New mental health crisis center: ‘No wrong door’

Most people don’t know how to navigate the mental health system or where to find entry points even on their very best days. So when a crisis comes, the challenge can seem overwhelming. But Wasatch Front adults will find a new open door to begin their journey when the Kem and Carolyn Gardner Mental Health Crisis Care Center formally open its doors to those who are struggling.

Huntsman Mental Health Institute, part of University of Utah Health, cut the ribbon Friday for its new facility and was holding an open house from noon to 6 p.m. for the public. They’ll be hosting a grand opening block party from 10 a.m. to 2 p.m. Saturday including tours, music, face painting, special guests and food trucks. The center officially opens Monday.

The new 81,600-square-foot facility, located at 955 W. 3300 South in South Salt Lake, will provide walk-in care to adults experiencing a mental health crisis, then will help that person navigate the ensuing mental health journey.

The mental health experts call the approach “no wrong door.”

“No fear, no shame, no confusion, no nothing,” is how Kevin Curtis, the center’s director, describes it. The goal is to remove any feeling of stigma for someone asking for help. What people need, he said, is a “warm welcome, no judgment and reassurance you’re on the right track, and we’re here to help figure out what your path looks like, to immediately stabilize and help connect you into that.”

It’s a new model of care that welcomes all adults with a mental health crisis, regardless of insurance or its lack. Because of the unique funding for intake, people can be stabilized and then get long-term needs figured out. Funding at the stabilization stage is provided by a unique blend of commercial insurance and Medicaid, as well as county and state allocations, so patients don’t face out-of-pocket costs. Finances aren’t a barrier to starting to feel better.

The institute’s existing adult receiving center, which this will replace, could serve 11 guests, but this new center increases that to 33 experiencing mental health crises who can be stabilized. Within 23 hours, the center is designed to figure out what should happen next, which may be onsite, in another program or in the community with some supportive resources. The center also has 24 in-patient beds, a legal clinic, a dental clinic and the ability to make a “warm handoff” to other mental health providers as needed.

The center staff will try to understand a person’s insurance situation, but it won’t impact whether someone in crisis receives care. It becomes relevant with those next steps. If a person with a particular insurance needs an inpatient environment for longer, the center will try to direct them where that insurance can be used, Curtis said.

The point is to get people out of crisis and started on being well.

An often unmet need

The need for mental health services in Utah is substantial and often goes unmet. The Utah Department of Health and Human Services’ recent data reports that Utah averages 670 suicides a year. An additional 5,492 Utahns try to take their own lives every year. “Those numbers are consistently higher than national averages and have been for a long time,” per the data.

Russell Belt and Heidi Bruce are among Utahns who once struggled to find the help they need and will tell you how important finally starting the journey to care can be. But where to go was a very real question for each of them.

Belt was a high-performing and sociable high school student until suddenly he wasn’t, instead plagued by depression and anxiety. His journey turned out to be a roller coaster of highs and lows that included coming home from a mission for his church, letting go of plans for medical school, though he eventually returned to college and completed a bachelor’s degree, several moves, therapy and different medications and treatments that had varying degrees of success. Some prescriptions left him sluggish and feeling worse, but he found neurofeedback and therapy helpful. He now also has a medication plan that works.

Along the nearly quarter-century of that journey — he’s now 43 — he started medicating with alcohol. And an occasional drink turned into one nightly, then became two or three drinks. He maintained a job the whole time at Codale Electric Supply, but weekends he drank himself into misery. And when he tried to stop, he couldn’t maintain it and his periods of sobriety got shorter and shorter while he felt worse and worse.

When he knew he needed help, he had no idea where to go, so he did what most people do: He went to the emergency room. In time, he received inpatient treatment from the Huntsman Mental Health Institute and is no longer in crisis.

Places to go

Bruce’s story is somewhat similar, but with a heavier dose of fear of being stigmatized, so she kept her struggles a secret for years. Now, the general manager of Pioneer Theatre Company speaks openly of desperately needing and finding treatment. She, too, is in alcohol recovery. And she’s now a member of the Huntsman Mental Health Institute’s Patient and Family Advisory Council.

Bruce said she tried to handle things on her own for several years and was very good at functioning and hiding her addiction. But she could tell she was losing control of it. “I didn’t know what to do,” she said, adding that she thinks she created a crisis for herself so she would have to get outside help.

A friend took her to the institute, which back then was called the University Neuropsychiatric Institute.

“It was the best vacation I ever had. My brain got to relax and focus on getting better. At the tail end, I was meeting amazing people: social workers, nutritionists, psychiatrists,” she said.

Long out of residential care now, she still works after-care and also mentors others.

“Powerful” is the emotion she said she felt as she recently toured the new center with other members of the patient-family council. The center is built on the expertise of the staff, but also the experience of those who have lived with mental illness, addiction and related challenges and were asked what they needed and did or didn’t get during their struggles and treatment.

“There are so many different ways into a solution and this place inhabits all of them. In extreme mental crisis, there are places they can take you. If you are coming off something, there are places they can take you,” Bruce said. “What I think is most helpful is, a lot of times police and ambulance services don’t have recourse other than jail and these aren’t situations for that.”

The center has resources for many different situations, as well as “all the bells and whistles,” she said.

Inside the center

Curtis gave Deseret News a tour of the center a few weeks ago, as furniture and art was just being moved into place. It’s a bright, airy three-story building that’s designed to reduce stigma and make mental health services readily accessible.

“We’re trying to make part of this project be about not only better responding to the mental health crisis, but also using this project to fight some of the stigma that continues to be part of mental health,” he said.

The dental health clinic is really important. A 2023 study in the Journal of Dental Research highlights a link between mental health and oral health, noting that symptoms of problems related to depression or anxiety “are plausible risk factors for future oral disease.” The study calls for coordinating dental care and mental health treatment.

But there’s another link, too. The center is built around the idea that mental health crisis isn’t just about big problems. Sometimes a series of smaller but very real problems pile up. If you’re struggling with mental health and your teeth ache, it’s that much worse. Same for the legal clinic. Add an eviction, for instance, to your mental health crisis and it may seem insurmountable.

“This model is very focused on identifying the drivers and creating connections for resolving them,” Curtis said.

The legal clinic is a partnership with the University of Utah’s S.J. Quinney College of Law, the dental clinic a collaboration with the University of Utah School of Dentistry. They also have a couple of primary care medical-oriented pieces they’re building in collaboration with a couple of different health-based departments at the university. Some of the simple legal and dental things can be done at the center; more complicated can be referred.

”None of these things are things that you can stabilize in one day, but if we can create an experience that says, I see you, I understand what it is that you’re struggling with, let’s get you started on the path towards resolution, that is magical in terms of how quickly it resolves that feeling of, I can’t do this anymore,” Curtis said.

The crisis care center staff includes psychiatrists, advanced practice nurses, nurse managers, social workers, case managers, certified peer specialists and psychiatric technicians, as well as full support staff, from environmental techs to dietary support, check-in staff and security. It also benefits because those receiving medical training will rotate through. And it’s a location for University of Utah’s interdisciplinary research, too. While the people seeking help there benefit, so do various bigger communities.

While emergency rooms weren’t designed to do mental health intake and they didn’t volunteer for the task, they often are used that way, said Curtis. So one goal is to provide people in crisis with an understanding of how to get help that starts instead at the center’s doorstep.

It’s estimated fewer than 10% of those seeking mental health services at an ER receive any long-term guidance on how to address their issue.

The center’s first floor is about stabilizing those in crisis, Curtis said, with space for intake and assessment. Under its triage model, just 3% require emergency room care. Police and emergency medical service personnel are being trained to use their judgment and when possible divert those in mental health crisis to the new center, reducing the number of times someone is taken to an emergency room or jail when it’s not necessary.

If someone who goes to the center needs to be in an emergency room, they’ll figure it out quickly, Curtis said.

“This whole space is about very brief encounters that are meant to evaluate medical safety. So our nurses ask folks a set of evaluation questions there about understanding their medical safety, and if there are concerns that they might actually truly need to be in an emergency room. Most people don’t.”

One of the drawbacks of emergency rooms for someone in a mental health crisis is long waits, Curtis said.

Instead, while guests — they’re not called patients in this facility — wait for evaluation, they can engage in therapeutic and recreational activities. Those can be flexible based on acuity, diagnosis and comfort level. Nursing staff and psychiatric technicians observe and support guests based on individual need. Someone who’s highly agitated might be placed in a calming setting, for instance.

The crisis center will use suicide risk scales, agitation risk scales and violence risk scales. Curtis said, “Based on that, we’re able to immediately get people into more active treatment environments.”

To make it more efficient for law enforcement, the center has a restroom and snacks in an area where the officers can take a break and complete their reports. That floor’s also home to the medical, legal and dental outpatient services.

‘That place saved my life’

Inpatient care occupies the third floor with 24 single-occupancy rooms, set up in three pods of eight. This floor also has a floor simply called “the porch.” It’s an outdoor-facing alcove with fresh air and a look out onto the grounds. Bruce said when she was in an inpatient program, that would have meant everything.

“I don’t think they maybe even understood what that means. You are literally locked in a building and get out for maybe 15 minutes,” she said of the program she was in. “The porch is life-altering. It lets you feel freedom, that you’re not just trapped.”

She can’t say enough good things about the institute or its role in her turnaround. “I don’t come off as a very emotional person, but that place literally — literally! — saved my life. I know that for a fact,” Bruce said.

Bruce emphasized she’s not an especially emotional person, but the center makes her feel emotional. “I hope the people who go there feel what I feel the opportunity is.”

The center partners with various university departments to provide specialized care, including transcranial magnetic stimulation for treatment-resistant mood disorders. They have intensive outpatient programs for those requiring additional support but not inpatient care. Part of the partnership with others includes community events and training. For instance, law enforcement crisis intervention training is provided.

Always more to do

Walk-in crisis short term intensive care is just a piece of the mental health puzzle. There are others, including the 988 suicide and crisis lifeline that’s staffed by Huntsman Mental Health Institute professionals, the SafeUT app used by educators, parents, students, frontline workers and Utah National Guard members and their families; mobile crisis outreach teams; mental health first responders that provide after-hours crisis support for University of Utah students; follow-up calls and a warm line.

The breakdown of what’s already happening is telling. The institute said that 1 in 10 walk-in crisis guests need inpatient care, which is provided at the institute and will also be available at the center. Slightly over that 1 in 10 are transitioned into residential care. In the last year, the existing institute program had 2,649 individuals in walk-in intensive crisis care. Nearly 8 in 10 were returned to their community with some outpatient support.

Belt had a complicated journey with moves and stops and starts. He started and stopped school, then started again. He started and stopped drinking, then started again. He was lonely and isolated and couldn’t keep a relationship going, he said.

Becoming well has involved a lot of different people. When he knew things were out of control, he executed the safety plan he’d crafted with his therapist. He took his crisis to the institute where he found some direction. He spent seven days in residential detox, then transferred to a residential treatment center. And he told a couple of people he really trusted what was going on: his mom and a boss.

Belt had been sober 175 days when he told the Deseret News his story last month, looking forward to his sixth-month mark, which he’s now past. His work life has blossomed and he now manages others within the automation division of his company. He has tools to manage stress and feels like he’s growing.