Community Mental Health Systems Improvement

A doctor's hands holding the hands of an elderly person.

Our Challenge

People in psychiatric crisis deserve access to timely, appropriate care. 
In Metro Nashville, as in cities nationwide, mental health services are in short supply and often become the domain of the criminal justice system. This can lead to an increase in incarceration rates of individuals experiencing mental illness, who would be better served through treatment. And, it's often a poor use of police officers' time.
Metro Nashville has a 24/7 Mental Health Crisis Services Center (MHCSC), which is part of the Mental Health Cooperative (MHC). The number of people in need often surpasses the beds available. Intake processes are often lengthy, and if patients present a danger to themselves or others, the police are required to supervise the entire evaluation. 
The Community Mental Health Systems Improvement Public Investment Plan (PIP) seeks to: 
  • improve the speed and capacity of the Mental Health Crisis Services Center
  • limit use of police as supervisors and caretakers
  • decriminalize mental illness by reducing incarceration rates of mentally ill patients

6,000 Hours

That's a conservative estimate of the amount of time police officers spent in 2016 waiting alongside patients who needed to be assessed and receive a care plan.
6,000 hours is equal to two to three officers' time per year. Here's how we got to that figure — and some additional factors to consider: 
  • 924 patients were transported to the Mental Health Cooperative (MHC) in 2016. 
  • Nearly half of those patients — 448 — needed to be committed to a psychiatric hospital. As these patients present a potential risk to themselves or others, they can't be left alone. Police spend an average of 27 hours accompanying patients to regional hospitals, waiting for a bed to become available. 
  • Often, this population's needs are manifold — patients often present with both medical and psychological conditions. In 2016, over 700 individuals were sent from MHCSC to a local emergency room for medical clearance.
This system — using emergency room and police department resources — clearly needs improvement. 
What people need is treatment. They don’t need to be put in jail.
—Dr. Bill Paul, Director, Metro Nashville Public Health
A nurse's hands holding another person's hand.
A male doctor explaining something to another adult man.

Why It Matters

Insufficient Services for Persons with Mental Illness 

For patients in crisis, experiencing a mental health emergency, an extended wait time alongside police officers increases the likelihood of an arrestable offense. Shuttling between the ER and a psychiatric hospital is also a poor patient experience. 

Inefficient, Costly Use of First Responders

Not only are multiple shifts of police officers waiting with patients for care, but other officers must provide back-up patrol services for the duration of the patient intake process. 

Our Plan: Expand MHCSC's Capacity 

An investment in Mental Health Crisis Services Center (MHCSC) will allow the facility to serve patients better, while eliminating the need for police officers to remain on site. The PIP has three main goals: 
  1. Transform the drop-off process. Creating a secure drop-off location, along with an additional safe room space for patients in immediate danger. The goal is for police to be able to drop off patients in 10 minutes (as opposed to staying during intake, assessment, and transfer to a psychiatric hospital, which takes an average of 27 hours). 
  2. Expand medical services at MHCSC. Having more medical staff available 24/7 will allow MHCSC to avoid costly transfers to the emergency room.
  3. Promote public awareness. A marketing campaign will inform the Metro Nashville Police Department Emergency Departments and the general public of MHCSC's expanded capacity, as well as providing details to all TennCare Managed Care Organizations. 
Implementing these changes will occur through a partnership between the Mental Health Cooperative (MHC), a 501(c)(3) organization, and the Metro government.  
You have people with mental illness, who have substance abuse issues, and they need rapid treatment. Or they’re going to end up in our jails, in our emergency rooms, waiting for days-on-end for treatment.
—Amanda Bracht, Senior Vice President, Clinical Services, Nashville Mental Health Cooperative

Projected Outcomes  

  • Patients are assessed faster
  • Police spend less time on drop-offs
  • Potential for adverse encounters and arrests decreases

Exterior of a high-rise hospital

Our Goals

Efficient, Effective Service

The transformation of MHCSC will result in more effective treatment of patients experiencing mental health emergencies.  

Cost Savings 

Fewer mental health patients in ERs, as well as less police time spent waiting alongside patients, will reduce the burden on both systems. 
By developing true drop-off capacity at MHCSC, we estimate the eventual cost savings will be nearly $219,000 per year in police staff time. 
—Community Mental Health Systems Improvement Public Investment Plan proposal 

See More PIP Projects

Public Investment Planning is an innovative approach to budgeting, launched in 2016, that challenges Metro departments and agencies to think creatively about how they can collaborate on pilot initiatives to better serve Nashville-Davidson County residents. Learn more at http://www.nashville.gov/Finance/Public-Investment-Plans.aspx.