Rule 24-2-19.1 - Crisis Response ServicesA. Crisis Response Services are intensive therapeutic services which provide assessment and intervention in a mental health crisis. Crisis Response Services are provided to children/youth and adults who are experiencing a significant emotional/behavioral crisis in which the person's mental health and/or behavioral health needs exceed the person's resources. Trained Crisis Response personnel provide crisis stabilization to navigate a crisis safely and prevent hospitalization if possible. Employees must be able to triage and make appropriate clinical decisions, including assessing the need for inpatient services or less restrictive alternatives. Crisis Response Services may also include the engagement of family and other natural supports in crisis resolution strategies. Without Crisis Response intervention, the person experiencing the crisis may be inappropriately and unnecessarily placed in a jail, holding facility, hospital, or inpatient treatment facility. (Crisis Response Services do not include the Crisis Intervention/Crisis Support Services provided through the ID/DD Waiver). The following three (3) Crisis Response Services components pertain to on-site/provider-based crisis response and crisis response hotlines.
1. Agency Provider Crisis Response: An immediate and unscheduled mental/behavioral health service provided to people at the provider's physical location in response to a person's mental/behavioral health crisis; the purpose is to prevent imminent harm and/or to stabilize or resolve an acute mental or behavioral health issue.2. Crisis Hotlines: Crisis Hotlines are an integrated component of the overall crisis service delivery system and are accessible toll-free throughout each LMHA service area. The lines are a 24 hour a day, seven (7) days a week telephone service operated by trained crisis staff providing crisis screening and assessment, crisis intervention services, mental health and substance use referrals, dispatch of mobile crisis teams when needed, connection with 988 when appropriate, and general mental health and substance use information to the community. Both currently-served people and people possibly needing services may access Crisis Hotlines operated through the LMHA and other DMH-certified mental/behavioral health providers of crisis response services.3. 988: 988 provides confidential support at no cost for people experiencing a mental health/behavioral health or suicide crisis. This service is available 24 hours a day, seven (7) days a week to all people in Mississippi and throughout the nation. When a caller connects to one (1) of the 988 crisis centers or a national backup center, trained crisis personnel are available to listen to the caller, provide support, and share resources or referrals, as needed. The 988 network crisis centers offer support via telephone, online chat, and text. DMH designates the 988 centers in Mississippi.B. Crisis Response Services must be made available to the public in every county/area served by agency providers certified by DMH to provide Crisis Response Services. Crisis Response Services must be able to serve mental health, IDD, and substance use disorder service populations.C. Crisis Response Services must have the capability to respond to multiple crisis calls at a time. Services include: 1. A Crisis Hotline, which is a designated toll-free crisis telephone number which covers the agency provider's entire catchment or service area.2. Provider-based (i.e., "Walk-in") Crisis Response capability at all DMH-certified service locations in the agency provider's catchment or service area.D. The "on-call" Crisis Response personnel answering the designated Crisis Hotline must: 1. Ensure that a mental health representative is available to speak with a person in crisis and/or family member(s)/legal representative(s) of the person at all times.2. Ensure people or family member(s)/legal representative(s) of the person in crisis should only have to call a single time to the designated crisis number to request and receive assistance.E. Crisis Response Services must coordinate with DMH and respond to crisis call referrals from DMH generated from the toll-free DMH Help Line or any agency provider DMH contracts with to provide after-hours Help Line coverage.F. The agency provider must: 1. Ensure Crisis Response Services availability is publicized in a prominent location on the agency provider's website.2. Ensure the person speaks with a trained professional if an answering service is used after typical work hours (which is permissible). Automated answering devices are not permissible. If the provider uses an answering service, the service should not roll to 911, 988, or the CMHC/LMHA.3. Ensure the agency provider's toll-free number is provided to DMH.G. Complete an assessment of the person's risk and acuity using an assessment tool as required by DMH. The assessment will include, but is not limited to, current risk level related to suicide/homicide, substance use, mental status, current and past mental health diagnoses and treatment, coping skills, and medical condition.H. Policies and procedures must be in place which detail how provider-based, unscheduled crisis situations will be handled by Crisis Response Services. The policies and procedures must be specific to each DMH-certified location in the agency provider's catchment or service area. I. Crisis Response Services must have access to medical and psychiatric support as needed 24 hours a day, seven (7) days a week. Medical and psychiatric support can be provided through the use of telemedicine and must be provided by a licensed health/medical professional, as per the practitioner's scope of practice via the practitioner's licensing/credentialing entity.J. When the crisis situation subsides, Crisis Response Services must facilitate and verify formal initial assessment and therapy appointments with the mental health provider of the person's choice (if the person is able to remain in the community) utilizing the "warm handoff" method. A "warm handoff" is an approach to care transitions in which health care providers directly link people with typical service providers, using face-to-face, virtual, or phone transfer.K. Crisis Response Services must follow-up daily and provide any necessary services to the person between the initial stabilization of the crisis and the initiation of typical therapeutic and psychiatric care.L. Recipients of Crisis Response Services do not have to be currently or previously enrolled in any of the services provided by the agency provider. Crisis Response Services may be provided to a person before the person participates in the initial assessment that is part of the intake/admission process.M. Crisis Services employees must meet and complete the staff development training requirements, as outlined in Chapter 12.N. All providers certified in Crisis Response and/or Mobile Crisis must have a full-time Crisis Coordinator who meets the qualifications for this position as outlined in Chapter 11.O. Providers certified by DMH in Crisis Response Services must maintain a working relationship with local hospital emergency departments (EDs). The provider must develop protocols for their agency staff to address the needs of people receiving services in psychiatric crisis who come to those emergency departments.