Cook County Announces Bold Plans to Address Behavioral Health

In response to decreased funding of community-based behavioral health services and the impact on Cook County, Cook County Board President Toni Preckwinkle and Cook County Health & Hospitals System (CCHHS) CEO Dr. Jay Shannon today announced plans to expand behavioral health services in the coming year.

“Whether through the emergency room or at the jail, Cook County taxpayers are disproportionately paying the price of years of funding cuts to community-based behavioral health services. We continue to watch the negative effects on patients, our communities and our finances. Clearly, it’s time we expand our portfolio of behavioral health services,” said Cook County Board President Toni Preckwinkle.

CCHHS intends to make significant investments in the coming year to provide a continuum of behavioral health services available to those who need it. Plans include:

Community Triage Center
Working closely with President Preckwinkle and the Cook County Justice Advisory Council, CCHHS will establish a pilot 24/7 Community Triage Center (CTC) in the Roseland neighborhood to provide early intervention services for individuals who are at risk of detention or hospitalization due to behavioral health conditions. CCHHS recently received a grant from the Otho S.A. Sprague Memorial Institute for initial planning of the CTC and will invest an additional $3 million to operationalize the center. The CTC is expected to open later this year and county officials predict it could divert hundreds of individuals from local emergency departments and the Cook County Jail in the first year.

Officials believe that a community-based center is a more appropriate setting to care for individuals with a fragile mental state than a jail or hospital emergency department (ED). By providing an early intervention alternative to detention or a hospital visit, officials anticipate law enforcement resources, as well as jail and emergency room costs, will decrease.

A primary goal of the CTC is to reduce the number of detainees in the Cook County Jail who have an identified behavioral health condition by connecting them with care in the community. In 2013, the County spent $143 per detainee per day on housing, food, health care and security. CCHHS, through Cermak Health Services, provides the health care at Cook County Jail. It is estimated that on any given day, approximately 20% of the detainees at Cook County Jail have a behavioral health issue which may have contributed to their detention. Between January 2013 and April 2015, more than 20,000 emergency department visits were recorded for individuals exhibiting behavioral health conditions at Stroger Hospital alone.

The CTC will provide evaluation, crisis stabilization and treatment for patients presenting with psychiatric and/or substance-related crises, and work closely with the local hospitals and outpatient mental health services to best meet patient needs 24 hours a day, 7 days week, 365 days per year. Additionally, CCHHS intends to work closely with the Chicago Police Department to allow police officers to drop off individuals and rapidly return to their patrol areas, as well as provide walk-in services for residents and for those released from the Cook County Jail needing follow-up care.

“Waiting until an at-risk individual is arrested and detained is both costly and a failure of our societal systems. If we can employ strategies to link individuals with the needed services before they commit a crime related to untreated or undertreated behavioral health disorders, then we can reduce the jail population, emergency room visits and improve the health and safety of our communities,” said Dr. Shannon.

Behavioral Health Consortium
Working closely with several key behavioral health providers, CCHHS, through its Medicaid health plan CountyCare, will establish a Behavioral Health Consortium to transform community-based care. Among other interventions, providers in the CountyCare network will have access to a single point of contact when in need of services for a patient 24/7/365. Each call to the consortium will be triaged and appropriately referred to a community-based mental health or substance abuse provider. The initial providers in the consortium include: Community Counseling Centers of Chicago (C4), Metropolitan Family Services, Human Resources Development Institute Inc. (HRDI), Habilitative Systems, Inc. (HSI), the South Suburban Council on Alcoholism and Substance Abuse, and Family Guidance Centers Inc.

“This strategy has the potential to transform the delivery of behavioral health services. Nowhere else in the country are behavioral health providers teaming up to address this national epidemic and caring for patients in this collaborative way” said Chris Carroll, interim executive director of Community Counseling Centers of Chicago, who will lead the consortium.

Integrating Behavioral Health into Primary Care Medical Homes (PCMH)
Integrating behavioral health into primary care promotes effective and efficient systems of care. The vast majority of individuals with behavioral health conditions present in the primary care setting and not in a specialty behavioral health clinic. Overwhelming evidence indicates that historic primary care models are inadequately prepared to recognize and treat these conditions. Furthermore, it is well documented that primary care settings can effectively treat and manage individuals with mild to moderate behavioral health needs and, in many cases, prevent the escalation of illness requiring specialty behavioral health services, including inpatient services.

In the coming year, CCHHS will be focused on increasing access to a full array of outpatient services through its network of 16 community health centers. By embedding behavioral health services within primary care medical homes, patients will benefit as their care will be coordinated through a single team of providers. Proper and comprehensive care management is the key to CCHHS’ strategy to reduce unnecessary hospital visits.

“The integration of behavioral health services into our health centers will ensure that we are caring for the whole patient rather than providing episodic care focusing on the acute need of the day. This strategy is a win-win for patients and providers. Patients get quality comprehensive care, closer to home and we get the satisfaction of caring for them before their condition requires intense interventions,” said Andrew Kulik, MD, CCHHS chair of psychiatry.

Expanded Substance Abuse Treatment
CCHHS currently provides substance abuse treatment at the Cook County Jail and in its emergency rooms. At Stroger Hospital, 14% of emergency room visits and 16% of inpatient visits are attributed to the growing problems of addiction and overdoses of opioids. Community-based opioid overdose prevention services are available but are declining due to funding cuts. CCHHS is developing a strategy that would provide these treatments to at-risk patients in the event of an overdose.

“Just a few months ago, we treated more than a dozen individuals who had ultra-potent drug related to heroin called fentanyl. Without treatments such as naloxone (Narcan), the results could have been fatal. Instead, each of these individuals survived. Educating and teaching users and their friends and family members about how to effectively use naloxone in an overdose situation is a proven intervention to combat the growing opioid addiction trend,” said Steven Aks, MD, chair of toxicology at CCHHS.

CCHHS is developing clear guidelines and standards for the distribution of naloxone for at-risk patients and intends to roll-out a comprehensive naloxone program in the coming months, in addition to expanding addiction medicine services.

“CCHHS has been on a journey these past several years to transform itself into a modern, integrated patient-centered health care system. This new behavioral health strategy is indicative of our commitment to providing the right care, at the right time, in the right place. We have great expectations for the impact this strategy will have on the patients and communities we serve,” said Dr. Shannon.