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When a mental health crisis happens in Box Elder County, law enforcement officers are usually the first to respond, yet most lack the training to effectively deal with such situations once the initial emergency has subsided.

Recognizing this, Bear River Mental Health Services has placed the issue at the forefront of its action plan for the upcoming year.

Coordination and cooperation between law enforcement and mental health workers is among the top priorities in the agency’s 2021 area plan for Box Elder, Cache and Rich counties, said Beth Smith, president and CEO of BRMH.

In recent weeks, Smith has been visiting with leaders in the tri-county area to share details of the agency’s plan. The annual tour is a key requirement for the funding BRMH receives from the state each year.

In her most recent presentation before the Box Elder County Commission, Smith shared some statistics to suggest that BRMH needs every penny of the government funding it receives, and then some.

She said that at any given time, one in five Utah adults is experiencing some kind of mental health issue, yet more than half don’t seek or receive help. The situation is even more dire among the youth population, with suicide being the leading cause among Utahns aged 10 to 17, yet Smith said 60% of at-risk youth don’t get the help they need.

Meanwhile, BRMH’s caseload is seeing significant, steady growth. Smith said admissions to mental health facilities in the area are up 15% over the past year, and the number of crisis contacts requiring some sort of in-person response are up 30%.

“This is despite COVID hitting in mid-March,” she said. “We saw an initial drop in services for almost two months, and yet admissions for the year are up. This is an indication of need.”

The increased demand for services also comes despite the fact that the University of Utah’s Neuropsychiatric Institute has become the first point of contact for crisis calls.

“They hand it back to us if they can’t handle the issue, and still crisis response codes are up 30%,” she said.

While caseloads are growing, the number of available mental health workers is not keeping pace with the increase, she added.

“We have a provider shortage,” she said. “Every county in Utah is lower than the national average (of mental health workers) per 100,000 residents.”

Facilities that house people who need inpatient treatment also fall short of the need.

“The state hospital beds are completely full all the time,” Smith said. “We have eight beds, and there’s always eight or more people on the waiting list.”

A major focus of the BRMH plan for 2021 involves providing more resources for the agency’s Mobile Crisis Outreach Team, which was first funded by the Utah Legislature in 2019. When police respond to a mental health-related call, BRMH sends a mental health professional and a case manager to the site once it has been deemed safe by first responders.

“They provide relief and support for the police, who are generally untrained in mental health emergencies,” Smith said. “(The police) will make the situation safe, then we can stay and deal with the crisis.”

She said that not only is this approach more useful in providing timely help to those who need it most, it’s also more cost effective.

“It’s $380 per event versus $9,000 if a person ends up in the emergency room or an inpatient unit,” Smith said.

BRMH is currently working with police departments throughout the region to provide training for officers on how to coordinate efforts between the agencies.

While securing more funding for the MCOT program is a top priority, it’s not the only item on the BRMH wish list for increased financial support.

Another effort that started as a pilot program in Cache County this year aims to allow the sharing of patient information between all agencies involved in mental health services. Health privacy regulations often make it difficult for those various groups to communicate with each other, and this new effort creates a release form that patients can sign to allow the sharing of crucial information.

“No matter where the client comes from, if we can get that signature, now we can start working together as multiple agencies,” Smith said.

The BRMH plan for next year also puts a strong emphasis on telehealth services, which have become more important than ever due to the COVID-19 pandemic.

In addition, the agency received a grant from the Utah Commission on Criminal and Juvenile Justice to serve more individuals who have been in and out of jail, working with those who have been recently released as well as those who are still incarcerated.

Other areas of focus for the upcoming year include bringing in more case managers to make sure people are discharged from hospitals when they no longer need to be there, and to follow up with patients after they are discharged; helping people navigate the often-complex process of receiving Medicaid benefits; seeking more grant funding; increasing pay for therapists to help with retention; and ramping up community education efforts through social media channels.

It all adds up to making the best use of a limited budget to address a problem that continues to grow in modern society, and leveraging local funding to bring in more financial resources from higher levels of government, Smith said.

“We have a lot of staff working really hard,” she said. “We really appreciate the support Box Elder County gives us. That dollar that draws down two dollars in state funds, that draws down seven more dollars in federal money, is so valuable to us. It just feels like it’s not enough.”

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