There are huge barriers to obtaining access to behavioral healthcare treatment services in the United States, and this was also the case in Georgia. Gwen Skinner is fond of saying, “Treatment works… if you can get it.” She is the director of behavioral health for the Georgia Department of Human Resources (DHR) which originated, manages, and funds the Georgia Crisis & Access Line (GCAL). Georgia’s solution to improving access was to pioneer a crisis call center program operated by Behavioral Health Link that receives more than 1,000 calls on most business days from people seeking crisis intervention or access to mental health or addiction services. Individuals, families, friends, and professionals call 800-715-4225 from across Georgia’s 159 counties to gain fast, friendly and accurate assistance and linkage to care 24 hours per day, every day. GCAL removes key barriers that keep residents from getting help with significant cost savings while providing real-time data reporting for strategic planning.
Georgia had anecdotal reports of waiting times for mental health intake that ranged from 3 weeks to 3 months. Individuals often faced a maze to reach the right agency; busy signals and lengthy hold times were commonplace. In 2003, the President’s New Freedom Commission on Mental Health targeted access as a key area in removing the barriers of a fragmented and complex system. In addition, stigma can make picking up the phone to seek help nearly impossible. The situation became more complex in 2005 when Hurricane Katrina displaced 120,000 individuals to Georgia from the Gulf Coast. This disaster placed even more pressure on the state’s hospital emergency rooms, law enforcement, and overcrowded publicly funded inpatient hospitals.
GCAL’s integration of caring and compassionate engagement, staffing by professional counselors and social workers, and use of advanced technology is unique. The service is supported by best practice clinical expertise and protocols, and individualized software solutions. It is statewide in scope and receives high volume. However, its true innovation is ensuring access and continuity of care for people with psychiatric needs, whether routine, urgent or for emergencies. Actively linking individuals with programs that serve their needs is groundbreaking and has revolutionized practice. The waiting time for an intake with Community Mental Health Centers (CMHC) has been reduced drastically and is now generally less than five business days for callers who are also given a choice of providers. Callers receive a reliable answer and supportive help 24/7 through one number, instead of the 25 lines that previously existed.
Most call centers across the country utilize an Information and Referral approach, giving people in crisis 3 to 5 more phone numbers to call. These programs are unaware of barriers to access that callers face. In this model, staff members are generally not clinicians and lack sufficient training to provide a clinical triage or advanced crisis assessment and intervention. Two professional models also exist. Managed care entities focus on whether the caller meets criteria for a particular benefit plan. CMHC providers frequently utilize an answering service after hours and do not offer choice. GCAL was designed and functions uniquely to focus on measuring, monitoring, reporting and improving access to care while offering choice.
Since July 1, 2006, nearly 700,000 calls have been received by the Georgia Crisis and Access Line. Callers now know there is just one number throughout the state for accessing behavioral healthcare services, and the hotline is marketed directly to the public through television advertising, billboards, radio, and the Internet. Georgia DHR required that the vendor for GCAL not provide direct services, so callers are always linked with their choice of other agencies (there is no potential conflict of interest inherent in this system). Prior to GCAL there were few if any choices. Today, callers may be linked with over 100 credentialed community providers in nearly 250 intake sites across the state.
Instead of long waits for an initial intake, callers to the Georgia Crisis and Access Line can expect an appointment to be scheduled over the phone in less than five business days. This single contact experience has benefited over 100,000 people so far.