The Living Room Model

A Better Solution for Mental Health & Substance Abuse Crises in Our Community

Each year in the United States, approximately 1 in 5 people visit an emergency room at least once. These visits are typically due to injuries and issues such as chest pain, broken bones, falls, strokes or back pain. Although emergency rooms are designed for physical ailments such as these, approximately four percent of all visits are due to mental illness or substance use, including overdose, acute psychotic episodes, panic attacks, suicide attempts and more.

Unfortunately, emergency rooms are not always set up to adequately treat mental illness or behavioral health due to time constraints and stressful surroundings—often a fast-paced environment filled with bright lights, loud noises and other factors that can be anxiety-inducing for those undergoing treatment. Most emergency room doctors also do not specialize in mental health or addiction and will often treat the medical symptoms rather than the mental and emotional causes of a person’s condition. As a result, many people with mental illness leave the emergency room in emotional pain and turmoil because the origin of their crisis was never addressed. This isn’t the fault of emergency room care providers or the patients themselves. Rather, it is a complex problem that needs addressing in the community.

The Living Room Model was designed as a response to the community need for mental health services outside of the emergency room setting. The Living Room model is a community crisis center that offers people experiencing a mental health crisis an alternative to hospitalization. When people experience a mental health crisis, they are faced with the decision to go to the emergency department or to try to manage the crisis themselves. This model is an evidence-based, alternative solution to emergency rooms, and even involvement of law enforcement, to properly respond to crises related to mental health and substance abuse. The Living Room model was developed by the National Alliance on Mental Illness (NAMI) to provide a walk-in respite for persons experiencing mental health crises. The Living Rooms are staffed by persons with lived experience, known as Recovery Support Specialists (RSS), allowing them to better connect with “guests” who walk in.

St. Margaret’s Center for Holistic Health & Wellness (CHHW) has partnered with Arukah Institute of Healing in Princeton to bring the Living Room model of care to Central Illinois. Arukah provides client-centered, complementary health and counseling services to foster prevention wellness and mental health in rural communities. Arukah’s method involves a variety of unique approaches, including novel, video-based programs and mind-body therapies, as well as more conventional, individual and group therapies. As with previous collaborations, CHHW is combining resources with Arukah to better serve the needs of the community and expand mental health services throughout LaSalle, Bureau, Putnam and Marshall Counties.

The partnership between Arukah and St. Margaret’s has been developing for approximately two years now. Arukah, as a behavioral health and wellness organization, came together with St. Margaret’s to collaboratively provide nine core Certified Community Behavioral Health Clinic (CCBHC) services that span from medical care to mental illness and substance use (MI/SUD) care to daily needs care. Prior to the CCBHC, many behavioral health needs were being detected in primary or emergency room care, but the connection to behavioral healthcare was inefficient and persons struggling would fall through the cracks. Additionally, the rising opioid epidemic and the insufficient access to crisis and wraparound care for people with chronic MI/SUD have necessitated new models, particularly those that can operate outside the four walls of a clinic. Integrated behavioral health services—the model used by CHHW and Arukah—have shown much success at reducing unnecessary Emergency Department visits and reducing chronic and communicable diseases throughout the country.

St. Margaret’s Health and Arukah have developed an effective partnership and hierarchical structure for the Certified Community Behavioral Health Clinic that best synergizes efforts for community-wide impact. Leadership of CHHW is shared by the two organizations and supported by an Advisory Committee that includes sixteen members and representatives from vulnerable populations within the community. Ten members are consumers/family members of persons in recovery from MI/SUD, nine are women and four are persons of color. Linda Burt, MSN, Sarah B. Scruggs, PhD and Benjamin Shepherd, MD, are Chief Officers for the CCBHC, serving as Project Director, Evaluator and Medical Director, respectively. Mike Lau, MA, MS, PhD, LCPC and Mike Miroux, LCPC, serve as Clinical Directors for each organization. Arukah administers outpatient behavioral health and substance use services, recovery support and re-entry services, 24/7/365 crisis services and care coordination. St. Margaret’s Health brings the psychiatric and medication-assisted treatment services, primary care screening for key risk factors and the Behavioral Health Integration (BHI) model, which embeds therapists and case management within primary care clinics to create a more effective care plan for clients. Each entity provides a combination of services that align with their strengths. This utilizes staff and resources in a more efficient manner, expands access to care throughout the four counties and ultimately strengthens the rural healthcare system as a whole.

The Living Room will open in June 2022 and provide additional clinical resources, substance misuse/recovery resources and access to social determinant resources, such as housing, employment and food. Living Rooms are rare in rural communities, making this effort somewhat unique. The Illinois Valley, like every community, faces its own unique set of issues and challenges. The Living Room model here has been adapted to address the most pressing needs. Sarah Scruggs, PhD, Director of Arukah Institute explains: “We will also address substance use-related crises, something not addressed by conventional Living Room facilities. We believe the creation of the Living Room in our rural area will provide much needed access to vital services, without judgement and regardless of ability to pay. We also recognize that, in spite of their empathy and dedication, police officers and emergency room staff are not trained or equipped to handle mental health and substance misuse crises as well as trained RSS and clinical staff can. We are partnering with local hospitals, law enforcement and a host of others to bring these services to our community.”

The Living Room model is one piece of expanding mental health, substance abuse and crisis care in the Illinois Valley. The partnership between St. Margaret’s Center for Holistic Health and Wellness and Arukah Institute of Healing will continue to offer traditional and complimentary/ alternative therapies. There are a variety of providers between St. Margaret’s and Arukah that have an array of clinical competencies and focus. These range from trauma-informed, addiction-focused, crisis counseling, serious and persistent mental illness, anxiety/depressive disorders, eating disorders, recovery-oriented, faith-based counseling, psychological testing, family- and youth-focused counseling, among others. In addition, they offer a variety of group counseling options geared towards teens, substance misuse, life skills and boundaries. Community training for groups such as schools, first responders and other leaders are also available.

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