Alachua County explores ways to curb reliance on ER for mental health conditions

More mental health resources, medicated-assisted treatment and increased peer specialist follow-ups after overdoses or mental health crises were among the recommendations made Friday by Alachua County's Healthcare Advisory Board Mental Health Subcommittee and Outreach and Case Management Subcommittee.

Data collection by the subcommittees found increased emergency room use by residents living in ZIP codes 32609 and 32641, which span from the northeast and central parts of the county. ER use is twice the state average in the 32609 ZIP code area and three times the state average in the 32641 area. Many of these emergency room visits are related to substance use or mental health. The committee decided to draft three action items to present to the county — education, treatment and follow-up.

Mental health among children is of particular concern. Children are experiencing post-traumatic stress disorder and chronic stress disorder, said James Reiser, a member of the National Alliance on Mental Illness’ Board of Directors. Mental health education needs to be more accessible to providers, families and teachers.

“A lot of this going on is unacknowledged in the community, and I think there are real barriers to getting help,” Reiser said.

The most significant barriers to mental health services are cost and availability of providers, said Karen Billings, an advisory board member and the assistant director of administrative services in the University of Florida Department of Clinical and Health Psychology.

“A lot of the ER data will point to alcohol abuse versus traditional mental health, such as depression, anxiety and grief,” Billings said. “We have this whole other population that needs counseling and therapy that is not driven by substance abuse.”

During crises, law enforcement is mostly called to help with anxiety, depression, bipolar disorders, schizophrenia and substance abuse, said Kamelia Klejc, program coordinator for the Gainesville Fire Rescue Community Resource Paramedicine Program. Substance abuse cases are some of the most common calls the program receives.

Hospital staff encounter many patients whose conditions are linked to substance abuse, said Wendy Resnick, a retired UF Health administrator and a volunteer for GNV4ALL, a Gainesville Sun initiative that aims to address racial and economic inequities. But others struggling with traditional mental health issues never make it to the ER or hospital and fail to receive assistance.

Identifying the different needs of individuals with traditional mental health issues and those with substance abuse problems will create an opportunity to improve access and wellness by expanding providers, Resnick said.

People cope with their mental illness by self-medicating with various substances, said Cathy Cook, an advisory board member.

“These are two big looming categories that are so intertwined, and separating them may be complicated,” she said.

Other members, including Ali Martinez, said they believe a major component to improving mental health concerns is to establish an educational foundation in communities, including Hawthorne and around ZIP code 32609. People dealing with traditional mental health issues are undercounted in data because of limited resources and interaction with law enforcement.

Until there is a network that can provide continuity of care and treatment for uninsured individuals or those with Medicaid, Klejc said people will continue to rely on 911 and the ER.

Follow-up services are necessary, but it would be expensive to employ more providers, Reiser said. Instead, he suggested that certified peer specialists, people with credentials who volunteer to help patients, offer follow-up services.

In the surveys administered, the communities in ZIP codes 32609 and 32641 ranked certified peer specialists at the bottom of the list of needed mental health services. But Reiser said he believes the service would be cost-effective for heavy users of the ER, who may not be aware of other resources.

Billings said she believes the community needs more than certified peer specialists.

“Just like we have urgent care centers for physical health, there should be options for mental health treatment,” she said. “We would place items, such as support for 988 Program [a nationwide suicide prevention hotline], under education and mapping mental health services and identifying gaps under treatment.”

Martinez suggested setting up mental health clinics throughout the county to establish relationships and build trust with communities.

“A lot of people in poor communities call 911… because historically, they have felt their concerns weren’t taken seriously by systems,” she said. “[Setting up clinics] would be an immediate way for people to feel like someone will attend to their crisis.”

Deep social and cultural issues still deter residents from seeking treatment for mental health concerns, Martinez said. Mental health is still stigmatized around the county.

“Mental illness is a label, and that label repulses people,” she said. “I think education and cutting through that stigma in a culturally relevant way is going to solve a lot of these problems.”

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