ÿWPCŠ Ô$@â¡oÒÁå0ß3}KNÜŸ×ÙfÀùc×ÍžŠÐÞâWå0ËTŒ,o‹Â¥ Ëb»ý Ù©Òªµ ¡ËdVºËù|ä×kê|LmM'Ê¢3`Ê@4¾ƒixzÃÏ¥Zç.!’ÊϪ382ûˆt¼›=œë=!xÚ1Ýß‘ÐÃ÷ûò=DÕ$ó0sWwæGÌ3·µÐf„Oî½oÂ,…ý±©‡ ÏÍ©üL.ö5žt¬×l'ûåõÙEµÂ‚†«‰¥•Q5ý¹™ÁãÒN9w™k[BC”eìÎÎýš‚.ícDÎ!&Œ\(6ƒn%`÷ce¿3T ñ6~Œàe? O—Iž*QÓf&8A.Ói¢ ÞéG†-¬?vÂ&È{n0m[‘$a”<²üGŠ•E“ò—üØ`œtÈŒvÊC§ªPO%ZÜÞö2Z0‰Uë ØÅa$^á}2J8 Câ9U:Ä %þU@DnXT 0B¬#!îN^ w@4]q ms<þ6X9`("Courier 10cpiX*Ͼ¦ `(CG TimesScalable3|x «<þ6X9`("Courier 10cpiXôxþ6X@É“87ûX@*Ͼ¦ `(CG TimesScalableXXwϾ¦ P쉊7ûXP(†‹$¡¡ÒܰÒÓ  Ó˜HP LaserJet III (2nd Floor)Ø,,,,,Ø,0Sl -c [  {{U{E{Àe -COREH"ˆÿU‹ÿÀÀÀÝ ƒ†‹!ÝÒܰÒÓ  ÓÝ  ÝÔ_Ôò òÔ€XÕXXXÔà@D D ‚àELEMENTS€OF€A€GOOD€MENTAL€HEALTH€ˆÐ ° ÐÓ  ÓCRISIS€INTERVENTION€SYSTEMÌÌñ ñó óñ ññ ññ ñpREPAREDñ ññ ññ ññ ññ ñPreparedñ ññ ñ€ñ ñññfor€Ô_ÔNAPASÔ_Ô€byÐ €Ð ÐññññññcfprññññññññññCenter€for€Public€Representationññññ€ññññÌññññññnohoññññññññññNorthamptonññññññ€ññññññññññ,€ññññññmassaññññññññññMassachusettsññññ€ñññ ñññó óñññ ñÌÓ°ÓÌò òQ:à0 4 àWhat€are€the€basic€elements€of€a€crisis€intervention€system€to€prevent€unnecessaryÐ @  Ðadmissions€to€an€institution?ó óÐ0 €4(#4(# ÐÌà 4 àEither€as€part€of€a€negotiated,€comprehensive€community€service€plan€or€a€systemicÏlitigation€remedy,€advocates€should€attempt€to€incorporate€an€effective€crisis€interventionÏsystem.€€There€are€at€least€four€distinct€elements€of€such€a€system.ÌÌà0 4 àò ò1.ó óà Œ àò òCapacity€to€provide€crisis€intervention€servicesÐÐ 4(#4(# ÐÌó óà0 4 àà0Œ 4(#4(#àà ä àA€comprehensive€crisis€response€system€includes€five€service€models:аŒ (#Œ (# ÐÌà0 4 àà0Œ 4(#4(#àà0ä Œ (#Œ (#àà < à(1)à ” àòòEmergency€telephone€responseó󀄀area€wide,€accessibleÐ à Ðtelephone€contacts€with€skilled€crisis€intervention€workers€who€canÏscreen€requests€and€respond€with€Ô_ÔcounsellingÔ_Ô,€support,€or€otherÏtelephonic€interventions.€€This€component€is€often€referred€to€asÏ"hotlines"€or€"Ô_ÔwarmlinesÔ_Ô"€and€also€include€information€and€referral.€€Ð ä (#ä (# Ðà0 4 àà0Œ 4(#4(#àà0ä Œ (#Œ (#àà < à(2)à ” àòòMobile€outreachó󀄀a€team€of€trained€crisis€interventionÐ @ Ðworkers€who€are€available€to€visit€a€person€in€her€home€or€other€settingÏwhere€the€crisis€occurs,€to€provide€Ô_ÔcounsellingÔ_Ô,€support,€and€otherÏinterventions€on„site,€to€conduct€an€initial€assessment€and€determineÏwhether€additional€on„site€support€is€appropriate,€and€to€remain€with€theÏindividual€for€as€long€as€necessary€until€the€crisis€subsides.Ð ä (#ä (# ÐÌà0 4 àà0Œ 4(#4(#àà0ä Œ (#Œ (#àà < à(3)à ” àòòEvaluationó󀄀formal€assessment€to€determine€whatÐ Ð  Ðongoing€services,€if€any,€are€appropriate,€including€additional€in„homeÏsupports€or€interventions€to€address€the€crisis€without€requiring€theÏindividual€to€leave€her€own€home€or€other€setting.€€In€many€programsÏthis€capacity€is€provided€as€part€of€the€mobile€intervention€program,€inÏorder€to€avoid€the€unnecessary€dislocation€of€the€individual€to€aÏcentralized€clinical€site.Ð ä (#ä (# ÐÌà0 4 àà0Œ 4(#4(#àà0ä Œ (#Œ (#àà < à(4)à ” àòòCrisis€residential€settingó󀄀a€specialized,€staffedÐ P( #& Ðenvironment€where€an€individual€can€live€for€a€brief€(usually€up€toÏseven€days)€period€in€order€to€be€provided€with€intensive€support€andÏintervention€outside€of€the€individual's€home€or€other€location€whereÏthe€crisis€occurs.€€Ð ä (#ä (# ÐÌà0 4 àà0Œ 4(#4(#àà0ä Œ (#Œ (#àà < à(5)à ” àòòRespite€residential€programó󀄀a€residential€program€whichÐ ð-@), Ðprovides€residential€support,€usually€for€up€to€one€month,€if€a€longerÏresidential€alternative€is€needed€then€a€crisis€residential€program.€€Ð ä (#ä (# ÐÌà0 4 àà0Œ 4(#4(#àà ä àEach€of€these€five€service€models€can€be€staffed€primarily€byÏconsumers,€although€some€licensed€professionals€are€needed€to€make€clinicalÏevaluations.€€Most€importantly,€the€evaluation€and€residential€services€shouldÏbe€provided€outside€of€a€hospital,€in€more€integrated€community€settings,€withÏappropriate€staff.Ð Œ (#Œ (# ÐÌà0 4 àò ò2.à Œ àStandardó óÐ p 4(#4(# ÐÌà0 4 àà Œ àMost€states€have€a€statutory€or€regulatory€standard€for€emergency€detention€orÏinvoluntary€admission€to€its€mental€health€or€retardation€system.€€Since€these€standardsÏdefine€the€criteria€for€involuntary€admission,€it€is€appropriate€for€there€to€be€aÏdifferent,€lower€standard€for€crisis€intervention€services,€particularly€because€theseÏservices€are€offered€on€a€voluntary€basis.€€Conversely,€it€is€reasonable€to€establish€evenÏmore€rigorous€standards€for€involuntary€hospitalization€when€crisis€interventionÏservices€are€available.€Ð 4(#4(# ÐÌà0 4 àà Œ àOnce€a€community€service€system€has€established€an€adequate€array€of€crisisÏintervention€services,€there€should€be€a€significant€decrease€in€involuntary€admissionsÏto€psychiatric€or€retardation€facilities.€€The€capacity€not€only€diverts€unnecessaryÏadmissions€but€it€also€can€prevent€involuntary€treatment€which€otherwise€might€haveÏbeen€required€under€existing€statutory€or€regulatory€standards,€in€the€absence€of€anÏeffective€crisis€response€network.€€Therefore,€states€should€narrowly€define€the€criteriaÏfor€involuntary€Ô_ÔinstitutionalizationÔ_Ô€after€a€crisis€services€have€been€utilized.Ð 4(#4(# ÐÌà0 4 àò ò3.à Œ àProcessó óÐP4(#4(# ÐÌà0 4 àà Œ àSimilarly,€states'€statutory€and€regulatory€mechanisms€define€the€procedures€forÏinvoluntary€admission€to€psychiatric€or€retardation€facilities.€€Usually€certifiedÏclinicians€can€involuntarily€admit€an€individual€to€a€public€or€private€facility€if€theÏstatutory€standards€are€satisfied.€€Further€review€of€this€clinical€decision€is€not€usuallyÏrequired.€€However,€once€a€comprehensive€crisis€network€is€established,€it€isÏappropriate€to€limit€the€authority€to€involuntarily€admit€an€individual€to€the€staff€of€theÏcrisis€assessment€program.€€It€is€also€reasonable€to€subject€the€admission€decision€toÏfurther€review€by€the€public€entity€which€funds€and€oversees€the€crisis€system,€in€orderÏto€assure€that€the€evaluation€and€admission€decision€is€consistent€with€the€moreÏrigorous€standards€described€above.€€Frequently,€administrators€from€county€orÏregional€public€entities€which€fund€and€operate€the€entire€community€system€have€finalÏreview€and€approval€authority€over€admissions,€as€a€safeguard€to€minimize€costlyÏinpatient€utilization.Ð 4(#4(# ÐÌà0 4 àò ò4.à Œ àFundingó óÐ-P(+4(#4(# ÐÐ ð-@), Ðà0 4 àà Œ àTraditionally,€funding€for€crisis€programs,€other€community€services,€andÏinstitutions€were€distinct.€€Many€states€are€now€experimenting€with€unifying€theÏfunding€so€that€community€programs,€and€particularly€crisis€intervention€services,€areÏfinancially€responsible€for€inpatient€hospitalization€or€other€costly€Ô_ÔinstitutionalizationÔ_Ô.€ÏThis€fiscal€disincentive€to€transfer€a€person€to€a€more€restrictive€setting€has€beenÏextremely€effective€in€encouraging€crisis€response€systems€to€address€and€resolve€theÏcrisis€without€the€need€for€segregated€inpatient€treatment.Ð 4(#4(# ÐÌà 4 àAdvocates€should€consider€consulting€with€mental€health,€retardation€and€otherÏdevelopmental€disability€experts€who€have€designed€and€operated€comprehensive€crisisÏintervention€systems.€€These€experts€are€usually€willing€to€assist€in€the€design€of€new€programsÏand€can€be€an€invaluable€asset€to€advocates€in€their€negotiation€of€either€systemic€remedies€orÏcomprehensive€community€services€plan.