Brattleboro crisis care center helps cut down on health care costs

Friday February 1, 2013

BRATTLEBORO -- Health Care and Rehabilitation Services saw so much success at its Springfield Crisis Care Center, it decided to duplicate it here in town.

HCRS opened a crisis care center at 208 Linden St. in August 2011 to offer mental health crisis treatment, and Chief Operating Officer Dr. George Karabakakis told the Reformer it was replicated after "an excellent model in Springfield" that opened in June 2010.

He said the center, which he described as similar to an outpatient clinic, operates on state funding from the Department of Mental Health and is open Monday through Friday from 9 a.m. to 10 p.m.

Karabakakis said it has paid dividends to the community since it opened.

"I think (things) have been going very well," he said.

He said Brattleboro is not exempt from the national issue of overutilization of hospital emergency rooms. He said people with mental health concerns often show up at ERs for help dealing with a problem or as the result of an accident caused by their condition. Karabakakis cited a study that indicated 20 percent of an emergency room's patients utilize 80 percent of all its resources.

He said facilities like the Brattleboro Crisis Center have crisis staff members that accept walk-ins, which reduces ER congestion and lowers health care costs.

According to HCRS statistics, the Springfield CCC diverted 102 clients from the ER, saving an estimated $122,000 in unnecessary Medicaid billing, while redirecting 89 clients from inpatient psychiatric facilities, sparing approximately $783,000 in inpatient expenses.

Karabakakis also said emergency rooms are often overburdened with medical emergencies, which results in lengthy waits for mental health treatment.

He said one of four crisis staff members meets with all walk-ins and assesses each situation on a case-by-case basis. He said individuals often arrive at the center due to other unmet social service needs, such as homelessness.

The crisis team specializes in the treatment of adults, adolescents, and children struggling with an acute crisis such as suicidal or homicidal thoughts, feelings of being out of control or unsafe, and/or extreme emotional distress. The crisis staff can also -- based on the needs of the client -- provide referrals to counseling, medical, psychiatric and substance abuse services, as well as inpatient psychiatric admission.

The Brattleboro Area Drop In Center also staffs a public inebriate bed at the center. Will Fay, a case manager, said the bed is for people identified as being under the influence and the drop-in center is responsible for monitoring the individual's vitals until he or she becomes sober. Fay said most cases are brought to the drop-in center's attention by an emergency room.

But the HCRS' crisis care centers should not be confused for medical facilities. Individuals who have serious medical issues, who have taken an overdose, or who are injured, should go to their nearest ER. In these instances, the ER staff will call for a crisis-screener once the patient is medically stable.

Karabakakis said this sort of care is possible thanks in part to Act 79 of 2012, which reformed Vermont's mental health system.

According to HCRS, the typical client in the CCC is seen within 15 minutes of arrival, and is usually ready to go in less than two hours.

"It is a very warm, welcoming place," Karabakakis said.

If you or someone you know is in need of crisis services, call HCRS to coordinate a screening, either at the Brattleboro Crisis Care Center or an emergency room. The 24-hour crisis hotline is 1-800-622-4235.

Domenic Poli can be reached at, or 802-254-2311. You can follow him @dpoli_reformer.


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