One of the most profound challenges with the mental health epidemic is crisis care. It's one thing if someone is in need of mental health care, but how should they be treated if they’re undergoing a mental health emergency? Emergency rooms aren’t well equipped for mental health crisis care but often treat these patients because there’s a lack of better options. 

In Utah, the Huntsman Mental Health Institute, in partnership with state and local government, private donors and other stakeholders, decided to do something about the problem. This spring, the institute opened the Kem and Carolyn Gardner Mental Health Crisis Care Center in South Salt Lake. The innovative center takes a unique “no-wrong- door” approach to crisis care. All walk-in patients are treated regardless of their finances, and within 23 hours, each patient is triaged to see where and how they should receive further care.

For this episode of HealthChangers, host Ashley Bach spoke to Kevin Curtis, clinical operations director at the Mental Health Crisis Care Center, and Dr. Mike Franz, executive medical director for behavioral health at Regence, about the new center in Utah and what it can teach us about how to best address the national mental health epidemic.

Listen to the full podcast episode on the player above. Below are some highlights, which have been edited for length and clarity.

AB: Kevin, what has been the state of mental health and mental health care in Utah?

KC: In Utah, we have the seventh-highest suicide rate in the country. We used to be even worse on suicide rate in the rankings.

At the Huntsman Mental Health Institute, we’ve been long engaged in trying to make things better for our state. We've implemented a 988 crisis line, mobile crisis outreach teams, non-emergency warm lines, the SafeUT chat app for youth, really trying to create innovative approaches to access to care, access to support and de-escalation and really trying to get those numbers down through innovative access solutions. 

But we know that we need to continue to work in those areas and need more of an integrated approach. Our system has been missing, in spite of all of those innovations, an in-person mental health crisis environment, and that's what the new crisis care center is really about.  

AB: How does the Kem and Carolyn Gardner Mental Health Crisis Care Center stand out?

KC: The simple answer is it’s designed specifically to treat mental health crisis. It's not that medical emergency rooms don't care and don't try to provide good support. It's that they didn't set out to do that work, and they're not designed to do that work. So, ours is a facility and a program that's designed to be a better answer to the question, “Where do I go if I'm experiencing a mental health crisis?”

Some components to that are really eliminating the barriers to care, reducing the stigma involved in accessing care, and making the physical environment and the programming designed to meet the needs of people that are in mental health crisis. Part of our design process was really, how do you engage with stakeholders in the process of actually understanding what do people in mental health crisis need, and what are the bad experiences they've had with other systems of care?

Our law enforcement community was involved. Our treatment provider community was involved. One of the most profound stakeholder involvements was our patient and family advisory council, made up of former patients, current patients and family members of patients. We asked them, “What makes the emergency room bad? Tell us about what was hard about receiving care in those environments.” They created a metaphor that guided almost everything we did on this project. One of them said, “Mental health care in crisis should feel like being wrapped in a warm blanket.”

And so we really tried to design our building, our programming, our relationship with stakeholders all around, what is the warm blanket way to do this? And we've ended up with warm and friendly environments that help us communicate that treating mental health care, treating crisis, is about hope, light and healing. It's about recognizing that this isn't just a disease of biology and neurotransmitters—although those are a part—it's also a disease of disconnection and despair. And how can we have our crisis response really targeted and designed to treat that whole thing?

AB: Dr. Franz, Regence and our corporate foundation have been longtime supporters of efforts to improve access to mental health care in Utah and to boost the mental health care workforce in that state. Our corporate foundation has invested in the Huntsman Mental Health Institute. Why is it so important for patients undergoing a mental health crisis to be treated outside emergency rooms?

MF: Kevin articulates the value of their model so well for me; I'll try to distill it into two words: one is “access,” and one is “experience.” And by developing the Huntsman crisis center, this community in Utah now has a lot more access to immediate walk-in crisis services, and it's in a very humane environment. The experience that the patients, and our Regence members, have there is markedly different and much more positive than what it would be in a traditional emergency department for the vast majority of patients.

Because, remember, most patients having a behavioral health emergency or crisis don't need the services of an emergency room. And so the Huntsman Mental Health Institute has been able to develop a program in an environment, and a workforce, that is really honed in to the needs of what those patients are experiencing, from the lighting that they have to the furniture that they have, to the architectural design of the new center. It's really created to de-escalate and create a warm and caring environment. And that's huge. Because it's a great patient experience. But what does that lead to? It leads to better clinical outcomes.

AB: As we look at other states and across the country, are there many walk-in crisis-care centers like the Mental Health Crisis Care Center?

MF: The integration of the new center in the university environment (at University of Utah), and bringing a dental clinic, some medical or primary care to it, the strong coordination of care component, the legal component to it, with the academic research component, that is pretty unique. I certainly haven't heard of someone putting all of that together. But these crisis stabilization centers are increasingly common. I actually live in Central Oregon, and we recently developed a crisis-stabilization center here, and it's transformed the way crisis care is rendered to people in our community, and it obviates that need to refer to the emergency department in the vast majority of the cases. Fortunately, a lot of people are realizing this is what we need to do.

AB: Kevin, the new center is located by design near the Salt Lake County Jail. What went into that decision?

KC: We know that one of the largest providers of mental health services are jails and prisons. So when we were talking with stakeholders that work on the police side and on the jail side, they told us that sometimes the people that are being held in jail for the longest amounts of time are actually people with serious mental illnesses. And they're staying longer because they have difficulty engaging in the jail programming, or their untreated mental illness is causing behaviors that lead to their stay being extended.

There are lots of people that currently end up in jail, primarily because of an untreated mental illness; they're engaged in crimes of vagrancy, nuisance crimes, low-level offenses that cause fear and concern in the community but are really a reflection of untreated mental illness. And so, we think that it's important for those types of cases that we have a treatment diversion because we think treatment does it better and gets them more safe to be in the community better, and also, once they go on that jail route, all of a sudden now the charges that hang over their head reduce the amount of options they have for connections to treatment.  

Being near the jail allows our law enforcement officers every day to drive past and have that thought process of, “Is this appropriate for a mental health diversion, or should this really be going to jail booking?”

AB: Kevin, some of the most striking things about the new center are its design and look. Can you go into more detail on how you took design into account?

KC: We learned early on in the stakeholder process that if the center was too scary, if it was too stigmatizing, people wouldn't feel comfortable walking through the doors. So we really made the facility design focused around being accessible and shame free.

In the physical design, that looks like lots of light, lots of open spaces in the lobby, no obscured glass that makes it impossible for a person to see what's on the other side of the door when they're walking in. Welcoming, almost feeling more like a hotel than a traditional crisis or a medical facility.

I don't think that we were prepared for how people would respond to that. And I think part of why people have responded so positively to it is that the contrast is, most mental health care happens in the darkest, dampest corner of the building that nobody wants. And with the new center, we're almost leapfrogging even past the traditional medical environment to something one step further that's really more focused on warmth and hospitality.

AB: I wanted to pose the last question to both of you. How could the Mental Health Crisis Care Center be replicated nationally? I'm thinking of not just the resolve in the community, but also resources. The center in Salt Lake was the result of many different stakeholders coming together for the common good, as well as both public and private donations.

MF: What Kevin's team has been able to do by bringing together a variety of stakeholders is to ensure that you have all the payers at the table. You certainly need your Medicaid payers, but you also need your commercial payers. You need the state that may be offering some additional support. You might need to bring in the grants for startup costs, and then that gives it some financial possibility of being sustainable, if you can get that fractured multi-payer environment to agree that this is a worthwhile concept to invest in.

And while there might be some initial upfront costs or some initial utilization costs associated with the crisis center, in the long run and maybe even in the medium run, I would suspect you're going to decrease total cost of care and improve outcomes because you have a more humane, more accessible, more functional crisis system that gets people plugged in to the right level of care, at the right time and at the right place.

KC: For us, it was as simple as saying, “Hey, we've got this model. We've been doing it on a smaller scale. These are some of our outcomes.” And most of our commercial partners lined up pretty quickly to say, ”Hey, we'd like for more of our people to come and receive services in that model.” 

We aligned the Medicaid payers as kind of the basis. We brought in the commercial funding to shore up the operation, since we were already serving a lot of commercially covered lives. And then partnerships at the Utah Legislature created an ongoing funding source for covering the care of people that have no health coverage. And then all of a sudden, we have this model where it doesn't matter whether you have this or that coverage, you just come in and we provide care.

Then the final piece is the philanthropic piece. The Huntsman family took the very bold step to say we're going to make it our family's cause to change the way that people view and receive care for mental health illnesses. Because they jumped in, other donor families came forward and said maybe it's okay. And people started talking and recognizing that mental health problems affect all of us across socioeconomic lines, across racial and ethnic lines, across gender lines. There's nobody that's not impacted by this.

The philanthropic families stepping forward is really what allowed us to go from trying to innovate care as best we can in the dark, damp corner of the building nobody wants to being able to start designing spaces that match the ambition of the programming that we've been working to innovate for so long.