Portland's mental health crisis center could be a model for state networks

Brandon Krim works as a peer support specialist at the Cumberland County Crisis Reception Center in Sparwink, also known as the Living Room. The first-of-its-kind center is designed to provide an alternative to emergency rooms and prisons for people experiencing a mental health crisis. That's the kind of thing Krim could have benefited from when he was going through his own crisis. Ben McCanna/Staff Photographer

Brandon Krimm started using marijuana as a teenager when he struggled to process his emotions after losing several people close to him within a short period of time.

He soon started hanging out with friends who introduced him to other drugs and alcohol, beginning a cycle of addiction, rehab, and relapse. He was taken to the hospital, but he remembers being too scared to accept help.

“Even though I had negative thoughts and negative emotions, I said what I needed to say to leave,” Krim said.

Krim later received the help she needed and now uses her experience to help others at the Cumberland County Crisis Reception Center in Spurwink, also known as the Living Room. The first-of-its-kind center will provide people experiencing a mental health crisis with a 24-hour alternative to emergency rooms and prisons.

The state is considering replicating the center in other areas after the October mass shooting in Lewiston highlighted the need for more access to mental health care. Gov. Janet Mills announced legislation Wednesday that includes opening a new center in Lewiston, a step toward a statewide network based on the Portland model.

“We know these centers are working,” Mills said in his State of the State address last month.

human response

The Portland center opened in 2022 as a partnership between the Maine Department of Health and Human Services and Sparwink, a nonprofit organization that provides mental and behavioral health services.

Two years later, more than 8,400 visits have been recorded, including multiple visitors, and last year the number of unique visitors averaged 172 per month.

It's set up like a real living room, with sofas lined up in the middle and surrounded by smaller rooms where guests can have private meetings or rest. There are snacks and other items designed to help people feel at home, as well as shelves with spare clothes that anyone who comes might need.Coffee hour every day at 4pm

The center accepts walk-in guests 24 hours a day, seven days a week, and has a team that includes nurse practitioners, clinicians, nurses, crisis service providers similar to case managers, and peer support professionals like Krim. is staffed by. .

“Someone says, 'Hello,' and you walk in,” says Ben Strick, Sparwink's vice president of adult behavioral health. “I think that's the key. It's not 'Why are you here?' Sit down and go through all your checklists. ” (Our response) really varies from person to person. ”

Strick said people come to the center with a variety of needs. They could be older people who feel lonely, people experiencing a psychotic episode, or people who are newly homeless and don't know what to do. Some may have recently been discharged from hospital shelters.

“It’s very broad,” he said.

Brandon Krim, a peer support specialist at Sparwink's Cumberland County Crisis Reception Center, said he can use his experience to help people who come to him for help during a mental health crisis. Ben McCanna/Staff Photographer

It's the kind of resource that might have helped Krim when he was facing his own crisis, and where he now provides assistance to others as a peer support specialist. .

Krim is one of the people who greets and talks to the visitors, many of whom suffer from suicidal thoughts. He strives to provide an empathetic and human response.

“We bring comfort and let people know, 'Hey, what you're going through, I've been through something similar,'” he said.

Visitors are provided with private rooms, but can also stay in the public areas if they are comfortable.

“There’s really a menu of providers available depending on your needs,” Strick says. “A typical crisis assessment is done by one of our crisis service providers, but some people only want to talk to their colleagues and that’s fine too. You don’t have to do a crisis assessment. …Very personalized There's no set way to do it. That's the beauty of this model.”

Some people visit the center, talk to their peers, have coffee, and then leave. Some people contact nurses to obtain medication. If you have a physical problem, our staff will refer you to a clinic or take you to a hospital.

Most people who visit the center return for five or fewer visits. Approximately 33% have only visited her once.

“We thought some people would be stuck forever, but what we've seen is that if you know you can come back, you don't have to stay there,” Strick said. “Some people come to the hospital and say, 'I know I can go back, I'm going home,' rather than go to a higher level of care,” but after one night they find out they're perfectly fine. .at home.”

A smaller proportion (about 13%) require a higher level of care and more follow-up, and the center works with them to connect them with other supports and services.

Brandon Krim, Sparwink Peer Support Specialist, Ben Strick, Sparwink Vice President of Adult Behavioral Health, and Sarah Squirell, Director of the State Department of Behavioral Health. Sean Patrick Ouellette/Staff Photographer

The center charges a very small amount of private insurance and helps people who don't have MaineCare or other insurance get it, but it does cover costs and people who don't have insurance. We also use state funds for this purpose. An uninsured person.

“Nobody gets a bill,” Strick said. “This is one of the highlights here in terms of what the state is doing. You shouldn't come in and go into a crisis and think, 'I can't afford that.' ”

Bridget Sliwak, behavioral health unit coordinator and licensed clinical social worker for the Portland Police Department, said her division often uses the living room as a resource for people with mental health needs. He said he was doing it.

Without this, police would have to respond to the same person multiple times a day or week, costing them more time or potentially taking them to the hospital when it wasn't really necessary. there is.

“Spending time face-to-face with someone in a professional capacity in a place where you're like, 'Hey, I'm here to help,' really makes that person feel like they have a problem.” I think it will be helpful.’ We took the appropriate steps,” Sliwak said.

model growth

The Living Room's budget is $3 million, of which about $2 million comes from state and federal funds and the rest primarily from MaineCare claims.

The state has already expanded its services and is preparing to establish a specialized crisis reception center in Kennebec County that will focus on substance use disorders and combine it with a 10-bed medically supervised withdrawal program. The state is looking for partners to help run the program and plans to close a call for proposals in the coming weeks.

The Lewiston center Mills hopes to build will be the third and would be similar to Portland's one with a broader focus.

“We are certain that there will continue to be needs related to the trauma experienced by our community as a result of this tragic shooting,” said Sarah Squirell, director of DHHS' Office of Behavioral Health. “We want to ensure that victims and the wider community alike have access to care.”

After that, the state hopes to expand the model to locations around Maine. Squirrel said the centers could look slightly different depending on the needs of the community.

“In rural areas, transportation needs may need to be considered,” she said. “How do we prioritize to support them? And how do we prioritize the unique needs of different communities based on trends related to opioid use, other substance use, and the prevalence of mental health issues?” there is.”

While some aspects of Mills' bill are expected to face partisan debate, expanding crisis centers is likely to garner bipartisan support.

“Republicans have been pushing for mental health initiatives, for beds and funding,” said House Minority Leader Billy Bob Falkingham, R-Winter Harbor. “I’m glad it’s included (in the governor’s budget proposal). We support it as a concept, so we look forward to working with the governor on this issue.”

Senate Minority Leader Trey Stewart, R-Presque Isle, said Senate Republicans agree on the need to expand mental health services, but there are concerns about whether crisis centers will work everywhere, especially in rural areas. He said he had some concerns.

“We have to be careful not to throw money at problems that don't actually have solutions or that don't work,” Stewart said in a statement. “We have to do it wisely and where it has the most impact.”

If Congress approves funding for the Lewiston center, DHHS said it will begin the process of finding a partner organization to establish the center, with the goal of having it established within nine to 12 months.

“Crisis centers really have the ability to relieve pressure on hospitals and give individuals immediate access to the resources they need,” Krim said. “I really don't think there's anything comparable to this. I wish there was a way we could set up these crisis centers in every city in the state.”