Spokane County looks to mirror, modify Kootenai County crisis center model

COUER D’ALENE – The North Idaho Crisis Center is a humble brick building, on the corner of Kootenai Health’s hospital campus. But don’t let its plain appearance fool you: since December 2015, the center has been available to serve anyone with a mental health or substance use crisis who has walked through its doors, any time of day or night, at no cost.

In fact, the building has never closed its doors in the four years since it opened.

“The idea essentially is: we’re to provide basic stabilization and de-escalation services for somebody experiencing a mental health or substance use crisis. That’s fairly broad, and we like to say that crisis is in the eye of the beholder,” said Don Robinson, crisis and intervention services manager at the center. “If somebody appears at our front door, and they are in a crisis, we will bring them in. The key priority is to make them safe.”

In 2018, the center served 1,404 individuals. The vast majority of those clients stayed out of the emergency room or jail before and after spending time at the center. More than 700 clients left the crisis center with a safety plan, often to stay with a family member or somewhere where they felt supported. Others were referred to a higher level of care, a shelter or a social services agency.

While the majority of people the crisis center served last year were from Kootenai County, “out of state” was the second largest geographic area it served. Of these 160 non-Idaho residents who came through the crisis center’s doors, most were from Spokane County, Robinson said.

But the need for Spokane County residents in crisis to travel to Kootenai County could lessen, as Spokane is in the process of creating a mental health crisis stabilization unit of its own.

Ariane Schmidt, project manager for the city of Spokane, looked at the Coeur d’Alene center when planning Spokane’s unit.

Schmidt said much about the new crisis center will be similar what’s being done in Kootenai County, although Spokane’s facility will be geared more toward law-enforcement referrals. Reimbursement and funding for the Spokane unit are also not coming directly from the state, meaning Medicaid reimbursement and other funding sources are needed.

The Spokane County Board of Commissioners will vote Tuesday on whether to grant $350,000 to Pioneer Human Services to develop the operational framework for the center.

In Idaho, the state Legislature authorized crisis centers statewide in 2014 to keep residents with behavioral health crises out of emergency departments and jail. So far, numbers tracked by the North Idaho Crisis Center, which serves 10 northern Idaho counties, show it’s working.

The model used in Coeur d’Alene is unique for two reasons.

For one thing, the North Idaho Crisis Center is the only hospital-based crisis center in the state of Idaho.

Kasey Nixon, a senior crisis intervention specialist at the center, said the hospital relationship means he can get in touch with emergency department social workers and facilitate a warm hand-off for clients who need more urgent medical care.

“They are not going in cold on their own and having to advocate for themselves,” Nixon said. “They have a whole team of people advocating for their care.”

The center’s relationship with local law enforcement agencies also makes it unique. When people come to the crisis center, they must go through a security screening, but the center uses an amnesty box for people to surrender weapons or contraband, which local law enforcement are supportive of, Robinson said.

“We didn’t want somebody having contraband being a barrier to care,” Robinson said. “The ultimate goal is, let’s get them the care they need.”

After security, a client gets screened by a nurse for emergent medical needs. If a person needs more intensive medical treatment, they can be escorted or taken easily to the emergency department, a stone’s throw away from the center.

Some clients go get medically stabilized, then return to the crisis center for further services. The crisis center always has a mental health clinician on staff to talk to clients, walk them through treatment options and figure out a safety plan.

Security officers at the center were deputized by the Kootenai County Sheriff’s Department a few years into the program, so if a person presents as a threat to themselves or the community, the crisis center does not have to call law enforcement to place a hold on them. Robinson credits Sheriff Ben Wolfinger with coming up with that solution.

“We worked with the county prosecutor’s office and the legal counsel at the hospital and crafted a narrow deputization agreement, so on each shift we have a lead officer and that officer is deputized as a special deputy sheriff but only for the crisis center,” Robinson said.

Robinson said they rarely have to use this authority, however, just like they rarely have to report someone to law enforcement for contraband due to their amnesty box.

At capacity, the center can house up to 20 men and women at a time, although the census is typically no more than 12 people. A person can stay for up to 24 hours, but the average stay is about a third of that.

In 2018, more than a third of people who came to the crisis center wanted counseling or expressed feeling anxious or depressed. Suicidal ideation and chemical dependency and rehabilitation were also strong presenting needs, as well as 372 incidents of a person needing housing or shelter.

More than 800 referrals to the North Idaho Crisis Center come from individuals themselves or from family members. About 300 referrals in 2018 came from the emergency department or law enforcement. Using conservative estimates, the center estimates that they saved local law enforcement $37,800 in 2018, enabling those officers to attend to other calls.

The North Idaho Crisis Center saves more money than it spends, officials said. In 2018, the crisis center estimated its savings for the community to be around $2.58 million, largely due to the indigent hospital funds not charged to the county.

Crisis centers are allowed to charge fees, but the North Idaho Crisis Center has chosen not to.

“We didn’t want that to be a barrier, and if we get to the point where we’re billing individual insurances, I think we will lose people at the front door,” Robinson said.

Kootenai Health gives more than $300,000 to the center in kind for lease and operation expenses of the building as well as to cover all employee overhead. But the center is still facing a potential funding shortfall in 2020 due to budget cuts recently announced by the governor and cuts to state agencies that will result from the state’s expansion of Medicaid.

Robinson is hoping the crisis centers can make up the difference, if expanded Medicaid funds can help reimburse the center per client, but those details have yet to be arranged.

The Legislature fully funded the crisis centers statewide at first but planned to wean them off of state dollars so they could be at least partially funded by the community. In Coeur d’Alene, this means Robinson would have to find $750,000 in local funds annually, a nearly impossible task, he says.

The crisis center also operates a 24-hour hotline, which has increased its service to the community. Nixon said the center gets about 300 crisis calls per quarter. In surveys, clients are asked simple questions to back up the center’s exit data.

When asked, “Where would you have gone had we not been here?” Robinson said, “A third say ‘emergency department,’ a third say ‘jail’ and a third say ‘I don’t know.’ And that was a striking number to us: a third of the people we see that probably would have suffered in silence and not sought care anywhere.”