LINN — In September of 2023, Osage Ambulance District received a federal grant of $800,000 per year for four years, from the Substance Abuse and Mental Health Services Administration (a branch of the Department of Health and Human Services), to fund a pilot program meant to expand mental health and substance abuse services in their service area, which covers portions of Osage, Maries, and Gasconade Counties.

Per a stacker.com article published in Dec. 2023, Osage County ranks 13th from last in the nation (3,142 total counties), with only one mental healthcare provider in the county.

“Our existing protocols allow us to transport patients only to the emergency room,” said EMS Chief Josh Krull, in a September 2022 interview. “With an increase in behavioral health issues, unfortunately, all we can do is take them to a hospital.

There is no adequate treatment, and people fall through the cracks.”

With this pilot program, EMS staff hope to bridge that gap. Krull was invited to speak about the program at the 2024 Mobile Integrated Healthcare (MIH) Summit in Nashville, Tenn., last month, where he presented three case studies.

In the cases he presented, patients would have typically been transported to a medical emergency room by EMS or law enforcement, and seen by a medical doctor.

“They’re getting ER physicians (and) nurses,” Krull said. “That’s where patients that are having heart attacks and strokes and traumas go, and they are not staffed with psychiatrists and mental health professionals and counselors around the clock.”

The Compass Health Crisis Intake Center in Jefferson City and Rolla, however, are staffed 24 hours a day with mental health professionals.

“Our grant allows us to have some leverage,” Krull said. “And we’re trying to pilot a program where we can take patients that are cooperative and willing and not having any medical emergencies there, instead of to an emergency room, which has not been traditionally done before.”

Insurance companies cover transportation to the hospital emergency room, but not to a mental health center, so the grant will fund that transportation, among other things.

Paramedics are also being trained in Crisis Intervention, to give them the skills to deescalate a mental health crisis. Osage Ambulance District currently has five paramedics who have received the training, with more scheduled for summer and autumn.  The district currently has one of these personnel on duty at all times.

“In our case studies we recently took two patients that were having a mental health crisis, and would have otherwise gone to an emergency room, to the Jefferson City Crisis Center,” said Krull. “Then one patient, recently, we utilized Compass Health’s mobile crisis response team to respond out with us. It was a patient who was having a mental health crisis, and instead of being either arrested and put on a psychiatric hold, or us taking them to the hospital, we had a mental health professional come back to the scene with us, and we had one of our paramedics who is trained in crisis intervention go out there, assess the situation, and figure out basically what the root causes were — that they needed counseling services and needed to know where some resources were.

“Although they were having a mental health emergency, they weren’t a danger to themselves or weren’t a danger to anyone else, so we actually just worked on a stay at home plan for that person, that safety plan, and then set them up with next day services.”

Krull said he thinks it’s a huge success story that a person who didn’t know who to call was able to call the suicide hotline, where she knew someone would answer, and reach people who could connect her with the services she needed, both during her moment of crisis and to help solve the problem that put her in crisis to begin with.

“There is also the 988 number, which is for people in crisis,” Krull wanted to remind people.

“We’re basically trying to get people outside the comfort zone of doing things the way we’ve always done them,” Krull continued. “And how to better care for mental health patients and getting to try to affect change, starting here in Missouri.”

This pilot program also allows EMS personnel the ability to follow up after substance abuse calls.

“At a high level, it allows us to focus on substance abuse problems in our response area, with training with addiction, (and) with recovery,” said Krull. “We’re providing education, we’re leaving Narcan behind and teaching people how to use it, because in the rural areas, by the time we get there, we might not be able to do any good.”

Krull said they also have a community medic tasked with the job of following up with patients after a substance-related call. The new software they’re developing will allow EMS staff to flag calls for follow up when additional services are recommended.

Osage Ambulance District, Krull said, has almost 50 employees running about 4,200 calls per year over almost 1,000 sq miles, in partnership with approximately 11 local fire departments.

“Until we really started looking at this, and saying, ‘Wow, unless the same crew happened to run that person, they could fall through the cracks and (us) not know,” said Krull.  “So now we’re going into a system designed to where it will flag it. It will flag ‘Hey, it was an overdose, they need to have follow up.’ And then what happened on the follow up? So we’re going to actually have a system that is designed to allow us to track that better, and then track them no matter what crew runs them. (It’s the) follow up piece that we’ve been missing.

“The impact on the healthcare system is going to be significant,” Krull continued. “Our goal is, we want to be able to prove that not just our ambulance service should be able to do it, (but) that should be the standard of care.”