Approved by Committee Members 03/13/2023
Community Emergency Services and Support Act (CESSA) Statewide Advisory Committee
Meeting Minutes - Monday, February 06, 2023 - 11:00 am-1:00 pm via WebEx
This meeting was recorded.
- The February meeting was called to order by DHS Secretary Grace Hou at 11:04 a.m. Roll call and approval of meeting minutes were done simultaneously. A motion was made by Shelley Dallas and seconded by Richard Manthy to approve the minutes.
- Members Present: Cindy Barbera-Brelle (joined at 11:27am), Chris Huff, Curtis Harris, Erika L. Freeman, Pooja Nagpal, Shelley Dallas, Brent Reynolds (joined at 11:53am), David Albert, Ashley Thoele, Drew Hansen, Richard Manthy, Alice Cary, Jim Kaitschuk, Blanca Campos, Emily Miller
- The OMA notice was read.
- State Updates:
- 988 update - the monitoring reports are being closely reviewed. There was a drop in the overall answer rates of the six vendors, but the rates are higher than previously reported before there was statewide coverage. Monthly meetings are being held with 988 LLCs and Vibrant to rectify the differences in the reported data. Work is ongoing at Vibrant to ensure that there is not a repeat event with the untimely failure in their technology. SAMHSA has hired a TA expert whose focus is to ensure that there is not another outage. SAMHSA has held meetings with DMH for feedback as the ongoing operations of 988 is dependent on the functioning of the internet.
- Any public comments should be mailed to the dhs.dmh.cessa@illinois.gov site at least one week prior to the scheduled SAC meeting, to ensure that the comment can be responded to at the monthly meeting.
- Responses to previous public comment/submitted questions:
- Can a MH clinician responding to an emergency complete a petition or certification for involuntary admission NOW? Are the CESSA statutory changes prohibiting members of a MCRT from doing petitions effective NOW, or is it "business as usual"? Please address this confusion in the field. Note: CESSA is in effect. The July 1, 2023, date only relates to Protocol and Standards. The Act is in effect, now.
- A: (Lee Ann Reinert) While everyone should do their own reading of the statute, DMH's reading of the current statutory language (subject to any future statutory amendments) is that the language of CESSA regarding what responders can and cannot do related to involuntary commitment governs and, to the extent it conflicts with the MH Code, as the more recent legislation, would supersede.
- Q: (Grace Hou) - Is the short answer "NO"; If MCRT is responding to an emergency, they cannot complete a Petition or Certificate?
- A: (Lee Ann R.) - that is correct, the answer is "NO" MCRT staff cannot complete P & C. The Act is in effect, that is why these meetings are occurring; that is why the Regional meetings are occurring. We are working towards the July 1 date. However, that does not impact the language around the prohibition for involuntary commitment.
- Q: (Jim K.) - If the MH professional's (MCRT, non-police responder) clinical assessment confirms that the person needs hospitalization and the arriving police officer does not agree, how will this disconnect be resolved?
- A: (Lee Ann R.) There exist many gray areas, now. More guidance is being prepared for 590 (MCRT) providers, as we think through the larger system's issues. This matter is problematic. The intent is to move the system from crisis responders (MCRT) thinking that their role in community-based crisis response is automatically to initiate paperwork for hospitalization. The objective with the guidance is to help teams approach crisis work as problem resolution to avoid hospitalization.
- Comment (Blanca Compos) - I was wondering if you will provide us the guidance and the need to have robust conversations in the Learning Collaboratives about this matter.
- Comment (Richard Manthy) - comments inaudible
- Q: (Kathleen McNamara) - this is still a bit confusing. Can a mental health clinician, who is not part of the MCRT assist in completing a Petition & Certificate?
- A: (Lee Ann R.) DMH cannot give legal advice. DHS legal's reading is the interpretation of the law. A provider will have to consult their own attorney.
- Q: (Kathleen McNamara) - it gets to the matter of the mental health clinician (co-responder) attached to a police department. It is our understanding that the prohibition only applies to non-police responders Mobile Crisis Response Team.
- A: Please refer to the definition of a co-responder in the legislation. Police co-responders are outside of the definition as written in CESSA - does not apply.
- Comment (Jim K.) - if mental health clinicians (MCRT) cannot do Petitions and Certificates and law enforcement can, then transportation becomes an issue, because the way the Act is written it discourages law enforcement from transporting an individual for psychiatric evaluation. I just want to make sure that folks are aware.
- Q: (Curtis Harris) - What about Living Rooms?
- A: The question only applies to transportation to hospitals.
- Comment (Chris Huff) - In one of the first meetings, discussion ensued about changes mandated in CESSA that would necessitate a 5-year role out. We should be thoughtful in addressing these challenges. The challenges will have implications for future funding and planning. We should be developing plans on where the state should be 5 years from now.
- Q: Was the issue with data collection resolved? Is the data now accurate from the 988 call centers?
- A: (Lee Ann R.) According to Vibrant there should be no more than a 15% variance. We are still drilling down on the data, by working with the LLCs so that they can do a better analysis of their data. One of the critical differences is that Vibrant cannot see local calls that come directly to the 988 lines. These are calls that do not get counted in the Vibrant data. The FOIAs are only receiving data that Vibrant is giving back to us. It is hard to make a comparison.
- Comment (David Albert): CESSA is the law and supersedes the Mental Health Code. Program 590 providers cannot write Petitions and Certificates. If law enforcement does not observe a specific behavior is a very crucial question. To clear up confusion is to address the language of the legislation.
- Is it best practice for first responders to be present during "non-criminal situations" that can escalate quickly, to take control of an escalating situation to ensure safety of all involved. In my jurisdiction, law enforcement is sometimes reluctant to assure the safety of a scene because of this law. Under what conditions is it appropriate for law enforcement to "secure the safety of the scene" and all involved?
- A: (Lorrie Jones ) - CESSA Section 30 (a) in any area where responders are available for dispatch, law enforcement should not be dispatched to respond to an individual requiring mental or behavioral health care unless that individual is (i) involved in a suspected violation of the criminal laws of the State, or (ii) presents a threat of physical injury to self or others.
- Section 30 (a)(3) without regard to an assessment of threat to self or threat to public safety, law enforcement may station personnel so that they can rapidly respond to requests for assistance from responders if law enforcement does not interfere with the provision of emergency response or transportation services.
- Law enforcement is allowed to be at the scene and poised to be responsive if needed. MCRT and CIT officers should try to de-escalate the situation.
- The draft document which will outline law enforcement response vs MCRT will be imbedded in the guidance at the Regional level, and will be dependent on the resources available at the local level.
- In a related question, what will be done about the lack of training for paramedics in dealing with incidents involving a person with an apparent behavioral health issue? Whereas police (via CIT) have training, EMS has no such training and are not sufficiently prepared to deal with many behavioral health crises. We want to avoid an Aurora, CO, situation here where EMS and LE were charged with 32 counts of manslaughter assault, criminally negligent homicide due to the mismanagement (and misconduct) of a situation with a person with 'peculiar' behavior.
- A (Lorrie J.) the statue is limited on how to address training for EMS, with training needs focused on 988 LLCs and MCRT. This does raise an issue of focused coordination between all the partners. Training should be addressed through the EMS Medical Directors via IDPH.
- Q: (Chris Huff) - What training is involved in the project plan?
- A: (Lorrie J.) - DMH via the Crisis Hub is developing training for 988 LCCs and MCRT and then will coordinate with training for law enforcement.
- RAC Updates:
- Brenda Hampton (EMS Regions 1, 2, 3 & 7), Peter Eckart (EMS Regions 4, 5 & 6) and Lorrie Jones (EMS Regions 8, 9, 10 & 11) provided updates on RAC activities and status of planning.
- Region 5 co-chair, Sherri Crabb, provided an overview of what this specific RAC is accomplishing and their pursuit to gather data on the different models that currently exist in that Region. This Region is working on hosting its 4th meeting this month, and has a concern about the time frame to get all the work done and recommendations made.
- Technical Subcommittee Reports:
- Protocols and Standards Report (preamble Lorrie J):
- S & P subcommittee is presenting a near final form of the Risk Matrix for Illinois. While the committee did vote on this document, it was agreed to look at it again before moving it to the RACs.
- The Matrix was prepared after having extensive research on best practices from LA County, Westchester Co, the State of Virginia, and cities of Settle, Portland and Baltimore.
- The first thought of the subcommittee was to develop a 3-Level Matrix, but after discussion, it was agreed to move to a 4-Level Matrix.
- Shelly Dallas and Alicia Atkinson took the lead in working on draft for the 4-Level Matrix.
- We all agreed on the top Level and the bottom Level. The middle two Levels that are controversial.
- The top level indicates a threat to public or individual safety and necessitates immediate response from law enforcement.
- The bottom level has issues that can be addressed by a mental health provider agency and does not necessitate an emergency response time.
- The middle levels raise questions if there should be removal of law enforcement (immediate response) and a direct contradiction on how the mental health system works in response times up to 90 minutes.
- If a call comes into 911 there is a request/expectation for immediacy.
- SAMHSA has established guidelines on mental health response times (these are not immediate):
- 1 hour - urban area
- 2 hours - rural
- 3 hours - remote
- Several questions to explore:
- Should the focus move to rely on co-responder models?
- Should the focus move to co-responder models with MCRT & EMC?
- Should a model be with law enforcement securing the scene until MCRT arrives/
- Should a model include /use technology, i.e., an iPad, to access clinicians until MCRT arrives, on-site.
- Illinois' DRAFT Matrix presentation (Cindy B-B):
- Each Risk category identifies what decisions fall within the respective areas:
-
EMERGENT RISK TO HEALTH OR SAFETY
URGENT RISK TO HEALTH OR SAFETY
MODERATE RISK TO HEALTH OR SAFETY
LOW RISK TO HALTH OR SAFETY
LEVEL 4
LEVEL 3
LEVEL 2
LEVEL 1
Responses are based on the nature of the Risk
- Matters for consideration:
- Dispatch response Type
- Dispatch Entity
- Response Time
- Risk level may be modified by the dispatcher, including diversion to 988
Comment: (Shelly D.) - The most important thing to remember is that all areas of the State do not have the same resources. If the resources are available, then we do want the alternatives to happen. But, when a call is made to 911, the need for a response is immediate.
Q: (Chris Huff) - Is it possible to share emails or public comments made regarding the Risk Matrix? This will be useful to give the SAC members more information from the subcommittee's meetings.
A: SAC members can always request a recording of RAC meetings or Sub-committee meetings. Also, all public comments are brought to the SAC meetings, as are public comments in S & P.
Q: (Chris Huff) - It would be good if note takers include commentary and summarize points.
A: (Lorrie J.) - Unfortunately, timing did not allow for the sharing of public comments from the S & P meeting, which was held on Thursday, for this meeting today. It is our interest to have S & P comments before there is a vote on the Matrix.
Q: (Chris Huff) - Are we moving away from co-responder models or modifying it?
A: (Lorrie J.) - We need to continue to explore how to resolve the tension. MCRT cannot respond in a timelier manner. There are examples how other states have accomplished alternative models. The 911 system and the mental health system are totally different. 911 is an emergency response system with a 5 - 13 minutes response time. DMH's systems' response time is significantly longer. There is no way to have timely response with a system that does not have the capability to do so.
Q: (Jim K.) - What is the level of expectation for either law enforcement or EMS to have to wait until MCRT can respond?
A: (Lorrie J.) - I do not have an answer for that question.
Q: (Blanca C.) - How can we continue to ensure that there are options in who responds?
Comment: (Brent R.) - I have two comments, first, I am very adamant that the 4-Level Risk Matrix draft is a positive change; secondly, it is important to remind everyone that all the SAC subcommittee meetings are open meetings and that participation is critical. Nothing is being done behind closed doors.
Comment: (Chris H.) - I want people to have options on what resources they want and who to respond, particularly Levels 2 and 3. There is a need for intentional collaboration and where resources are not available to work to build standard for things to come in the future, and ultimately obtain the resources. This bill is based on Stephon Watts and to get the right resources in areas that do not have them.
Comment: (Brent R.) - There may be a misconception on the intent of the Matrix. The Matrix is to help PSAPs identify the best ways to address a crisis. The challenge is the resources that the PSAPs have available to send. If there is no Matrix, then there are no guidelines how to make dispatch decisions. There is no one who disagrees with you on the challenges.
Comment: (Lorrie J.) We are attempting to move to a shared vision, to communicate clearly, to move forward and to do things differently. This is complex work. It does not happen overnight. These types of reforms take years. A shared vision will get us on a common road.
Comment: (Chris Huff) - Police involvement criminalizes people in mental health crisis. In certain ways, in certain counties, it is business as usual. There are ongoing issues with EMS not coming into certain neighborhoods in Chicago, along the lines of race and poverty.
There was no vote called on the Matrix.
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- Technology & Data Subcommittee Report (Brent Reynolds)
- The last three meetings were poorly attended.
- There has been healthy discussion on data collection.
- The subcommittee is meeting this afternoon.
- Communication Subcommittee (Emily Miller)
- These meetings have also been poorly attended.
- All scheduled meeting dates are on the CESSA meeting page.
- Information sharing is critical.
- We had serious discussions at the last meeting on messaging for 988 to mirror the messaging for CESSA. There is a lot of confusion and misinformation between 911 and 988 and crisis response.
- The subcommittee would like to have meetings with the RACs to better understand who is involved and what type of outreach is needed, maybe a Town Hall meeting.
- A goal is to work through understanding the types of communication needed for the respective Regions.
- Next meeting is March 13, 2023, 1:00 p.m. - 3:00 p.m.
- Public Comment Period
- Comment: (Zachary Gittrich) - The video recording for S & P is not online, at least I could not find it. Was anything regarding the Risk Matrix sent outside of the S & P Committee to the SAC? Police use deception and that is not a way to build trust. The spirit of CESSA is to consider health care concerns. Having police out of sight is an alternative response model. There is no problem with MCRT responding with EMS, just not the police. I oppose the Risk Matrix recommendation. It involves too much direct police presence. Also, some 590 providers refuse to transport, allegedly due to legal counsel constraints. I have yet to hear an adequate reason why they cannot be required to transport as part of the grant.
- Secretary Grace Hou closed the meeting at 12:52 p.m.
