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The Real Solution Can’t Be Found Solely in IMD Beds but by Developing a Full Continuum of Crisis Care

Stephanie Hepburn is a writer in New Orleans. She is the editor in chief of #CrisisTalk. You can reach her at​

David W. Covington, LPC, MBA, RI International CEO & President, wrote a letter to the editor of Psychiatric Services in response to the policy debate on Medicaid’s IMD exclusion rule in the January issue. Covington says he supports an IMD waiver as a transitional step to help communities evolve a crisis continuum with the understanding that acute care hospital beds are just one component of the full solution. He says that crowded emergency departments and jails, with law enforcement often serving as a mental health transport and attendant, has made the mental health community painfully aware that change is needed. It’s essential that states move toward increasing their crisis care and implementing a no-wrong-door approach, and while that may sound challenging, he says Crisis Now offers a model that’s advancing around the country. The National Association of State Mental Health Program Directors site gives communities clear steps on best practices as defined by the National Action Alliance for Suicide Prevention. It provides access to tools that will help any community, regardless of location or population density, expand and further develop their crisis care continuum, ensuring that the people they serve get the level of care they need.

Covington writes that he applauds the Centers for Medicare and Medicaid Services (CMS) for creating an expectation that states assess their systems and evolve their non-IMD solutions to best meet the needs of each community, “particularly crisis stabilization services.” He also commends CMS’s direction that states improve their capacity to track inpatient and crisis stabilization bed availability. Covington hopes though that CMS goes even further by requiring states to use admission and discharge data to develop real-time bed capacity inventory tracking so that people in need can be connected with appropriate level of care services as soon as possible. He says that building a sustainable model with a full continuum of services during the waiver period fosters a clinical fit to individual need and, as a result, lowers costs: making it a win for all involved.

Read the entire letter here in Psychiatric Services 70:6, June 2019. (Readers need an account to have access.)