Florida Partners in Crisis

Featured Program: Orange County's Central Receiving Facility

Written by: Susan Zehel, LMHC, Project Coordinator
Approved by: Donna Wyche, Division Manager for Orange County and Michele Saunders, LCSW, Executive Director

The Central Receiving Center (CRC) operated by Orange County, FL is Partners in Crisis' latest "Featured Program." The CRC serves as the single point of access to treatment for individuals who have been brought to the facility by law enforcement officers or referred by hospital emergency staff for an involuntary examination or voluntary exam under both the Baker Act and the Marchman Act.

This collaborative program, considered the first integrated, comprehensive acute crisis assessment system in Florida, began operations April 13, 2003. The facility serves over 400 people a month and over 5,000 a year.

Of the total 23,000 people seen at the CRC during its first five years of operation, 20,147 were referred to mental health treatment and 2,113 for substance use treatment.

Located at Lakeside Behavioral Healthcare's Princeton Plaza in western Orlando, the CRC is a collaborative partnership, with administrative and operational oversight shared by Lakeside Behavioral Healthcare, the Center for Drug Free Living, and Human Services Associates.

The CRC Governing Board was established to provide oversight of the entire operation. Its members are high level community stakeholders, including the chief judge, clerk of the court, public defender, state attorney, law enforcement and corrections officials, county and state government, provider agencies, representatives of individuals with mental illnesses and substance use disorders and others. Together they contribute to making program operations seamless.

The Governing Board also addresses funding inequities and lack of resources with state officials in order to ensure appropriate services are available. Further management and oversight comes from Donna Wyche, division manager for Orange County's Department of Health and Family Services Mental Health and the Homeless office.

County Government Took The Lead

The CRC came about largely due to the efforts of Orange County Mayor Richard T. Crotty and the Orange County Commission and was prompted in part by the recommendations of a Jail Oversight Commission. At the time of the JOC report, police and sheriff's deputies in Orange County who came into contact with people in a mental health or substance abuse crisis had few options. One option was to take them to an emergency room, where an officer could wait with a person in crisis for hours for a treatment decision to be made, return the person to the streets or book them into jail.

Community leaders felt a better option was a centralized triage facility, where officers could leave individuals in crisis in a secure facility knowing they would be assessed and referred for appropriate services.

Orange County government provides the majority of funding, $2 million a year. These funds are also used to provide aftercare for people seen at the CRC. Additional funding is contributed by the Department of Children & Families, Florida Hospital and Orlando Regional Healthcare System.

The CRC is unique in that it has become a central point of access for law enforcement officers, allowing them to divert individuals who might otherwise be taken to jail or an emergency department. This triage process allows for quick assessment and appropriate placement for people who are in crisis who need acute care services either because of mental illness and/or and substance use problem.

The program also provides state-of-the-art cross training for clinicians in both mental health and substance abuse assessment so that any professional can identify co-occurring disorders. Assessments done by CRC staff enable treatment providers to make decisions on needed services based on accurate information.

Mental health and substance abuse professionals are able to divert individuals to the most appropriate level of care, providing jail diversion when needed. CRC tracks statistical data and the movement of individuals within the system of care in hopes of diverting these individuals from the jail and/or local emergency departments.

Law enforcement professionals are trained and now have better options for those individuals experiencing a crisis due to mental illnesses and/or substance use disorders. Officers asked about the value of CRC say that it is easy to use, enabling them to drop someone off and be back on the streets in about 10 minutes on average - compared to a two to four hour wait before the facility opened.

After a law enforcement officer drops someone off at the CRC, a behavioral healthcare technician accepts the person and reviews the paperwork. The person will then be seen by a triage nurse to ensure there are no acute health problems that require immediate medical attention. If there are, the CRC staff contacts an ambulance and the individual is transported to the nearest hospital. If there is no acute medical problem, the nurse completes the medical screening.

The person is then seen by a master's level clinician who conducts the intake screening, focusing on both mental illness and/or substance use disorders. The clinician gathers information regarding current problems and past psychiatric and substance abuse history as well as the person's support system. Next, the clinician determines which facility to refer the person to for inpatient care. This entire process takes about two to three hours from the time of the individual is brought to the facility.

The Human Side

Since its inception, the CRC has seen many successes. One example is Orlando resident Nelson Kull.

Kull operates the Pathways Drop-In Center in Orlando and has a serious and persistent mental illness. Prior to the opening of the CRC, Kull said he had nowhere to go other than a hospital emergency room when he was experiencing a crisis.

After the CRC opened, Kull said, "Although I was in crisis and the situation was difficult, I felt safe, was treated friendly and was considered a priority."

Kull said he was given his much needed medications, support and food at the CRC. Without the quality treatment and quick assessment he received, he said his situation would have likely gotten worse.

Value to the community

Because of the huge reduction in wait time for law enforcement officers, it is estimated that the CRC has saved the county $1.2 million - the equivalent of 27 additional officers - during the five year period from April 2003 to March 2008.

During that same time, no Marchman Act patients were brought to the county jail for protective custody and an average of 150 Baker Act patients a year were released from the jail to the CRC. The diversion of individuals in crisis to the CRC has saved nearly 54,000 jail bed days during the five-year period. (Figures for daily jail costs were not available.)

The facility also has reduced pressure on hospital emergency departments. Last year along, 1,623 bed days were "saved" through diverting people to the CRC.

The CRC has helped coordinate the use of the inpatient beds in the community, track more accurately information about bed utilization, and better identify those individuals who have had frequent admissions and may need more intensive services upon discharge to reduce their chances of recidivism.

The CRC continues to evaluate and improve its services. Intensive case management for homeless individuals who have a mental illness and/or a substance use disorder recently has been added.

In 2005, the CRC received an award from the Department of Children & Families and the Florida Alcohols & Drug Abuse (FADDA) for the best innovative program and best practices.