Crisis Tech 360 Honored With 2018 National Council for Behavioral Health Excellence in Technology Award

Crisis Tech 360WASHINGTON DC, USA, April 10, 2018 / — Crisis Tech 360, LLC (, a wholly-owned subsidiary of Behavioral Health Link (BHL), was named the recipient of the National Council for Behavioral Health’s 2018 Excellence in Technology award, which recognizes organizations that use new technologies to achieve operational efficiencies and improve access to care for persons with mental illness and addictions.

Co-developed in a joint venture with RI International (d/b/a for Recovery Innovations, Inc.), the Crisis Tech 360 application replaces manual admission and discharge tracking with a web-based electronic bed board and dashboard interface that provides real-time views of behavioral health and intellectual developmental disability crisis program activity from anywhere.

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A Huge Step Forward


 inaugural meeting of the federal Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC)

Yesterday was the inaugural meeting of the federal Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC). While the acronym is a mouthful, the meeting is an important step to better health and quality of life to members of our community with the most significant needs; individuals with schizophrenia, bipolar disorder and major depressive disorder. Health and Human Services (HHS) has prioritized mental health alongside two other top priorities: opioid abuse and childhood obesity.I’ve attended many government meetings on mental health and suicide prevention in Washington DC over the past decade but this represents my first mental health meeting next to the Capital at the HHS offices Hubert Humphrey Building. It’s a clear signal that mental health is a priority to the US government and our healthcare system.

HHS Secretary Dr. Tom Price began with the challenges for the 10 million people with serious mental illness; including lifespan, homelessness and incarceration disparities. “Recovery is the expectation” with employment and social connectedness being mentioned during the discussion. According to Price, prejudice and apathy have weakened the way we address these issues but they require the same expertise and commitment as cancer or heart disease treatment. Secretary Price also called out the importance of family support and inclusion in the collaborative process to evolve our health care system.

There were prior mental health initiatives under Presidents Jimmy Carter and George W. Bush, but Secretary Price explained that the ISMICC is the first to report to Congress and he expressed strong confidence in the newly appointed Assistant Secretary for Mental Health Dr. Elinore McCance-Katz. This new role reports directly to the Secretary of HHS and Dr. McCance-Katz is the first psychiatrist to lead SAMHSA.

The charge of the ISMICC is three-fold:

  1. Report on advances in treatment, recovery and prevention;
  2. Provide rigorous assessment that is candid and sober; and
  3. Make specific recommendations on policy reform.

“I firmly believe mental health care does not receive the emphasis or resources it needs,” Secretary Price stated, adding “We need a true continuum of care from outpatient to inpatient.” Lisa Dixon from Columbia University shared her feelings on the inspirational opening: “My heart is in my hands with the promise for what this group might achieve.”

All branches of government were represented. Department of Housing and Urban Development Secretary Dr. Ben Carson spoke next sharing his lifelong interest in psychology. He explained that his mother struggled with major depression when he was growing up and was hospitalized.

One of the highlights for me personally was the active participation of the Center for Medicare and Medicaid Services. Kimberly Brandt described the largest health insurer in the world with 130 million covered lives and $1 trillion in spending. She identified several key CMS initiatives; including states reporting on outpatient follow-up to psychiatric inpatient services, the prevalence of smoking for individuals with serious mental illness, and expanded telehealth opportunities for delivering crisis psychiatry services. She also pointed to an upcoming CMS meeting on September 8 which will lay the groundwork for innovations in behavioral healthcare payment models.

Dr. McCance-Katz shared with the ISMICC ten key areas that she hopes to hear addressed in the dialogue:

  1. How do we move treatment back to community supports and services for those in jail or prison?
  2. How do we improve therapeutic relationships and what role might advanced directives play?
  3. How do we increase evidence-based practices like Assertive Community Treatment, Assisted Outpatient Treatment, and linkages to peers?
  4. How do we improve civil commitment laws?
  5. How do we improve access to care, especially given that 35% of people with serious mental illness receive no treatment at all?
  6. How do we address the long waits frequently experienced in hospital emergency departments, ensuring adequate acute care, crisis intervention and additional levels of care?
  7. How do we improve recovery supports and ensure better evidence for these approaches?
  8. How do we protect privacy rights?
  9. How do we address workforce deficits, including the numbers and geographic distribution?
  10. How do we incorporate co-occurring substance use services?

Next, four panelists presented on federal advances to address challenges in SMI and SED.

Dr. Joshua Gordon from the National Institute of Mental Health offered a strategic framework for SMI and SED research that would deliver personalized interventions. He presented RAISE as an example of success using this approach (RAISE stands for Recovery After an Initial Schizophrenia Episode).

Gordon also prioritized suicide prevention and described the NIMH RFA on applied research to evaluate the effectiveness of the Zero Suicide in Healthcare systems model.

SAMHSA’s Paolo del Vecchio leads the Center for Mental Health Services and started with the stark disparity between people with SMI/SED related to receipt of evidence-based practices. For example, unemployment rates for individuals with serious mental illness are extraordinarily high. 70% of individuals express a desire to work but only 2% receive evidence-based supported employment services.

Del Vecchio surveyed the principles of coordinated care: medications, therapy and recovery supports while highlighting approaches that integrate all three components. Great emphasis on the need for a coordinated continuum of crisis care and the Zero Suicide in healthcare. “We prepare people for a life of recovery, not a life of disability.”

Dr. John McCarthy with the Department of Veterans Affairs, Office of Mental Health Operations, described the advances in treatment and access. While the overall number of veterans in the US has declined since 2005, the penetration for those receiving treatment with the VA has increased 24%. The growth in outpatient mental healthcare is up 85% over the same time period.

McCarthy reported on the substantially increased hazard ratio of suicide for individuals with serious mental illness and the July 2017 findings from Dr. Mark Olfson related to the very significant suicide risks for individuals in the immediate aftermath of a psychiatric hospitalization. He described several VA initiatives to address these risks; including the Veterans Crisis Line, 400 suicide prevention coordinator staff nationwide and the REACH vet program, which uses predictive analytics to determine those at highest risk.

Finally, the Bureau of Justice Assistance’s Ruby Qazilbash shined a light on the prevalence of people with SMI in the criminal justice system. She cited data that approximately 4% of the general population has a serious mental illness, but 17% of the 11 million annually incarcerated in the jail population has a serious mental illness. She also described the frustrations of local law enforcement, whose experience can find one in ten calls involve mental health, contacts which require twice as long to resolve as other police activities.

After the lunch break, a second panel presented non-federal advances.

Lynda Gargan with the National Federation of Families for Children’s Mental Health shared her own powerful personal journey of challenges and successes regarding her son.

Columbia University Medical Center’s Dr. Lisa Dixon reviewed the evidence for Coordinated Specialty Care for individuals experiencing a first psychosis, which demonstrates dramatic reductions in inpatient hospitalization and strong improvements in school and/or work progress. She asserted that “being productive equals a basic human need.” People want to work. It’s an essential part of recovery. And… Individual Placement and Support (IPS) is very effective, creating employment rates as high as 78%.

Dixon also reviewed the impacts of peer supports strategies; concluding that they reduce the use of acute services, result in decreased depression and substance use and increase engagement and hopefulness (Bellamy et al, 2017, “An update on the growing evidence base for peer support,” Mental Health and Social Inclusion).

Dr. Sergio Aguilar-Gaxiola from the University of California encouraged a focus on a comprehensive view of the non-medical determinants of health, including co-morbid medical diseases, smoking, obesity, physical inactivity, poverty, trauma, poor social connectedness and homelessness.

Formerly medical director for the state of Missouri, Dr. Joseph Parks is the lead psychiatrist at the National Council for Behavioral Health. Parks discussed the challenges of access to care; including a psychiatry workforce shortage, psychiatric boarding with people waiting in hospital emergency departments for mental health services and insurance gaps. He also encouraged the enforcement of parity requirements to appropriately resource services.

Using a data driven approach, Parks recommended a framework for strengthening community treatments and crisis services. He stated that standard definitions of levels of care (using placement criteria like the LOCUS and CALOCUS) will ensure better matching to needed supports and ultimately decrease the shortage of psychiatric inpatient beds.

Committee member Elyn Saks summarized the four presentations stating the most important element is access to care. She also encouraged a thoughtful analysis of the use of coercion and force in behavioral healthcare treatment, and suggested we create more engaging treatment.

There was generous and passionate input from everyone in the room. One of the most memorable threads related to the word “Interdepartmental.” Dr. Ken Minkoff with ZiaPartners, Dr. Clayton Chau of the Institute for Mental Health and Wellness St. Joseph Hoag Health System and author Pete Earley, among others, encouraged the ISMICC to action around the central importance of integrated solutions across federal departments. Minkoff shared his involvement in both the prior Presidential mental health initiatives and stated this is the first-time integrated solutions have been the goal.

What an amazing day… an amazing opportunity… an amazing mission… and an amazing group of people. I am truly honored!

Key Timeline

  • December 13, 2017 – First report to Congress with a summary of advances in SMI and SED, evaluation of the effect of federal programs and impact on public health and specific recommendations for actions that the departments can take to better coordinate.
  • October 15, 2017 – First draft of the report with a seven-day turn around for feedback from the ISMICC.
  • November 15, 2017 – Second draft modified with comments with another seven-day turn around for further feedback.
  • ISMICC Non-federal committee members are serving a three-year term.
  • A second report to Congress is required by the 21st Century Cures Act in 2022.

Returning to the Why in Behavioral Healthcare

whyThe most important question is always why. So, why do we do what we do in behavioral healthcare? Put simply, we seek to equip individuals with serious mental illness to live happy, healthy, productive, and connected lives.

On Thursday, August 31, 2017, the 21st Century Cures Act takes a very important step forward with the inaugural meeting of the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC). The ISMICC is composed of senior leaders from 10 federal agencies; including HHS, the Departments of Justice, Labor, Veterans Affairs, Defense, Housing and Urban Development, Education, and the Social Security Administration along with 14 non-federal public members. I am exceptionally appreciative of the opportunity to be a part of this amazing team.

HHS Secretary Tom Price will introduce the proceedings and review the charge to the committee and recently confirmed Assistant Secretary for Mental Health and Substance Use, Dr. Elinore McCance-Katz, will kick off a discussion of federal advances, challenges, and recommendations. The focus will be on outcomes; including rates of suicide, employment and education as well as other measures that might be used to evaluate the efficacy of efforts to address the needs of individuals who experience serious mental illness (SMI).

I’m very optimistic. The ISMICC charter and first meeting’s agenda point to a central focus on why. “WHY are we doing this work?” (HINT – It’s about real-life outcomes). It’s the best and right place to start, and should serve as a call to action to open our collective minds to a multitude of options of WHAT we might do and HOW we might do it to realize better outcomes.

In recent months, we in the field wrung our hands during the congressional debates over healthcare. Our talking points referenced WHAT we do: educational programs like Mental Health First Aid and services like case management and peer and recovery supports. We talked about HOW we deliver care and we contrasted our engagement now with the institutions of the 1950s. We looked at ways to do the things we have been doing better. These are worthwhile discussions. It’s so very easy to get caught up in the how and the what but it looks like we will now be challenged to dig deeper and focus on why we do what we do. This is not a completely foreign notion to many of us who have seen significant efforts in our Medicare and Medicaid programs to engage in value based contracting arrangements.

Several years ago, I was working as a counselor with a young man who was hard-charging through an advanced degree; seemingly destined for great success in life. He initially came to me because of grief around a broken relationship. Over the course of a six-month period, our team concluded that he was experiencing his first onset of serious mental illness.

Today, he would be in his 40s. As a person with a serious mental illness, there is only a one in five chance he will be employed. He would be twice as likely to be employed if he had instead been in a tragic accident that resulted in a visual, hearing or mobility disability. If unemployed, he would likely be missing the sense of contribution to community and the connection to others that many of us feel as a result of our work.

Additionally, he would be two to three times more likely to have developed diabetes, heart disease, or obesity than the general population. The average American has a life expectancy of 79 years. In 2006, the National Association of State Mental Health Program Directors (NASMHPD) found that a person with serious mental illness in the US dies on average 25 years younger than the general population (that’s 54 years). In comparison, the average life span in war-torn Afghanistan is 61 or seven years longer than someone with a serious mental illness in the United States.

Valuing Recovery - SMI Outcomes

These outcomes are relatively well-known but in recent years more attention has been paid to the impact of non-medical determinants of health that warrant consideration. Holt-Lunstadt and colleagues conducted a meta-analysis of health outcomes that revealed friends and social supports are the single most powerful indicator of health life and longevity. Simply put, loneliness increases the likelihood of early death by 30%. For context, increasing one’s community connections correlates more closely to longevity than quitting smoking according to the study.

When Americans are asked if they have “someone to rely on in times of trouble,” 90% answer yes. In Iceland, the answer is nearly 100%. Not a lot of research has been done in this area for people with serious mental illness. However, Magellan Health contracted providers surveyed over 20,000 people with a serious mental illness in Arizona between 2010 and 2013 with similar questions about whether the person has “someone to talk to about problems” and “someone who invites me out occasionally for dinner/activity.” The findings would suggest that only 55-65% of respondents with serious mental illness  have “someone to rely on in times of trouble;” which is again on par with Afghanistan where 57% answer in the affirmative.

Lastly, the young man I saw all those years ago was accustomed to making decisions about his life. Tragically, many individuals with serious mental illness realize less autonomy and self-direction, and may even be incarcerated. Elyn Saks is a non-federal member of the ISMICC, an expert in mental health law, and a person who lives with schizophrenia. Her recent article in Politico, The Consent Dilemma, thoughtfully examines the negative impact of increasing coercion and force in behavioral healthcare treatment.

These real outcomes can be measured and tracked for improvements. I’ve summarized them in the balanced scorecard graphic (above), Valuing Recovery: Real Outcomes for People with Serious Mental Illness.

WHY do we do what we do in behavioral healthcare? We seek to equip individuals with serious mental illness to live happy, healthy, productive, and connected lives. It’s not only their illnesses that conspire with barriers to achieving these objectives, but our society also limits their potential success through low expectations and discrimination. We can and must move beyond a focus on symptom reduction and stabilization to support people beyond their behavioral health needs to succeed in the community where they live, work, and play.

Thomas Joiner’s groundbreaking 2005 work “Why People Die by Suicide” suggested that the two most painful experiences in life are loneliness and feeling like a burden to others. By contrast, he suggested that people who are connected and perceive they are making a contribution to others are protected. We tend to think of suicide as simply a symptom of serious mental illness, but the outcomes generally experienced by SMI individuals (lonely, unemployed, etc.) would suggest tremendous risk for any population. In fact, the hazard ratio for suicide for people with SMI dramatically exceeds other “at-risk” groups like LGBT, older white males, active duty military and veterans, and Native Americans/Alaskan Natives.

SAMHSA reported national expenditures for mental health treatment of over $200 billion in 2014. Despite this investment in services and programs, the typical outcomes experienced by the nearly 10 million people with serious mental illness in the United States look more like those from impoverished and war-ravaged Afghanistan.

The young man I worked with had a past, one in which accomplishing his goals in life seemed straightforward. He had a future in his mind’s eye, a roadmap for meaning and purpose. But if he experienced the outcomes most typical for people with serious mental illness, our view of him in the present would miss so much of that potential. This can change!

We can imagine that what he wants today may very likely be what all of us want in life. We want to make a difference in the lives of those around us. We want to work. We want friends and family that love us and that we love back. We want to live a healthy life. And we want to be the ones responsible for our decisions. These are the things that make humans happy, and their absence makes any one of us grieve.

Today, the national expansion of First Episode Psychosis programs led by SAMHSA based on the National Institute of Health’s Recovery After an Initial Schizophrenia Episode (RAISE) study is transforming care for young people just like the man described above. RAISE began with two studies of Coordinated Specialty Care (CSC) and a clear focus on the why, but the approach is too rare an example of starting our program development with the end in mind.

We in behavioral health have lost sleep this past year over the how and the what. But we started the Community Mental Health movement over 50 years ago with a strong why — introducing services and programs that would empower individuals with SMI to live in local neighborhoods, not institutions.

On first take, the ISMICC seems focused on the heart of the matter; on the outcomes experienced by those with schizophrenia, bipolar disorder, major depression, and other serious mental illnesses. It’s time again for us to ask and answer the question why and begin taking strong actions to achieve measured success.

I’m inspired that the ISMICC is returning our focus to the purpose of our work and I’m confident this approach will engender actions that over time dramatically improve the lives of those with serious mental illness.

Note: The SAMHSA website includes information to join the August 31 ISMICC Advisory Committee meeting by teleconference as well as additional resources like the ISMICC charter.

RI International CEO & President David Covington Appointed to National Department of Health & Human Services Committee

WASHINGTON D.C., US, August 29, 2017 / — RI International CEO and President David W. Covington, LPC, MBA, will participate in the inaugural meeting of the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC) on Thursday, August 31, 2017. David was selected as one of 14 targeted appointments to serve alongside leaders from 10 federal agencies (representing a leading research, advocacy, or service organization for adults with a serious mental illness). The Department of Health & Human Services formally announced the non-federal members on August 16, 2017.

The ISMICC is focused on the heart of the matter; on the outcomes experienced by those with serious mental illnesses. It’s time for us to begin taking strong actions to achieve measured success.
– David W. Covington

Read the full article here.

RI CEO and President David Covington featured on New Zealand Zero Suicide News Program

David Covington interviewed by Ryan Bridge about Zero Suicides goal

Is suicide preventable? Or is it inevitable? If somebody’s suffering reaches a no-turning back stage, can they be turned back?

Ryan Bridge speaks to world-renowned Suicide expert David Covington,  who founded the Zero Suicide initiative.

Listen to the interview here:

Opioid Crisis Hits Wilmington Area Hard; Lack of Public Resources Hinders Response

This is an abridged version of the original article. Click here to read the full article.

North Carolina’s place in the national opioid crisis is nothing new here – and the news that Wilmington is the top city in the nation for opioid abuse doesn’t surprise people.

These days, from well-to-do Market Street lined with live elms to the dilapidated and garbage strewn Houston Moore and Hillcrest housing projects, addiction is uniting the city. Acknowledging that has been a long time coming.

Joe Stanley Wellness City

Joe Stanley has been clean for 13 years and now helps others at Wellness City. (Photo: Joe Killian)

“There’s been a bad drug problem here for a lot of years,” says Joe Stanley. “But people are just beginning to really pay attention to it because you’re seeing that other demographic affected – middle class white people, rich people, people who are into prescribed pills and don’t start out with heroin. Now they’re seeing it can happen to anybody. Addiction can come for anyone.”

Stanley knows. He’s been clean for 13 years and now works as a peer support specialist, helping other addicts at the Wellness City recovery center on South 17th Street. But he spent decades abusing drugs – mostly crack – in Wilmington.

Most people working with addicts here agree – when the bodies were mostly black and being found in flop houses or behind gas stations, there was a lot less attention to the epidemic. But in the decade between 2005 and 2015 opioid-related deaths jumped from 26 to 45 in New Hanover County. That’s nearly as many as in Guilford County, whose population is more than twice as large.

But New Hanover County is 81 percent white. Its median income is just over $50,000 a year – higher than much larger Guilford. So not all of those struggling with and dying from addiction are, as so many people here say carefully, “who you’d think.”

Kris Ludacher, director of the Wellness City.

Kris Ludacher, director of the Wellness City. (Photo: Joe Killian)

Kris Ludacher is the director of the Wellness City – a no-cost, peer-support recovery operation that opened just last year. The group held 125 sessions – they don’t like to call them “classes” – last month for people struggling with addiction, mental health problems and both.

But before he was running the Wellness City, he spent eight years with a mobile crisis unit here. Even eight years ago about two-thirds of the calls were for substance abuse – and the number of opioid overdose calls were on the climb. Ludacher said he noticed a related trend.

“It used to be that you’d get an overdose call and it would be in a Chick-fil-A bathroom,” Ludacher said. “But then you started getting those calls and they were at half-million dollar yachts.”

Government services in New Hanover County are doing their best to combat the epidemic – but the need is great and the resources sorely lacking.

The county recently produced a series of public service announcement videos on various angles of the epidemic. But the piece of the story that is often overlooked is the impact on the families and children of those struggling with addiction here.

Mary Beth Rubright is Child Protective Services Chief with the Department of Social Services in New Hanover County. Her department has been hit hard by the opioid epidemic here, experiencing a 93 percent increase in the number of children who need foster homes in the four-year period between 2012 and 2016.

Add to that the sharp spike in child deaths related to opioid addicted parents –  in car crashes, parents who roll over on children who sleep with them, severe neglect and suicide.

“The numbers are scary,” Rubright said.

There are now nearly 500 children in foster care in New Hanover, a number approaching that of some of the state’s largest counties.

Medicaid expansion would be a godsend to some people trying to get on and stay on a real recovery path, Davis said. That’s a call many lawmakers in Raleigh have been sounding for years, but the GOP majority is not yet on board.

In the meantime, those on the ground agree a serious commitment of resources to combat the epidemic is needed.

Wanda Marino, assistant director for Social Work Services in New Hanover, said the first step is acknowledging the problem – something New Hanover is doing, but many communities are not.

“And we need more resources, more staff who receive substance abuse training, more resources to hold on to good staff so that we aren’t having to replace them and they aren’t chasing their tails,” Marino said. “We have a great staff here. They work hard and they are trained. But we just need more of them. I think that’s the case in a lot of places.”

Read the Full Article Here

Trillium Aims To Provide Health Services

Kris Ludacer Wilmington Program Director

Kris Ludacer is program director of Wilmington Wellness City, a partnership between Trillium Health Resources and RI International that is fully funded by Trillium and housed at 1960 S. 17th St. (Photo by Chris Brehmer)

Wilmington Wellness City, a partnership between Trillium and RI International that is fully funded by Trillium, celebrated a grand opening in January at 1960 S. 17th St. in Wilmington, a much larger location from the previous one-room space the program operated out of at The Harrelson Center downtown.

Getting more people who are recovering from addiction or mental illnesses to use the service means getting the word out about Wilmington’s location, said Kris Ludacer, program director of Wilmington Wellness City.

That also means “having people stop by to see the facility and just kind of take a tour. One of the things I think people aren’t realizing is we don’t infringe on anyone else’s services. We are an additional support, and we’re free to anybody over the age of 18. It doesn’t matter what insurance you have; it doesn’t matter what level of service you’re getting from another provider,” Ludacer said.

Potential funding cuts from the state could affect Wellness City locations, including in Wilmington, New Bern and Greenville, officials said.

Ludacer said one of the main impacts could be an overflow of people who need the free help because they can’t pay for other sources, although he said the Wilmington Wellness City would try to accommodate everyone.

Read the Full Article Here

Ribbon Cutting Held for Riverside, CA Mental Health Urgent Care

Riverside, CA Mental Health Urgent Care Grand Opening

RIVERSIDE, CALIFORNIA, U.S., April 28, 2017 / — RI International CEO and President David Covington announced today that the ribbon cutting for the Mental Health Urgent Care located at 9890 County Farm Road in Riverside, CA, will be held on May 3rd at 10 am.
“We are grateful to the Riverside Board of Supervisors, the Riverside University System -Behavioral Health and the Riverside County Economic Development Agency for making this beautiful mental health facility possible. RI International’s aim is to ensure that every crisis facility we manage is inviting — resembling an upscale home rather than an institution – and serves as a healing space. In this facility, staff and guests will not be separated by Plexiglas fish tank walls, and our engaging teams will focus on helping every person we serve return to a life of meaning and purpose in their communities.”

Read the full press release here.

David Covington Announced as the President-Elect for AAS Board

AAS Header

The results are in! We are pleased to announce the newly elected AAS Board Members as follows:

  • President-Elect: David Covington, MBA, LPC
  • Secretary: Jonathan Singer, PhD
  • Clinical Division Chair: Melinda Moore, PhD
  • Research Division Chair: Jie Zhang, PhD

Other recent members appointed to the AAS Executive Committee include Bart Andrews, PhD and April Foreman, PhD.

We extend our congratulations to the winners, and our appreciation to all candidates for their willingness to serve.

A special thanks to Past-President Bill Schmitz, PsyD and his committee for their time and effort.

Suicidology at 50

Elected Board Members will begin their duties at the 50th annual Conference in Phoenix, AZ. For more information, please click on the banner above.

#RecoveryNow Annual Leadership Retreat 2016

RI International’s Board, Executive Team and RSAs from across the US met for RI’s Annual Leadership Retreat #RecoveryNow