Metaphor for Crisis White Paper

National Action Alliance for Suicide Prevention Survey 01 of the Crisis Services/Systems Task Force

November 2015

Target AudienceThe Crisis Services Task Force is timely because of potent changes underway in health care—catalyzed by national “parity” legislation and the Affordable Care Act–that include shifts in responsibility away from state mental health agencies to control by mainstream health systems and an increased emphasis on value payment and outcomes. The recently released CMS proposed rules on Medicaid managed care signal and will accelerate this shift in behavioral health care away from a being separate, protected industry to being part of mainstream systems. Given that care will increasingly be managed by health plans, it is crucially important to lay down a marker on the essential components of high functioning crisis care and hospital diversion systems.As a result, the Crisis Services Task Force is creating a white paper to inform leaders who might raise the bar on crisis systems in states across the country:• State Medicaid Directors• State Health and Mental Health/Addiction Commissioners• Health Plan Leaders and Hospital Administrators• Governors and Legislators

Why Some Ideas Survive and Others Die

• Simplicity. Capture your idea in terms anyone can understand.

• Unexpectedness. Our brains jolt out of autopilot when confronted with the unexpected. Communicate about your idea in an unexpected way to get it full attention.

• Concreteness. Forget vague; opt for distinct, specific language.

• Credibility. Ideas only spread if they’re believable. Use experts to back up your idea or story, or imbue it with facts and figures to illustrate your point.

• Emotional. Just as facts and figures offer credibility, so does appealing to your audience’s emotions so they feel inclined to act.

• Stories. Real world stories inspire people—far more than a marketing gimmick

The MetaphorOur goal is to galvanize a movement around crisis services. In order to capture lightning in a bottle, we will need more than a technical white paper. We will need an idea “Made to Stick.” The Zero Suicide in Healthcare initiative has been successful in large part because of its simple, unexpected and concrete language. Also, the Henry Ford Health System success story gives it credibility and a story.The metaphor does not need to carry the weight of the entire initiative, but provide a striking point for the burning platform that will draw attention and inspire action. The Task Force has generated four prototype options to date (see below). Please review the proposed framework and white paper outline below for a fuller picture of the total package being developed. Click the images below for a larger view.

Four Options

Surveying the MetaphorsMetaphor Option 1:

PuzzleOption 2: Air Traffic Control

Option 3: Uber

Option 4: National EMS

Aggregate Score (Lower Better)

67 50 87 66

First Place Votes

7 12 2 6

Last Place Votes

6 1 15 5

29 members of a total of 32 in the Crisis Services/Systems Task Force participated in this Survey Monkey questionnaire.

Option II: ATC#1 Choice with 12 first place and one last place votes• “Important to connote safety”

• “Big fan of ATC metaphor. Heard depersonalization concern - but - the reason people care about ATC, about planes falling from the sky is not because of the metal, it's because there are people on them. The metaphor animates.”

• “What appeals to me about the model is that there is a centralized and accountable system with trained people who know how to do the same thing routinely and yet respond to a severe crisis with a set of clear standards.”

• “Cost, public safety, and the law have driven major changes and investment. Crisis services need better data and technology to support the person. We need to target the intended audience.”

• “Great tie in with #zerosuicide, quality control, integrated systems with centralized focus. Towers have to hand off planes back and forth to ensure safety, love that metaphor. There is an inherent connection with flight, safety, life and freedom. Also helps get at the customer angle without having to say it, Its creates both a sense of responsibility and freedom, I believe overwhelming majority of public has a lot of faith in safety of our air system and that is a good tie and good inspiration for BH and crisis”

• “Re-thinking Crisis and Building a System that Cannot Fail” 50Lowest Aggregate Score Total Indicates Highest Interest

Option II: ATC (page 2)• “With no ATC, there is no assurance that flights are

landing safely. Without clear, electronic, real-time proof of where an individual is in the maze that is BH access, there is no assurance that individuals, fueled with serious illnesses are not being refused safe landings at facilities that can help them or are required to help them by law. There is no accountability without tight control. The diffusion of responsibility that occurs when referrals are shot-gunned all over the place perpetuates the problem. If nobody is responsible, then nobody is accountable…”

• “Time we embrace technology, and systems that will help BH integrate into the larger healthcare arena. Universal language is essential to this, everyone knows and agrees what ATC is, we cannot say the same for Crisis, but we need to.”

• “Although I don't have a metaphor at the moment, ‘any way and any time of day’ means call, text, chat, video interventions, mobile team, crisis walk-in/beds, etc. all available 24/7. We must find ways to be accessible in every way possible. Maybe we are the Expedia of Mental Health?”

50Lowest Aggregate Score Total Indicates Highest Interest

Option IV: EMS#2 Choice with 6 first place and 5 last place votes• “To simplify my preferred option (EMS), we could

drop "national" and leave it at "It's Time for a Mental Health EMS." This is clear, makes the point about what's missing, and is something people can easily remember/repeat. Air traffic control isn't clear enough/requires too much explanation to outsiders and we want state policy makers to get the gist of it from the title. People do have mixed feelings about Uber so I'd stay away from that, and ‘pieces together’ is over-used in our field.”

• “I would like to see where the Air Traffic Controller meets the National Mental Health EMS. The strengths of the two themes, technology and infrastructure, are critical during a time of crisis.”

• “No metaphor yet, but we must capture need for alternatives to boarding, hospitalization for containment”

66Lowest Aggregate Score Total Indicates Highest Interest

Option I: Puzzle#3 Choice with 7 first place and 6 last place votes• “All of them seem to be just a little off, but I can

not come up with a really catchy one. I have asked some of my creative minds in crisis services to give it some thought and if I get any more good ideas I will pass them along to you.”

• “There is a need to coordinate services through the use of an ATC model. Coordinated services should include State and Locally trained CIT, a crisis line that has real time data on access to services, a comprehensive mobile crisis program that includes peer supports and local emergency rooms linked to a bank of telemed providers trained in crisis management. Exceptional pieces alone are exceptional pieces. The masterpiece comes when the complement of exceptional pieces fitting and blending together.”

• “Suggest ‘Northstar - Guiding directions.’”

67Lowest Aggregate Score Total Indicates Highest Interest

Option III: Uber#4 Choice with 2 first place and 15 last place votes• “My concern about the Uber metaphor, beyond

that it may be controversial, is that many people still do not know what it is, and many who do have never used it. The power of the Uber metaphor comes when someone has actually used the technology, seen the little black cars on the screen... Plus, it's all about convenience and operational efficiency. But does not capture values of safety”

• “Is current and language immediately invites interest. ‘Uber’ translates to ‘over and above’ and describes a service which is immediately available upon demand to meet the needs of consumers. In current culture, Uber provides rides on demand with transportation in minutes to the desired location. What if BH services could be viewed as immediately and conveniently accessible in providing comprehensive crisis response and stabilization services and suicide prevention/ intervention for all individuals with MH and addiction challenges? An Uber approach would emphasize community-based services with the capacity for immediate and effective clinical intervention, triage, and stabilization services which would be a critical element of public mental health systems.“

87Lowest Aggregate Score Total Indicates Highest Interest