Rural health funding aims to address mental health care in Mississippi

• Using the EmPATH model, officials look to create soothing spaces near hospital emergency departments that will be staffed by mental health specialists.

The establishment of specialized mental health crisis units in emergency rooms in Mississippi aims to fill a missing component in the state’s continuum of care.

As part of the Rural Health Transformation Program, applications have been accepted to create open rooms within hospitals geared toward deescalating a situation where a person may be suffering from a mental health crisis.

Qualifying hospitals for the program are those serving rural areas in Mississippi.

The model Mississippi Rural Health Program Advisory Council determined would best meet the state’s needs is the Emergency Psychiatric Assessment and Treatment and Healing (EmPATH) model. Wendy Bailey, Executive Director of the Mississippi Department of Mental Health, said this model will fill a gap in current services.

This week, the advisory council closed the application process in preparation for awarding funding for the projects.

SAMHSA Continuum

To ensure states are able to meet the mental health needs of their citizens, the Substance Abuse and Mental Health Services Administration (SAMHSA) established a set of crisis continuum benchmarks. There are four components within that continuum, which include providing someone to call, somewhere to go, someone to respond, and someone who can follow up after the crisis. 

Mississippi is meeting several of those standards today, such as through the 988 Lifeline call system, the establishment of mobile crisis response teams in every region of the state, and the presence of 14 crisis residential units, Bailey explained. 

She said Mississippi’s two 988 call centers received 23,646 calls last fiscal year, reflecting a 33.8% increase compared to the previous fiscal year. Of that number, 98% of the calls were answered by Mississippi-based personnel. 

“I think we’re really solid in Mississippi on our ‘someone to call’ part of the crisis continuum,” Bailey said. 

The crisis residential units served 3,600 people last fiscal year, with an average stay of 9 to 10 days. 

“What we did not have in that ‘somewhere to go’ part of a continuum is what nationally is referred to now as crisis stabilization, or emergency psychiatric,” Bailey explained. “We had not built out that part of the continuum.”

What EmPATH Provides

The EmPATH facilities are designed to provide short-term care of about 23 hours or less within a hospital setting. Once established, the facilities will provide law enforcement with a place to bring those suffering from a mental health crisis rather than move them to a jail or leave them in an emergency room. 

“Neither one of those settings is truly optimized to provide timely trauma-informed psychiatric care,” Bailey noted. “Emergency departments do not have the adequately-trained staff for psychiatric emergencies.”

Families and individuals can also benefit from these units.

The advisory council found the EmPATH model recommended by SAMHSA during their research to improve care. To ensure the model was a good fit for Mississippi, Bailey said the advisory council toured already established EmPATH facilities in Tennessee, where they have a record of success. Under the model, about 75% of people suffering a crisis are stabilized and returned home in less than 24 hours.  

“And that’s without the costly inpatient admission or an emergency department boarding,” Bailey said.

The aim is to provide a person in a mental health crisis with a space away from the hectic environments often experienced in hospital emergency departments. 

“If you go into an emergency room there are all kinds of crisis and emergencies happening,” Bailey said. “You may have a gunshot victim, you may have someone that’s been in a car accident. There are machines going off and there’s just a lot happening because it is an emergency department.”

EmPATH units are typically established close to an emergency department, but offer a quiet place with recliners instead of hospital beds, better lighting, and other amenities. 

“When you come in, you receive a warm blanket. There’s food, you have sandwiches, you have snacks. It’s kind of dim lighting. It’s very soothing,” Bailey described. 

These facilities will also be staffed by trained personnel. 

“It is very calming. It is very therapeutic,” Bailey elaborated. “You are seen by a behavioral health specialist. It might be a psychiatrist, it might be a psychiatric nurse practitioner. You are seen, though, within 15 minutes.”

The combination of the environment of EmPATH units and the trained staff, including peer support specialists, are designed to help deescalate situations where a person is agitated, reducing the need for involuntary medication or physical restraints. The facilities are also required to be ligature resistant to protect those with suicidal thoughts, while offering a secure observation area and have private evaluation rooms.

The care provided in the units can help trained staff rule out whether a medical issue is an underlying cause of the crisis, which at times can lead a person to being denied service by a crisis residential unit. 

“What we hope to see, and what we’ve seen in other states, is a decrease in the number of denials by the crisis residential services,” Bailey said. 

Further, instead of that person being taken to a jail, EmPATH units give law enforcement a single-point drop off location. 

EmPATH Unit Essentials

Some of the requirements for establishing an EmPATH unit is that they must be open 24 hours a day, 7 days a week to serve as a drop-off point for law enforcement. They require no appointment to be seen, provide a comprehensive psychiatric evaluation and a suicide and violent risk assessment, and also provide substance use screening.

Trained staff within the facilities must be capable of initiating proper medication, and even adjust current dosages, provide detox services and withdrawal treatment. However, these services are short term, lasting less than 24 hours.

“So if that individual is not able to return home and does need to be transferred to either an emergency department or a crisis residential unit, they’ll be able to do that care coordination piece as well,” Bailey explained.

Hospitals that will participate in this funding opportunity will be tasked with creating an EmPATH unit through the renovation of space near the existing emergency departement, along with hiring staff to provide 24-hour access to psychiatric care.

Access to a psychiatrist could be offered through Telehealth, but there is a requirement for a number of trained staff to provide care in-person, such as a psychiatric nurse practitioner, peer support specialist, and a registered nurse, to name a few.

Next Steps

Initially, Bailey hopes the program will fund three such units, with one each in the north, central and southern rural regions of the state.

Now that the application process is closed, she said the council would like to see the facilities operational within 12 months. Grant awards are expected to be issued in September. 

“That will all depend on who applies, who is selected, and then, what renovations may possibly be needed and the hiring of staff,” Bailey explained about the opening of the facilities. “We want to get these services out there to Mississippians as quickly as possible.”