Police officers are often the first to respond to people experiencing behavioral health crises, with an estimated 20% of calls to them attributed to mental health and/or substance abuse crises. But many police departments are not equipped to respond to these calls. According to Ron Bruno, a police officer for 25 years and the executive director of Crisis Intervention Team International, “a handful of departments have done [crisis intervention training (CIT)] right. But others, too often, see CIT training as merely as a check-the-box, 40-hour exercise.” This can impact police officer morale, who have to witness the impact of an underfunded community mental health system. But the people in crisis suffer the most. From 2015 to 2020, almost a quarter of people killed by a police officer had a known behavioral health condition, with many others injured.

In GRAND’s area, police officers were also the first to respond to people experiencing behavioral health crises. In 2015, the local police department was overwhelmed by the number and severity of behavioral health needs in the community. Though officers lacked sufficient crisis intervention training, they spent considerable time with people in crisis, either ultimately arresting them or transporting them to the emergency department (ED) because they lacked any other option. This was often traumatizing to patients.

This dynamic was also challenging to the local health system. To manage the influx of patients, ED staff would diagnose behavioral health conditions and sign Emergency Detention Orders to discharge patients more quickly to accommodate other emergencies, even if a lower level of care was more appropriate. This led to over-admission to inpatient facilities. In 2015, the same year that the local police department signaled that they were overwhelmed by behavioral health crises, 841 patients served by GRAND also received inpatient psychiatric services at Wagoner Hospital, a hospital in the area. 

GRAND Mental Health is a Certified Community Behavioral Health Clinic (CCBHC) that offers behavioral health services in addition to support with diet, physical health, housing, and employment. The organization operates facilities in thirteen Oklahoma counties, including three crisis centers. 

GRAND Mental Health is a Certified Community Behavioral Health Clinic (CCBHC) that offers behavioral health services in addition to support with diet, physical health, housing, and employment. The organization operates facilities in thirteen Oklahoma counties, including three crisis centers. 

To reduce inpatient hospitalizations and create lower levels of care for people experiencing behavioral health crises, GRAND Mental Health created dedicated 24/7 crisis stabilization services and extended virtual care access points into the community. The model changed the way crisis care in the region works. 

Compared to the baseline year of 2015, the model has shown the following results for GRAND’s adult clients:

• Reduced inpatient hospitalizations at any Oklahoma psychiatric hospital by 93.1% (from 959 in 2015 to 66 in 2021)
• Reduced inpatient hospitalizations at Wagoner Hospital by 100% (from 841 in 2015 to 0 in 2021)
• Reduced inpatient bed days at Wagoner Hospital by 100% (from 1,115 in 2015 to 0 in 2021)
• Saved state and federal government $62 million dollars (from 2016-2021)
• Increased number of adult clients served by 163.5% (from 4,326 in 2015 to 11,401 in 2021)

When GRAND started the model, they were a fee-for-service (FFS) community mental health organization. Under FFS, GRAND was able to recoup the money spent from their general revenue budget by reducing the rate of no-show appointments. While GRAND eventually transitioned to a Certified Community Behavioral Health Clinic (CCBHC) business model, leadership believe this approach would have continued to bring a positive return on investment under FFS.

To reduce inpatient hospitalizations and create lower levels of care for people experiencing behavioral health crises, GRAND Mental Health created dedicated 24/7 crisis stabilization services and extended virtual care access points into the community. The model changed the way crisis care in the region works.

With GRAND’s new crisis care strategy, police can quickly and easily connect people with clinicians at the urgent recovery center to assess patient need. Patients can also communicate directly with clinicians when in crisis or if they need support. 

Compared to GRAND’s baseline year of 2015, the model has yielded the following positive outcomes: