Montefiore Hudson Valley Collaborative (MHVC) is a community-based, health care-focused organization that leads a group of nearly 250 health care providers, community-based organizations, local government officials and others. Its goal is to champion new models of providing Medicaid beneficiaries with higher quality care while reducing expenditures through enhanced coordination, community-focused care and education.
Montefiore’s partnership with Mental Health First Aid began as Kristin Woodlock, a consultant for the Montefiore Hudson Valley Collaborative, was working with Allison McGuire, MHVC’s executive director, to better address high emergency room visits in the MHVC community. Woodlock explained, “Nyack Hospital in Rockland County was concerned about the number of individuals presenting with mental health issues. Many of these individuals needed a variety of supports and/or crisis services, but not the higher level of care provided at the emergency department or inpatient level.” Woodlock led a rapid process improvement with a key group of community partners to better understand the root causes of the visits and discovered that a significant portion of these referrals were coming from adult congregate care facilities in the community.
After reviewing these results, the community took a multi-pronged approach. First, the Rockland Paramedic Behavioral Health Response Team, a 24-hour crisis service, began visiting adult congregate care facilities outside of crisis response situations to build relationships with the residents and staff. The Rockland County Department of Mental Health shared the WRAP crisis plan template and supports to help staff develop personalized recovery plans. In addition, MHVC “wanted to do something to help improve staff member skills around mental health.” Mental Health First Aid was chosen as a solution.
Woodlock encountered some initial skepticism about offering Mental Health First Aid, based on beliefs that a deeper type of crisis intervention training may be necessary to reduce emergency department visits. The rapid process community team diagnosed the problem differently: they saw entry-level staff with little training, noting that staff just needed a better understanding of mental illness, ways of working with people to support their recovery and alternatives to calling 911. MHVC’s leadership was persuaded, and the organization partnered with the Mental Health Association of Rockland County, an organization with certified Mental Health First Aid Instructors, to offer trainings to congregate care facility staff. Montefiore covered the cost of these trainings to remove potential barriers to attending.
Woodlock noted that the main drivers behind MHVC’s investment in Mental Health First Aid were the program’s ability to improve mental health literacy and equip people with confidence around addressing mental health issues, and the low investments required in terms of time and financial resources.
Mental Health First Aid training provided significant, measurable results for MHVC and the Nyack Hospital. Woodlock said, “We trained almost 80 individuals. While this number is small, we saw more than a 50 percent reduction in adult congregate care facility emergency room referrals for mental health crises.” Woodlock attributed this improvement to the training, saying, “Mental Health First Aid gave people a chance to step back and ask what the appropriate response was [rather than immediately calling 911].” These results have improved quality of life for the residents and have made business sense, given MHVC’s focus on the triple aim of improving the patient experience, improving population health and reducing per-capita health care costs.
A survey of congregate care staff trained in Mental Health First Aid further highlighted the value of the training. Ninety-five percent of respondents believed the training allowed them to more easily assess the needs of a resident experiencing a mental health issue or crisis. Eighty-nine percent of respondents reported using the skills learned in Mental Health First Aid training on a regular basis.
When asked about the future of Mental Health First Aid at Montefiore, Woodlock expressed, “In the end we were very satisfied with it and are now looking at other creative applications of Mental Health First Aid across MHVC.” The organization has worked to establish strong relationships between the congregate care facilities and the mental health administration of Rockland County so that “everyone knows where they can get the training and the homes know who, where, and what it takes to get their staff trained.”
MHVC will continue to utilize Mental Health First Aid as a tool. Woodlock mentioned that, “We are now focused on the substance use population, but our eyes have been opened to different uses of Mental Health First Aid. We now look at Mental Health First Aid in a different light.”