a patient may not have a follow-up appointment for a week or so, but during that week, peer specialists follow up to make sure that person has what they need to get to their first appointment. I would also say that our suicide and crisis hotline is a form of prevention. In the future, we would love to develop more partnerships with the Prevention Coalitions.
The BH Link website also explains that the facility is designed to connect people to ongoing treatment and care if needed. Can you tell us about how this works and how BH Link fits into the larger behavioral health system in Rhode Island?
When we intake a client, BH Link providers determine the level of care that is needed and discuss the client’s willingness to participate in care. For many people, daily obligations may prohibit them from accessing the care that is recommended. In these cases, BH Link providers work to find alternative care solutions. We have been extremely successful in creating linkages to care. 90% of people that accept a referral make it to their first appointment. Some people are just not ready for treatment, and that is completely okay. We want people to feel comfortable coming back when they are ready.
We currently have community liaisons doing outreach and coordination work throughout Rhode Island and we hope that communities will become more comfortable and familiar with these liaisons and BH Link overall. We work with substance use disorder providers and Health Equity Zones, and we would be interested in collaborating with any organization that offers supports for people with behavioral health concerns.
Who are some of your organizational partners and how do you collaborate with them?
We contracted with Horizon Health Partners and Community Care Alliance after a competitive Request for Proposals process and we have a very strong partnership with them. They have been incredibly responsive to any requests for changes to the program. In terms of collaborations with first responders, we work with the Department of Health because they oversee EMS and fire services. They were able to help us enact some protocol changes and initiate culture shifts. BH Link has a strong relationship with Chief Kenyon at Providence Fire and his Safe Stations program. We do not have as direct a relationship with the police department, but we are working with the Chiefs’ Association and have been trying to work individually with each police department to change protocols. We also have a strong relationship with state police through their Project Hope program.
How do you envision BH Link evolving? What are some of the broader goals of this work?
We really would like to see more recognition of BH Link throughout the state. Our hope is for the public to see the advertisements and hear success stories, and when they or their loved ones are in crisis, we want them to recognize that BH Link is a viable resource for support. Long-term, we would like to see this program be successful enough to develop a satellite operation in the southern part of the state. Operating within another location would really help us to increase access to behavioral health crisis services, and that is our main goal.
