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Challenge: Approximately 4,180 individuals visited the LMH Emergency Department in Douglas County for behavioral health-related issues in 2018 — an outcome that is neither cost-efficient nor the most effective way for behavioral health patients to get appropriate treatment.

Response: A centerpiece of the work to redesign how mental and behavioral health is now delivered in Douglas County is the recently completed Treatment and Recovery Center (TRC) which is open 24 hours a day, 7 days a week, 365 days per year. The TRC provides individuals in crisis with direct access to highly-trained providers who can assess and treat their immediate needs. TRC staff then work to connect the individual and their family to resources in the broader community, linking them to a robust recovery network built around tenacious care coordination and ongoing treatment and support designed to create stability for the individual moving forward.

Impact: With the opening of the TRC, community members now have immediate access to urgent psychiatry services 7 days a week, 365 days a year. Between 5,300 and 5,900 patient encounters per year are expected at the Treatment & Recovery Center based on a review of Community Mental Health Center (CMHC) and hospital data from 2018 to 2021.

• Learn more about the Treatment and Recovery Center
• Take a virtual tour
• Watch the Dedication Ceremony

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Engaged Adults, Thriving Youth

Challenge: In 2018, the Community Health Plan placed an emphasis on behavioral health and focused on moving from crisis as a norm to prevention and recovery as a practice. The plan identified a variety of data points indicating that substance use and suicide were issues of concern in the community. Prioritizing prevention emerged as a top issue.

Response: Community partners were convened to begin assessing prevention needs in the county and building capacity to address identified challenges. Engage Douglas County was formed in January 2019. With the goal of developing “Engaged Adults, Thriving Youth”, the coalition focuses on prevention efforts from a variety of resources and organizations within the county. Community stakeholders help connect these pieces to make it easier for residents to better utilize them.

Impact: Utilizing the Strategic Prevention Framework process, Engage Douglas County has developed a strong prevention plan with diverse community partners and continues to seek new partnerships within the community to grow youth prevention efforts. In 2022, Engage Douglas County was one of 15 coalitions to receive the national Blue Ribbon Coalition Credential from the Community Anti-Drug Coalitions of America (CADCA). The Blue Ribbon Coalition Credential recognizes high performing coalitions that do an exceptional job of creating a foundation for their work by updating and utilizing their coalition products. Engage Douglas County was also one of three coalitions in the nation to receive a 2022 Coalition in Focus Award from CADCA; the Coalition in Focus Award is awarded to a coalition with positive and sustainable short-term community level outcomes.

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Providing Intensive Care Coordination

Challenge: Douglas County residents with serious mental illness and substance use disorders often struggle unnecessarily to connect to the medical services and community resources they need to recover and then thrive in the community.

Response: In 2018, Intensive Care Coordination (ICC) was initially designed to coordinate services for clients identified through the Integrated Crisis Team in the LMH Emergency Department. ICC clients typically present in hospital emergency rooms or have contact with law enforcement due to active mental health and/or substance abuse crises. In response, Intensive Care Coordination works to link and engage clients with community services such as mental health, substance use treatment, physical health care, housing and/or longer-term case management services to enhance stability and reduce the use of costly community resources. The service is provided at no cost to all Douglas County residents, regardless of insurance status.

Impact: In 2022, Heartland RADAC’s Intensive Care Coordination served 577 unduplicated individuals. Over the last five years, ICC services have extended beyond the LMH Emergency Department to reach individuals in community settings such as Criminal Justice Services, the Lawrence Community Shelter, Treatment and Recovery Center and substance use treatment settings such as RSI and DCCCA’s First Step at Lakeview.

In addition, Heartland RADAC’s participation in the Douglas County Peer Fellows program has supported the addition of four full-time Recovery Coaches to the ICC team. In 2023, the Peer Fellows partnership has allowed Heartland RADAC to experiment with “Peer First” responses to community members with unmet behavioral health needs.

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Douglas County Crisis Line

Challenge: Prior to 2022, Douglas County residents in crisis often struggled to access the right type of crisis care at the moment they needed it. Too often, a behavioral health crisis led to a 911 call and law enforcement response, which can exacerbate a crisis and is more costly and potentially more restrictive.

Response: Thanks to the leadership exercised by Kansas Suicide Prevention Headquarters (KSPHQ), Douglas County residents can dial 988 or 785-841-2345 to reach the County’s 24/7 Crisis Line. Counselors answering the Crisis Line can provide immediate support and assistance to anyone in crisis or emotional distress or who is concerned about someone else needing help. The goals are to always provide compassionate, nonjudgmental listening and to de-escalate any immediate safety concerns over the phone. When a person does need an in-person response or safe place to go, Crisis Line staff can seamlessly refer the individual to the Mobile Response Team or the Treatment and Recovery Center. Additionally, under the protocols of the new 911 Call Diversion Program, 911 calls are triaged if they are primarily behavioral health-oriented and if there is no immediate life-threatening emergency requiring police or EMS, the call is transferred to KSPHQ to initiate a crisis response process, just as if the individual had called the crisis line in the first place.

Impact: Accessibility is critical during a crisis. A reliable, free and immediately available 24/7 Crisis Line is a key element of the ideal crisis system. Presently, about 13% of crisis calls in Douglas County arrive at KSPHQ via 988. The remaining 87% arrive on two primary local lines of service. Individuals seeking crisis care in Douglas County should direct their call to the local line for service. Integrating crisis services into a comprehensive system helps ensure people get the right care in the right place at the right time. Calls are typically answered in 15 seconds or less by a highly trained counselor who is prepared to provide immediate support and coordinate any resource referral needs.

Breaking the Cycle of Behavioral Health Crisis: 2018 vs. 2022

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Meeting Behavioral Healthcare Needs of Justice-Involved Individuals

Challenge: Due to a lack of behavioral healthcare resources, Douglas County residents experiencing behavioral health crises were often entering the justice system instead of the healthcare system and, as a result, were failing to receive appropriate medical treatment.

Response: In 2017, Douglas County was just starting its first full year of Behavioral Health Court, a specialty court designed to help justice-involved individuals with behavioral health challenges receive the treatment they need to stay out of the justice system going forward. By 2021, Douglas County’s Behavioral Health Court program was supplemented by a Drug Court, providing up to 15 participants at a time with the treatment required to maintain a substance-free, crime-free lifestyle. Additionally, the Douglas County Correctional Facility now has four staff members from the Bert Nash Community Mental Health Center and one staff member from DCCCA who work with people in the facility with serious mental illness and substance abuse challenges.

Impact: Since 2017, 62 individuals have graduated from the County’s Behavioral Health and Drug Court programs to more quickly move out of the justice system and into the behavioral healthcare support systems they need to thrive. The percentage of people booked into the County’s jail with serious mental illness has fluctuated over time. It declined significantly between 2014 and 2018 from about 18% of bookings in 2014 to 5.5% in 2018. Douglas County now tracks this data quarterly to more accurately monitor and understand these fluctuations. Between 2018 and 2022, SMI jail booking percentages reached a high of 13.4% in 2020 Q4 and a low of 7.2% in 2022 Q1. The Community Health Plan’s goal is to reach 5% by 2023. Additional information on individuals in the jail with serious mental illness can be found on this data dashboard.

Want to learn more about how Douglas County is addressing the behavioral healthcare needs of justice-involved individuals? Look at the stories below:

Graduates celebrate after completing Douglas County Behavioral Health Court program
Behavioral Health Court was turning point for 29-year-old Lawrence resident
Behavioral Health Court graduate grateful for second chance
Drug Court participants describe program as life-changing

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Providing Medication Assisted Treatment (MAT) for Opioid Abuse

Challenge: In 2020, the Kansas Department of Health and Environment ranked Kansas counties by vulnerability to opioid abuse, looking at opioid mortality data, prescription drug monitoring program data, crime data, Kansas electronic disease surveillance data, and American community survey data. Douglas County was ranked as a “high vulnerability” county.

In 2018 the Douglas County Community Health Plan identified a goal to reduce the total number of opioid prescriptions from 69,676 to 62,700 prescriptions.

Response: Medication Assisted Treatment (MAT) is a best practice for treating opioid use disorder, sustaining recovery, and preventing overdose. In 2019, the LMH Health Opioid Stewardship Committee initiated a planning process with the Heartland Community Health Clinic to enhance Medication Assisted Treatment for individuals presenting to the LMH Health Emergency Department due to opioid use. Willing patients for whom it was medically appropriate received an induction of buprenorphine (an MAT medication) by a certified LMH physician in the ED. The patient was immediately connected with Heartland clinic for ongoing MAT. While this process was put on hold during COVID, this service is once again available to those in need.

Impact: Since 2018, at least 350 people have received MAT as a therapy for either alcohol use disorder or opioid use disorder in Douglas County at either Heartland Community Health Clinic or LMH Health.

Between 2018 and 2020, Douglas County saw a reduction in the total number of opioid prescriptions from 69,676 to 58,321 prescriptions.

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Establishing a 24/7 Mobile Response

Challenge: In 2018, Douglas County residents in crisis often struggled to access the right type of crisis care at the moment they needed it. Prior to 2022, in Douglas County, it was common to report a behavioral health crisis by calling 911. Too often, individuals experiencing a behavioral health crisis were most often engaged with police, transported by ambulance, triaged and treated within the LMH Emergency Department or jail.

Response: Today, Douglas County residents can dial 988 or 785-841-2345 to reach the County’s 24/7 Crisis Line and deploy the Mobile Response Team. Mobile Crisis Response meets people where they are and helps to redirect individuals in crisis away from law enforcement and into the behavioral healthcare system.

Impact: The Mobile Response Team is available from 8 a.m. to 2 a.m., 365 days per year. Approximately 80% of 988 calls will be resolved on the phone, and of those that require Mobile Crisis Response Team intervention, 70% will be resolved in the field. Individuals experiencing behavioral health crises that cannot be resolved on the phone or in the field can turn to the Treatment and Recovery Center (TRC) or community partners for support.

Breaking the Cycle of Behavioral Health Crisis: 2018 vs. 2022

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Integrating Peer Support

Challenge: While Douglas County’s healthcare system is filled with passionate and committed clinicians, individuals experiencing behavioral health challenges often respond best to those who have faced similar challenges and are willing to share their lived experience with others.

Response: In 2019, Douglas County created an innovative workforce development project to increase peer support in Douglas County. The Peer Fellows Program locates highly-trained individuals with lived experience in community settings that allow them to be a different type of first responder. These individuals are in recovery from mental illness and substance use disorders.

Peer fellows provide support to those struggling with behavioral health challenges by drawing on their own lived experience with mental illness, addiction, and recovery. Peer fellows provide emotional and social supports along with resources that can lead to better health outcomes. Peer fellows work in a myriad of settings including emergency departments, libraries, and supportive housing programs, making telephone calls, accompanying clients to appointments, facilitating support groups, encouraging recreational activities, etc. Peer fellows are considered a best practice for helping individuals with mental illness and/or substance use disorder to recover.

Impact: To date, the Douglas County Peer Fellows Program has trained 33 individuals who draw on their own experiences to support individuals in recovery and gain valuable professional experience in the process. Twenty-two peer fellows have completed a year or more of service. Twenty peer fellows have transitioned to full-time employment following their fellowship year.

Douglas County considers creating peer program to help those in crisis
Douglas County peer support program expands to library, housing authority
KU’s Cofrin Logan Center

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Increasing Access to Psychiatry

Challenge: In 2018, Douglas County was experiencing a shortage of psychiatric service providers, making it hard for residents to access the medical treatments they need.

Response: In 2018, the Board of County Commissioners made a significant investment to increase the number of psychiatrists in Douglas County. Between 2018 and 2023, Douglas County has provided between $400,000 and $800,000 annually to support and sustain new psychiatry providers throughout the behavioral health system. Supplemental funds were initially allocated to Bert Nash Community Mental Health Center and Heartland Community Health Center (HCHC) to add one new psychiatrist and one psychiatric APRN at each agency. In 2019, collaboration between Bert Nash, LMH Health and HCHC created more opportunities than originally anticipated. Bert Nash was able to hire an additional psychiatrist and conclude an agreement with LMH Health to share a provider with county support. By 2021, collaboration and integration had resulted in a net gain of six psychiatrists to the Douglas County community. Psychiatric supplemental funds have also been invested to support a clinical rotation for KU Medical Center psychiatry residents and to add capacity in the LMH Emergency Department.

Impact: Targeted data reviews have shown that significant progress has been made in improving access to medication services and psychiatry in Douglas County. Increased county funding, collaborative recruiting efforts, modified policies, and improved scheduling practices have had a measurable impact. For example, the number of new patients has increased, the volume of patient encounters has grown, and the overall number of patients served throughout the system has expanded significantly. Additionally, the implementation of “Right Time Care” at Bert Nash has reduced wait times and client no-show rates. Finally, with the opening of the Treatment and Recovery Center, community members now have immediate access to urgent psychiatry services 7 days a week, 365 days a year.

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Providing Free Self-Care Resources for Residents

Challenge: In the aftermath of the COVID-19 pandemic, Douglas County residents, like citizens across the nation, are experiencing higher levels of depression, anxiety, and suicidal ideation—and members of underrepresented groups, including Black, Hispanic, and low-income individuals, are impacted in greater numbers.

Response: In 2019, Douglas County behavioral healthcare partners invested in community access to MyStrength.com, an app that provides free, confidential digital self-care resources, 24/7. MyStrength offers a variety of programs that are designed to help individuals improve sleep, reduce stress, control anxiety, practice mindfulness, manage depression, balance intense emotions, and cope with the impacts of COVID-19. The app can be accessed for free by Douglas County residents ages 13 and up from any computer or mobile device with the access code “Douglas County”. The platform is confidential, personalized to each user and allows individuals to set goals and track their changes over time.

Impact: Today, over 2,000 Douglas County residents have signed up for MyStrength. You can sign up for free today by using the code “Douglas County”.

Learn more about myStrength
See the impact for one individual
Sign Up Today

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Increasing Access to Social Detox Services

Challenge: Social detox services provide room, board, and interpersonal support to intoxicated individuals and individuals in substance use withdrawal. Prior to 2018, social detox services were available only to women in Douglas County at DCCCA’s First Step at Lakeview facility. There were no available social detox facilities in Douglas County for men.

Response: In 2018, Douglas County initiated a peer-led social detox program in partnership with DCCCA, LMH Health, and Heartland Community Health Clinic, so that men in Douglas County could receive social detox service in conjunction with the best practice of peer support, or support from those who have themselves experienced and survived alcoholism and addiction.

Impact: Between 2018 and 2021, 501 individuals (161 men) entered the County’s social detox program. The program completion rate has ranged between 68% and 73%.

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Increasing Supportive Housing

Challenge: According to the University of Kansas’s Center for Public Partnerships and Research’s Homelessness Interim Needs Assessment, between October 2020 and September 2021, 668 people in Douglas County experienced or were at risk of homelessness. Approximately 65% of those individuals have behavioral health challenges, and approximately 33% are considered chronically homeless.

Response: In 2020, Douglas County became one of 80 counties committed to achieving “Functional Zero” — a state in which “the number of people experiencing chronic homelessness is below the average number of individuals exiting homelessness in a month.”

In 2021, Douglas County engaged the Corporation for Supportive Housing (CSH) to conduct a comprehensive needs assessment and develop recommendations to increase permanent supportive housing units in the community.

In 2022, community partners adopted and incorporated the following objective into the Behavioral Health and Safe and Affordable plank of the Community Health Plan: “Promote integration of housing and behavioral health services to further support implementation of the Built for Zero initiative, increase supportive housing services, and achieve Functional Zero for chronically homeless individuals and households.”

In 2023, community partners began to develop a strategic plan to reduce homelessness, increase the availability of housing in Douglas County, and operationalize the recommendations in the CSH needs assessment.

Impact: Since 2018, community partners have added 43 new units of permanent and transitional supportive housing to the County’s housing inventory.

Read the CSH Supportive Housing Needs Assessment
Learn more about Built for Zero
Learn more about “Functional Zero”

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Providing Trauma-Informed Student Support

Challenge: In 2018, there was no way for law enforcement to notify schools if a K-12 student was involved in a traumatic incident.

Response: By 2022, Baldwin, Eudora, and Lawrence had implemented “Handle with Care.” “Handle With Care” is a collaboration between law enforcement and schools to better support children exposed to trauma at the scene of a crime, violence or abuse. The child’s name, age, and school are sent by law enforcement to the child’s school through a confidential notice before the school day. There is no information given except for the child’s name and the words “handle with care.”

Impact: Today, nearly 18,000 students under the age of 18 who live in both urban and rural communities in Douglas County receive the extra care they need during the school day in the wake of traumatic events at home.

Key partners in this effort include Baldwin City Police Department, Eudora Police Department, Lawrence Police Department, Baldwin City Public Schools (USD 348), Eudora Public Schools (USD 491), and Lawrence Public Schools (USD 497).

Learn more about Handle with Care
See the program in action

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Preventing Youth Suicide and Substance Abuse

Challenge: Suicide is a public health problem both nationally and locally. Since 1999, suicide rates for males and females have increased in the U.S. and Kansas. During this time, Kansas saw an overall increase in the suicide rate of 45% -the fifth largest percent increase in the nation. In Douglas County, suicide rates have increased 84% since 1999.

Youth suicide is a particular challenge in Douglas County. In 2018, half of Douglas County residents treated in the LMH Health Emergency Department for suicide attempts were under the age of 21. A suicide attempt is the strongest predictor of future suicidal ideation, suicide attempts, and death by suicide.

Response: In 2020, Douglas County high schools worked with Engage Douglas County to implement Sources of Strength, an evidence-based program designed to prevent suicide, bullying, and substance abuse.. In 2021, the program was implemented in Lawrence High School, Free State High School, Perry-Lecompton High School, Billy Mills Middle School, and Perry-Lecompton Middle School.

Impact: Today, over 4,152 Douglas County high school students and 749 Douglas County middle school students have had the opportunity to learn how to prevent suicide, bullying, and substance abuse and potentially save a life. (National Institute of Education: National Center for Education Statistics)

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Striving for Zero Suicide

Challenge: While Douglas County community organizations have always wanted to ensure the health of their constituents, many were lacking the suicide prevention skills they needed to understand risk factors, identify the signs of suicidal ideation or behavior, and intervene skillfully. Between 2017 and 2021, suicide was the second leading cause of death for Douglas County residents ages 15-44, and the seventh leading cause of death for Douglas County residents ages 45-64. It was raised as a priority concern for the County in the 2017 Community Health Assessment, which informed the 2018-2023 Community Health Plan. As a part of that plan, Zero Suicide was identified as both an integration and prevention strategy.

Response: In October 2020, Douglas County hosted the first Zero Suicide Academy in the state of Kansas and trained 60 individuals from nine different area organizations in the innovative Zero Suicide model to help better meet the needs of community members experiencing suicide risk.

Zero Suicide is a way to improve suicide care within healthcare and behavioral health systems. The framework equips these systems with all the training and tools they need to do this. The foundational belief of Zero Suicide is that suicide deaths for individuals under the care of health and behavioral health systems are preventable. Zero Suicide presents an aspirational challenge and practical framework for system-wide transformation toward safer suicide care. This work in Douglas County is groundbreaking. While there has been an enormous effort across the state for healthcare and behavioral healthcare organizations to implement Zero Suicide, Douglas County remains the only place in Kansas that is implementing this framework across the whole county system.

Impact: Since the Zero Suicide Academy in 2020, participating Douglas County organizations have continued the work of Zero Suicide by creating new policies and procedures to ensure the implementation of lifesaving Zero Suicide strategies. Implementing organizations include Bert Nash Community Mental Health Center, DCCCA, Heartland Community Health Center, Heartland RADAC, Kansas Suicide Prevention HQ, Lawrence-Douglas County Public Health, LMH Health, The Sexual Trauma & Abuse Care Center and The Willow Domestic Violence Center. These partners have made major strides on this project. One success is that every implementing organization in the County is using the same tools for identifying risk and planning for safety, which means that all providers and supports are speaking the same language, allowing for smoother communication across the system.

While each participating organization in Douglas County is in different phases of implementation, there are a few exciting site transformations that have taken place. One highlight is that LMH Health has altered their suicide screening processes so that every patient seen in the Emergency Department or admitted to an inpatient unit, regardless of the presenting issue, is screened for suicide risk. Additionally, primary care clinics across the LMH Health System have implemented new screening and response pathways so that all patients have the opportunity to receive suicide care if they need it. Lawrence-Douglas County Public Health has been working diligently to implement Zero Suicide in their WIC and Healthy Families programs and will eventually expand into their clinic.

With the Douglas County Crisis Line now linked to 988, the Mobile Response Team and the Treatment & Recovery Center, we foresee Zero Suicide implementation in our community being even more impactful in the coming months and years.

Learn more about Zero Suicide
Watch the Zero Suicide Healthcare Call to Action

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