President Trump’s declaration of a public health emergency to address the opioid epidemic brought renewed attention to a crisis that claimed more lives last year than annual deaths from car crashes and gun violence combined. All told, nearly 20 million adults nationally have a substance use disorder (SUD), yet 88% of these individuals do not receive treatment for their conditions. The lack of adequate treatment for SUD most acutely impacts local communities, often through rising rates of incarceration, homelessness, use of the criminal justice system and utilization of emergency departments (ED) and first responder services.
In “Communities in Crisis: Local Responses to Behavioral Health Challenges,” a report from Manatt Health, we highlight how cities and counties are responding to the opioid crisis and untreated mental illness by developing community-driven programs that connect individuals to treatment and social support services. Successful initiatives are creating systems of care that bridge multiple programs to provide coordinated services to individuals with SUD.
Here are five elements of successful local programs:
1. Collaboration and alignment of local resources.
Individuals with behavioral health conditions interact with a multitude of public and private institutions during the course of treatment or a crisis, including local public health and social service agencies, the criminal justice system, and a variety of community-based providers. These organizations have varying objectives, capabilities and funding, often leading to a fragmented system of care that inhibits coordination across settings and providers. Successful programs overcome these challenges by identifying shared priorities, and focusing on promoting collaboration and alignment of funding and resources, including through safe and secure information sharing among participating partners.
Some localities are leveraging partnerships with community-based organizations to expand access to services. The San Diego City Attorney’s Office, partnered with a local non-profit to expand transitional housing capacity in support of its SMART program to divert repeat offenders with behavioral health conditions from the justice system to community-based treatment. King County’s (Washington) Familiar Faces program for justice-involved populations with behavioral health conditions focused on breaking down information silos by developing a comprehensive, integrated, client-centric health and human services data system to support care coordination, risk stratification, and population health analysis.
2, Establishment of a holistic system of care.
Clinical treatment for behavioral health disorders is far less likely to be successful if it does not take into account the full spectrum of social service needs, such as housing, nutrition and employment assistance. The successful programs we reviewed sought to connect individuals to social security, Medicaid and supportive housing benefits to enable access to services during and after treatment to support recovery.
The Criminal Mental Health Project in Miami-Dade County, Florida, diverts individuals with behavioral health conditions from the justice system to treatment, and screens participants for eligibility for Medicaid, social security and other public benefit programs using the SOAR model (SSI/SSDI, Outreach, Access and Recovery). Santa Fe’s (New Mexico) Law Enforcement Assisted Diversion (LEAD) program uses a similar approach to support participants in applying for public benefits, including housing and transportation assistance.
3. Navigation across care settings.
Accessing and navigating behavioral healthcare across myriad public and private settings can be challenging for individuals with SUD, especially for the two-thirds of jail detainees with SUD that cycle in and out of the criminal justice system. Successful programs have invested in case workers and coordinators to create care plans and help clients navigate across settings to access the services they need.
King County’s Familiar Faces program developed a “golden thread” care management approach that leverages case workers to help coordinate city, county and community physical and behavioral health services with housing, employment, and other social supports. Medicaid managed care organizations are also engaged to develop care plans for justice-involved individuals as they transition from jail back into the community.
4. Community engagement and advocacy.
Social stigma associated with behavioral health disorders can be a barrier to accessing care and affordable housing, resulting in many individuals becoming homeless, cycling through the justice system, and ending up in the ED. Strong community engagement is necessary to overcome this stigma in order to build support for community-based treatment as an alternative to incarceration and repeated emergency responses to behavioral health crises.
In Huntington, West Virginia, Mayor Steve Williams established the Mayor’s Office of Drug Control Policy (MODCP) to address the prevalence of SUD and overdose deaths that were 10 times the national average. The MODCP brought together local law enforcement, providers and other stakeholders to implement harm reduction initiatives, including a syringe exchange program and a specialized drug court for prostitutes with SUD that combines traditional drug court services with behavioral health counseling and treatment.
5. Leveraging both public and private financing.
Many cities and counties are challenged to secure sufficient funding to respond to the crisis in their communities, especially rural localities where resources are more limited and the rate of opioid-related deaths is 45% higher compared to metro areas. Yet some localities are overcoming this obstacle by weaving together a patchwork of public and private funding streams, including state and local general funds, targeted assessments or taxes, grants from local health system community benefit programs and philanthropies, and federal programs, such as those administered through the Substance Abuse and Mental Health Services Administration.
Despite Medicaid being the single largest funder of behavioral health services in the nation, most local initiatives have not leveraged the full complement of Medicaid-reimbursable services to support their programs, such as case management. This gap suggests a need for better communication and coordination between local program leaders and state Medicaid agencies.
The SUD crisis is not abating and continues to devastate communities across the country. While local responses to the crisis vary significantly, what is clear is that no single organization or level of government can go it alone. The local initiatives we observed are making a difference, but the challenge is to evaluate and spread those that show promise by tapping into funding and expertise across public and private stakeholders.
Jonah Frohlich is a managing director at Manatt Health in San Francisco.
Christopher Cantrell is a manager at Manatt Health in San Francisco.