New walk-in center for people in mental health crisis offers alternative to jail, ERs

The mental health equivalent of the urgent care medical clinic has arrived in south central Pennsylvania and, in the eyes of many who work in the field, not a minute too soon.

It’s the region’s first 24/7, mental health walk-in clinic – and it will open next Wednesday in newly-renovated Dauphin County-owned building at 1100 S. Cameron St. in Harrisburg.

Serving people from age 14 and up, the Connections Emergency Behavioral Health Crisis Walk-in Center – a joint venture of the Dauphin and Cumberland / Perry county mental health agencies – will serve anyone showing up with mental health needs, regardless of their insurance coverage or ability to pay.

A separate back door entrance is dedicated to people bring brought in by police officers who have determined immediate mental health treatment is the better response than, say, a municipal lock-up or staying on the streets.

That is kind of the point.

“We know that mental health is not a crime. You hear me?” Dauphin County Commissioner George Hartwick asked attendees who turned out for tours of the new center Tuesday. “They (people struggling with mental illness) shouldn’t be given an option of jail, an emergency room, or the ability for them to be left out cold on the street.”

The new facility will be operated by Connections Health Solutions, an Arizona-based firm that operates similar centers in Phoenix and Tuscon, Ariz., Kirkland, Wash., and Chantilly, Va.

The company – which developed its clinic in Tuscon as part of that community’s response to the 2011 mass shooting outside a supermarket there that killed six people and left then-U.S. Rep. Gabby Giffords seriously wounded – prides itself on a “no wrong doors” approach that allows it to accept nearly any patient, round-the-clock.

The company says it stabilizes most of its clients within its 24-hour treatment limit, and then provides or connects them to longer-term courses of treatment that results in very few ever ending up in jail or needing hospitalization.

Connections officials couldn’t provide an estimate Tuesday for how many clients they expect to serve in the Harrisburg area year one, but they’re prepared to meet the market where it is.

“I anticipate the need for this community to be high, and I think our walk-in at this facility might be the largest of all the facilities that we have, including Arizona,” said Kimberly Jones, the vice president for clinical operations at the Harrisburg center.

What’s the promise?

First responders in this area see the walk-in facility as a welcome addition to the mental health treatment spectrum.

The need for mental health care has surged in recent years, especially since the COVID-19 pandemic. In the Harrisburg and all over Pennsylvania, people tell of having to wait several months for a first appointment and to receive treatment and medication for a condition such as depression.

The Connections walk-in center could slash that wait down to hours.

Police say they see the need just about every day.

Rob Martin, director of public safety for Susquehanna Township, told PennLive this week his department keeps careful records of its calls for service that have a mental health component. In 2023, there were 368.

“I think all too often over the years those with mental health challenges have found themselves in prison, and that is not where they should be,” Martin said.

But even if a person in crisis is simply taken to the nearest hospital emergency room, it can take hours – sometimes even days – for the appropriate staff to come in to evaluate them, and that whole time by regulation there is supposed to be a dedicated staff person there to keep them under observation.

That can lead to longer waits for people with pressing medical needs, who are now forced to wait outside the door.

“For us, we welcome all the help we can get,” said Nathan Harig, assistant chief for administration at Carlisle-based Cumberland Goodwill EMS.

Annie Strite, Mental Health / IDD administrator for Cumberland and Perry counties, was blunt about the positive results she expects to see: “This program will help decrease suicides in our community. Does this matter to you? It matters to me.”

How it works

The Connections facility actually has three doors:

• The front door is open to walk-in patients ages 14 and up, all of whom are guaranteed to receive a professional psychiatric assessment within 90 minutes.
• There are two mobile units staffed by mental health clinicians and a person with the lived experience of mental illness or substance abuse, but in recovery, available for on-site responses in the three counties, dispatched via 9-1-1 centers, the state’s 9-8-8 crisis hotline, or county-level crisis teams.
• A back door dedicated for secure patient drop-offs from police, EMS and other first responders. That’s designed to help speed their return to duty.

In all cases, “what we’re adding to the continuum that looks a little different is specialized behavioral health care… at minute one where we’re able to stabilize the person and put a plan in place to keep them safe,” said Sarah Lopez, Connections vice president for implementation.

That quick attention is key, said Strite, the Cumberland / Perry administrator.

“I think often people go to the emergency department and ask to meet with crisis, and depending on what’s happening in the emergency department, they wait,” she said.

“And if you arrive at the emergency department and you’re already struggling, you’re already anxious, you’re already feeling like things are really bothering you… that makes it worse. And sometimes people get so frustrated they just say: ‘OK, I gotta leave. I can’t stay.’”

Here, “they hit the door, and they’re can be seen by a clinician minute one, like urgent care, whenever we’re sick,” Strite said.

More severe cases will be placed in an airy observation unit at the clinic, where patients can stay up to 24 hours for treatment by a multi-disciplinary team that includes psychiatrists, substance abuse specialists and social workers.

If, during that time, it’s determined that higher levels of care are needed, those patients would then be handed off to the appropriate in-patient partner.

Based on results at its existing centers, Lopez said, up to 70 percent of Connections’ clients receive some level of direct care at the facility, work-out a follow-up plan and are discharged back home on the same day.

How we got here

The Harrisburg center is the result of a $13.1 million Community Mental Health Services block grant awarded to Cumberland and Dauphin counties in September 2022 for a joint project.

The grant funding will be used to backfill gaps between revenues and expenses through the first two years of operations, as Connections seeks to negotiate agreements for reimbursement for services from private insurers, managed care programs and Medicare / Medicaid.

The calculated risk is that those private insurers buy in, recognizing the cost prevention benefits of this type of treatment.

“We believe that there is a sustainable path here. We believe that it shouldn’t just be county-based dollars that are coming in to fund or supplement what commercial insurers should be paying,” Connections Vice President for Growth Matt Miller said, noting most commercial insurers are already doing business with Connections in its other states.

“And it ultimately should be viewed as a cost savings to those insurers because they’re not spending the dollars on an emergency room visit or potentially a long-term hospitalization that could have been provided here,” he added.

Strite said Connections was the unanimous choice of a selection team that included elected officials, professional staff and people living with mental illness evaluated the proposals.

Miller, said the company was interested in bringing its model to Pennsylvania because state laws and regulations concerning mental health treatment align with its operations.

While the center opens for adult services Dec. 11, Connections’ local team has already spent months on the ground here building relations with the community stakeholders that may be referring patients to – and receiving patients from – the Harrisburg center. (The center will start seeing youth clients on Jan. 13.)

When fully operational, the clinic will be capable of serving up to 16 adults and 8 youth at once.

It’s not going to solve all the pinch-points in the delivery of mental health services, Strite said. There’s still a major shortage, the local administrators said in short-term crisis stabilization beds that are designed to house patients for up to 14 days.

But the walk-in clinic is a start that the region hasn’t had before.

And everybody’s looking forward to that.

“In other parts of the nation that have implemented this model, they’ve seen a reduction in the use of in-patient psychiatric treatment… helping people stay well in their communities. And honestly that’s what it’s all about, is trying to help people be well in their communities,” Strite said.