Mental Health Crisis Care for Anyone, Anywhere, Anytime: Investing in Connections

By David Whelan, Hui Cheng

When we consider Town Hall’s mandate to invest in companies that radically change the healthcare status quo for underserved populations, nowhere is that more relevant than for individuals experiencing a mental health crisis — an acute episode that may include suicidality, paranoia / confusion, drug or alcohol overuse, and sadly the possibility of being a danger to oneself or others.

Anyone can have a mental health crisis. More often than not, individuals are most at risk when they have an unmanaged psychological disorder like serious mental illness or substance use disorder, experience chronic economic stressors, or have ongoing exposure to trauma.

Increasingly, hospitals & emergency rooms have become the landing zone for these vulnerable individuals, which is an improvement over the historic default of jail cell or back of a police car. Over the last 15 years, US ER visits for mental health reasons have nearly doubled. Treating mental health crises in the ER is expensive for payors, stressful for ill-equipped ER physicians, and most of all, traumatizing for the patient. The New Yorker captured the experience in a recent article:

It’s hard to imagine a less therapeutic environment for a person in crisis than an ER: crowded and windowless rooms; harsh fluorescent lights; the ceaseless ping of alarms. Patients who pose a danger to themselves or others may be sedated or kept in isolation, even tethered to bedside rails so that they cannot move….some patients boarded in the emergency department for days. They were required to stay inside their rooms, without their belongings and with little to do. If they had to use the bathroom or wanted food, water, or a pillow, they had to ask a nurse. Many patients said it felt like a jail.

The message is clear: there is a significant, unmet need to create an alternate behavioral health crisis care system that drastically reduces gaps and improves care quality for a highly vulnerable group.

Why now?

Until recently, the US had neither the necessary reimbursement nor underlying infrastructure to support a robust mental health crisis care system. A confluence of policy changes has changed this over the last few years:

• In 2020, Substance Abuse and Mental Health Services Administration (SAMHSA) published national guidelines for the design, launch, and funding of comprehensive crisis care services
• This was followed by key investments in national infrastructure: federal funding match in the 2021 American Rescue Plan Act (ARPA) for states to launch mobile crisis response teams, and rollout of the national crisis hotline (988) in 2022
• Those investments have been accompanied by ongoing payment reform: 28 state Medicaid agencies now reimburse for crisis stabilization, and a number of states have or are advancing coverage parity requirements for commercial plans
• Finally, a groundswell of bipartisan energy from governors and state legislatures across the country ensures ongoing funding in state budgets for mental health crisis services

For the first time, patients who need mental health crisis care have a way to raise their hand for help, get connected to care, and have that care paid for. The gap that still remains is on-the-ground care delivery, which became the challenge we sought to solve.

Over the last 2 years, we’ve sought to understand what crisis care care delivery should look like. In our numerous conversations with experts, we heard consistent themes: the care should be available to “anyone, anywhere, anytime”; focused on short-term support to stabilize and discharge the patient into the community, and complemented with social supports that help patients avoid relapse and stay in care. We met a number of organizations, but quickly became certain that Connections Health Solutions stood out above the rest.

The Connections Health Solutions model

Founded by two ER psychiatrists and led by CEO Colin LeClair (formerly Concerto Care, Optum), Connections has offered high quality care to thousands of Arizona patients in crisis for nearly a decade. In partnership with counties and payors, Connections provides the full spectrum of crisis care services including crisis urgent care; 23-hour observation, crisis stabilization, and short-term inpatient care. In place of a windowless ER with limited psychiatric resources, Connections clinics are safe alternative care locations offering warm lobbies, comfortable chairs, and dorm-like rooms for overnight stabilization, staffed with psychiatrists, therapists, peers, and care managers.

The Connections brand promise to the community is the ability to serve anyone who comes through the door — regardless of the mental health need, insurance coverage, or time of day. Backing this brand promise are two consistent outcomes shown to matter most to individuals in crisis: getting patients into care fast (under an hour — 3x faster than national ER average) and delivering high quality care (85% lower readmission rates, 70–80% community discharge rates). All this contributes to a better experience for patients, who give them an average NPS of 80+, and cost savings for state & payor partners by returning the majority of patients into a community setting rather than inpatient.

As he looks to expand this innovative model beyond Arizona, Colin has recruited an all-star team, including Dr. Margie Balfour, a psychiatrist and national expert in crisis care; COO Laura Buckley, who built complex multi-site operations from the ground up at Fresenius & WellCare, and CGO Matt Miller, the former leader of Magellan’s government business for the last 20 years. We could not be more thrilled to have Colin’s value-based expertise and decades of payor & provider collaborative experience at the helm of this business.

What’s next?

Connections’ newest locations in Washington and Virginia will be opening their doors next year. With a number of governors baking mental health & crisis funding into their budgets and favorable legislation in-progress on the Hill, we will be working closely with Colin & team to accelerate their growth roadmap and execute payment evolution that allows them to partner with healthcare payor entities, and be rewarded for the superior patient outcomes and value created by Connections’ services.

We are excited to lead Connections’ growth financing, together with our friends at the Heritage Group, and partner with their entire team to help Connections become the crisis mental health strategic partner of choice to payors, states, and individuals in need across the country