When someone is experiencing a behavioral health crisis, they – and family members – are often forced to resort to involving law enforcement or visiting a hospital emergency department. Across the country, people with mental health diagnoses represent about 36,000 emergency room visits each day[i], with some 84% of hospitals nationwide reporting the boarding of psychiatric patients[ii]. In 2017, a nationwide study found that an average of 21% of total police officers time was spent responding to and transporting people with mental illness or substance use issues, representing 10% of overall department budgets[iii]. The number of adults in Ohio experiencing serious mental illness in the past year exceeds that of the Midwest, as well as the country. One quarter of the population in Ohio Department of Rehabilitation and Corrections facilities are on the mental health caseload[iv]. Suicide deaths in Ohio have increased over the past decade, with an increase in rate of 22.3% from 2010 to 2021. Unintentional drug overdose deaths have also increased – an astounding 241.6% from 2010 to 2021[v].
To address these public health concerns, Clear Pathways established Clear Pathways Communities. Clear Pathways Communities (CPCs) launched with a group of diverse Ohio jurisdictions in early 2022 with the goal of working towards a full continuum of behavioral health emergency response services, aligned with emerging national best practices. With intensive training and technical assistance offered by Clear Pathways, these communities serve as exemplary prototype sites of innovation. We work with the CPCs to make progress toward the shared goal of people in behavioral health crisis getting connected to treatment and engaged in recovery through the least restrictive, most cost-effective settings. These activities are mainly channeled through the County Alcohol Drug and Mental Health Board authorities across many urban, suburban, and rural Ohio communities.
CPCs also apply lessons learned to drive policy and financing change in Ohio to elevate the state as a national leader in the delivery of crisis care services. These communities serve as prototype sites to create local and regional opportunities for growth, investment, and research.
The Clear Pathways team provides CPCs with technical assistance, training, and support via the development of local crisis steering committees, connections to national and state thought leaders in crisis care, opportunities for in-state and out-of-state site visits, and the coordination of peer-to-peer learning. The key to the success of this effort is the ability to create effective collaboration with cross-systems partners, including mental health and substance use providers, hospitals and hospital systems, judges, law enforcement and first responders, county leadership, local funders, and advocacy organizations, as well as those with lived experience and others with a vested interest in crisis care.
[i] Santo, L., Peters, Z.J., Defrances, C.J. (2021) Emergency department visits among adults with mental health disorders: United States, 2017–2019. NCHS Data Brief, no 426, https://www.cdc.gov/nchs/data/databriefs/db426-tables.pdf#2
[ii] Marketing General Incorporated (2014, April). 2014 American College of Emergency Physicians (ACEP) Polling Survey Results. https://op.bna.com/hl.nsf/r?Open=lroi-9kqklh
[iii] Treatment Advocacy Center (2019, May) Road Runners: Role of Law Enforcement in Psychiatric Crisis Response. https://www.treatmentadvocacycenter.org/wp-content/uploads/2024/01/Road-Runners.pdf
[iv] Ohio Department of Rehabilitation and Correction (2023, June). 2023 Annual Report. Annual Report 2023
[v] Ohio Department of Mental Health and Addiction Services. (2023). Annual data brief, behavioral health in Ohio: 2023. https://mha.ohio.gov/static/AboutUs/MediaCenter/Annual-Reports/Annual%20Report%20-%20FINAL.pdf
