Chapter DHS 34

DHS 34.22(1)(a)1. 1. A description of the nature and extent of the emergency mental health service needs in the county.

DHS 34.22(1)(a)2. 2. A description of the county’s overall system of care for people with mental health problems.

DHS 34.22(1)(a)3. 3. An analysis of how the services to be offered by the program have been adapted to address the specific strengths and needs of the county’s residents.

DHS 34.22(1)(a)4. 4. A description of the services the program offers, the criteria and priorities it applies in making decisions during the assessment and response stages, and how individuals, families and other providers and agencies can obtain program services.

DHS 34.22(1)(a)5. 5. A description of the specific responsibilities, if any, which other mental health providers in the county will have in providing emergency mental health services, and a process to be used which addresses confidentiality and exchange of information to ensure rapid communication between the program and the other providers and agencies.

DHS 34.22(1)(a)6. 6. Any formal or informal agreements to receive or provide backup coverage which have been made with other providers and agencies, and any role the program may play in situations in which an emergency protective placement is being sought for a person under s. 55.135, Stats.

DHS 34.22(1)(a)7. 7. Criteria for selecting and identifying clients who present a high risk for having a mental health crisis, and a process for developing, maintaining and implementing crisis plans under s. DHS 34.23 (7) on their behalf.

DHS 34.22(1)(a)8. 8. A description of the agreements, including any written memoranda of understanding which the program has made with law enforcement agencies, hospital emergency rooms within the county, the Winnebago or Mendota mental health institute, if used for hospitalization by the county, or the county corporation counsel, which do all of the following:

DHS 34.22(1)(a)8.a. a. Outline the role program staff will have in responding to calls in which a person may be in need of hospitalization, including providing services on-site and through telehealth.

DHS 34.22(1)(a)8.b. b. Describe the role staff will have in screening persons in crisis situations to determine the need for hospitalization.

DHS 34.22(1)(a)8.c. c. Provide a process for including the emergency mental health services program in planning to support persons who are being discharged from an inpatient stay, or who will be living in the community under a ch. 51, Stats., commitment.

DHS 34.22(1)(b) (b) If a program provides emergency services in conjunction with alcohol and other drug abuse (AODA) services, child protective services or any other emergency services, the coordinated emergency mental health services plan shall describe how the services are coordinated and delivered.

DHS 34.22(1)(c) (c) Prior to application for recertification under s. DHS 34.03 (6), a program shall review its coordinated emergency mental health services plan and adjust it based on information received through surveys under s. DHS 34.26, consultation with other participants in the plan’s development and comments and suggestions received from other resources, including staff, clients, family members, other service providers and interested members of the public.

DHS 34.22(2) (2) General objectives for emergency mental health services. A program providing emergency mental health services shall have the following general objectives:

DHS 34.22(2)(a) (a) To identify and assess an individual’s immediate need for mental health services to the extent possible and appropriate given the circumstances in which the contact with or referral to the program was made.

DHS 34.22(2)(b) (b) To respond to that need by providing a service or group of services appropriate to the client’s specific strengths and needs to the extent they can be determined in a crisis situation.

DHS 34.22(2)(c) (c) When necessary and appropriate, to link an individual who is receiving emergency mental health services with other community mental health service providers for ongoing treatment and support.

DHS 34.22(2)(d) (d) To make follow-up contacts, as appropriate, in order to determine if needed services or linkages have been provided or if additional referrals are required.

DHS 34.22(3) (3) Required emergency mental health services. An emergency mental health services program shall provide or contract for the delivery of all of the following services:

DHS 34.22(3)(a) (a) Telephone service. A telephone service providing callers with information, support, counseling, intervention, emergency service coordination and referral for additional, alternative or ongoing services. The telephone service shall do all of the following:

DHS 34.22(3)(a)1. 1. Be directed at achieving one or more of the following outcomes:

DHS 34.22(3)(a)1.a. a. Immediate relief of distress in pre-crisis and crisis situations.

DHS 34.22(3)(a)1.b. b. Reduction of the risk of escalation of a crisis.

DHS 34.22(3)(a)1.c. c. Arrangements for emergency onsite responses when necessary to protect individuals in a mental health crisis.

DHS 34.22(3)(a)1.d. d. Referral of callers to appropriate services when other or additional intervention is required.

DHS 34.22(3)(a)2. 2. Be available 24 hours a day and 7 days a week and have a direct link to a mobile crisis service, a law enforcement agency or some other program which can provide an immediate, onsite response to an emergency situation on a 24 hour a day, 7 day a week basis.

DHS 34.22(3)(a)3. 3. Be provided either by staff qualified under s. DHS 34.21 (3) (b) 1. to 19. or by fully trained volunteers. If the telephone service is provided by volunteers or staff qualified under s. DHS 34.21 (3) (b) 9. to 19., a mental health professional qualified under s. DHS 34.21 (3) (b) 1. to 8. shall be on site or constantly available by telephone to provide supervision and consultation.

DHS 34.22(3)(a)4. 4. If staff at a location other than the program, such as a law enforcement agency or a 911 center, are the first to answer calls to the telephone service, ensure that those staff are trained by program staff in the correct way to respond to persons in need, are capable of immediately transferring the call to an appropriate mental health professional and identify themselves as being part of the emergency mental health services system rather than the law enforcement agency or other organization where the calls are being picked up.

DHS 34.22(3)(b) (b) Mobile crisis service. A mobile crisis service that can provide onsite intervention for individuals experiencing a mental health crisis. The mobile crisis service shall do all of the following:

DHS 34.22(3)(b)1. 1. Be directed at achieving one or more of the following outcomes:

DHS 34.22(3)(b)1.a. a. Immediate relief of distress in crisis situations.

DHS 34.22(3)(b)1.b. b. Reduction in the level of risk present in the situation.

DHS 34.22(3)(b)1.c. c. Assistance provided to law enforcement officers who may be involved in the situation by offering services such as evaluation criteria for emergency detention under s. 51.15, Stats.

DHS 34.22(3)(b)1.d. d. Coordination of the involvement of other mental health resources which may respond to the situation.

DHS 34.22(3)(b)1.e. e. Referral to or arrangement for any additional mental health services which may be needed.

DHS 34.22(3)(b)1.f. f. Providing assurance through follow up contacts that intervention plans developed during the crisis are being carried out.

DHS 34.22(3)(b)2. 2. Be available for at least 8 hours a day, 7 days a week during those periods of time identified in the emergency mental health services plan when mobile services would be most needed.

DHS 34.22(3)(b)3. 3. Have the capacity for making home visits and for seeing clients at other locations in the community. Staff providing mobile services shall be qualified under s. DHS 34.21 (3) (b) 1. to 15., except that staff qualified under s. DHS 34.21 (3) (b) 15. to 19. may be included as part of a mobile crisis team if another team member is qualified under s. DHS 34.21 (3) (b) 1. to 14. A mental health professional qualified under s. DHS 34.21 (3) (b) 1. to 8. shall either provide in-person supervision or be available to provide consultation by phone.

DHS 34.22(3)(b)4. 4. Permit the provision of additional mobile crisis services via telehealth when those services are provided concurrent with onsite response.

DHS 34.22(3)(c) (c) Walk-in services. A walk-in service that provides face-to-face support and intervention at an identified location or locations on an unscheduled basis. A walk-in service shall do all of the following:

DHS 34.22(3)(c)1. 1. Be directed at achieving one or more of the following outcomes:

DHS 34.22(3)(c)1.a. a. Immediate relief of distress and reducing the risk of escalation in pre-crisis and crisis situations.

DHS 34.22(3)(c)1.b. b. Referral to or arrangement for any additional mental health services which may be needed.

DHS 34.22(3)(c)1.c. c. Self-directed access to mental health services.

DHS 34.22(3)(c)2. 2. Be available for at least 8 hours a day, 5 days a week, excluding holidays. The specific location or locations where walk-in services are to be offered and the times when the services are to be offered shall be based on a determination of greatest community need as indicated in the coordinated emergency mental health services plan developed under sub. (1).

DHS 34.22(3)(c)3. 3. Be provided by the program or through a contract with another mental health provider, such as an outpatient mental health clinic. If the walk-in services are delivered by another provider, the contract shall make specific arrangements to ensure that during the site’s hours of operation clients experiencing mental health crises are able to obtain unscheduled services within a short period of time after coming to the walk-in site.

DHS 34.22(3)(c)4. 4. Be provided by persons qualified under s. DHS 34.21 (3) (b) 1. to 14. However, persons qualified under s. DHS 34.21 (3) (b) 9. to 14. shall work under the supervision of a mental health professional qualified under s. DHS 34.21 (3) (b) 1. to 8.

DHS 34.22(3)(c)5. 5. Permit the provision of walk-in services via telehealth when those services are used in conjunction with in-person response.

DHS 34.22(3)(d) (d) Short-term voluntary or involuntary hospital care. Short-term voluntary or involuntary hospital care when less restrictive alternatives are not sufficient to stabilize an individual experiencing a mental health crisis. Short-term voluntary or involuntary hospital care shall do all of the following:

DHS 34.22(3)(d)1. 1. Be directed at achieving one or more of the following objectives:

DHS 34.22(3)(d)1.a. a. Reduction or elimination of the symptoms of mental illness contributing to the mental health crisis.

DHS 34.22(3)(d)1.b. b. Coordination of linkages and referrals to community mental health resources which may be needed after the completion of the inpatient stay.

DHS 34.22(3)(d)1.c. c. Prevention of long-term institutionalization.

DHS 34.22(3)(d)1.d. d. Assistance provided in making the transition to a less restrictive living arrangement when the emergency has passed.

DHS 34.22(3)(d)2. 2. Be available 24 hours a day and 7 days a week.

DHS 34.22(3)(d)3. 3. Be available for both voluntary admissions and for persons under emergency detention under s. 51.15, Stats., or commitment under s. 51.20, Stats.

DHS 34.22(3)(e) (e) Linkage and coordination services. Linkage and coordination services to support cooperation in the delivery of emergency mental health care in the county in which the program operates. Linkage and coordination services shall do all of the following:

DHS 34.22(3)(e)1. 1. Be provided for the purpose of achieving one or more of the following outcomes:

DHS 34.22(3)(e)1.a. a. Connection of a client with other programs to obtain ongoing mental health treatment, support and services, and coordination to assist the client and his or her family during the period of transition from emergency to ongoing mental health services.

DHS 34.22(3)(e)1.b. b. Coordination with other mental health providers in the community for whom the program is designated as crisis care backup, to ensure that adequate information about the other providers’ clients is available if a crisis occurs.

DHS 34.22(3)(e)1.c. c. Coordination with law enforcement, hospital emergency room personnel and other county service providers to offer assistance and intervention when other agencies are the initial point of contact for a person in a mental health crisis.

DHS 34.22(3)(e)2. 2. Be available 24 hours a day, 7 days a week as a component of the services offered under pars. (a) to (d).

DHS 34.22(3)(e)3. 3. Be provided by persons qualified under s. DHS 34.21 (3) (b) 1. to 19.

DHS 34.22(3)(f) (f) Services for children and adolescents and their families. Each program shall have the capacity to provide the services identified in pars. (a) to (e) in ways that meet the unique needs of young children and adolescents experiencing mental health crises and their families. Services for young children and adolescents and their families shall do all of the following:

DHS 34.22(3)(f)1. 1. Be provided for the purpose of achieving one or more of the following outcomes:

DHS 34.22(3)(f)1.a. a. Resolution or management of family conflicts when a child has a mental health crisis and prevention of out-of-home placement of the child.

DHS 34.22(3)(f)1.b. b. Improvement in the young child’s or adolescent’s coping skills and reduction in the risk of harm to self or others.

DHS 34.22(3)(f)1.c. c. Assistance given the child and family in using or obtaining ongoing mental health and other supportive services in the community.

DHS 34.22(3)(f)2. 2. Include any combination of telephone, mobile, walk-in, hospitalization and stabilization services determined to be appropriate in the coordinated emergency mental health services plan developed under sub. (1), which may be provided independently or in combination with services for adults.

DHS 34.22(3)(f)3. 3. Be provided by staff who either have had one year of experience providing mental health services to young children or adolescents or receive a minimum of 20 hours of training in providing the services within 3 months after being hired, in addition to meeting the requirements for providing the general type of mental health services identified in pars. (a) to (e).

DHS 34.22(3)(f)4. 4. Be provided by staff who are supervised by a staff person qualified under s. DHS 34.21 (3) (b) 1. to 8. who has had at least 2 years of experience in providing mental health services to children. A qualified staff person may provide supervision either in person or be available by phone.

DHS 34.22(4) (4) Optional stabilization services.

DHS 34.22(4)(a) (a) In addition to services required under sub. (3), a program may provide stabilization services for an individual for a temporary transition period, with weekly reviews to determine the need for continued stabilization services, in a setting such as an outpatient clinic, school, detention center, jail, crisis hostel, adult family home, community based residential facility (CBRF) or a foster home or group home or child caring institution (CCI) for children, or the individual’s own home. A program offering stabilization services shall do all of the following:

DHS 34.22(4)(a)1. 1. Provide those services for the purpose of achieving one or more of the following outcomes:

DHS 34.22(4)(a)1.a. a. Reducing or eliminating an individual’s symptoms of mental illness so that the person does not need inpatient hospitalization.

DHS 34.22(4)(a)1.b. b. Assisting in the transition to a less restrictive placement or living arrangement when the crisis has passed.

DHS 34.22(4)(a)2. 2. Identify the specific place or places where stabilization services are to be provided and the staff who will provide the services.

DHS 34.22(4)(a)3. 3. Prepare written guidelines for the delivery of the services which address the needs of the county as identified in the coordinated emergency mental health services plan developed under sub. (1) and which meet the objectives under subd. 1.

DHS 34.22(4)(a)4. 4. Have staff providing stabilization services who are qualified under s. DHS 34.21 (3) (b) 1. to 19., with those staff qualified under s. DHS 34.21 (3) (b) 9. to 19. supervised by a person qualified under s. DHS 34.21 (3) (b) 1. to 8.

DHS 34.22(4)(b) (b) If a program elects to provide stabilization services, the department shall provide or contract for on-site consultation and support as requested to assist the program in implementing those services.

DHS 34.22(4)(c) (c) The county department of the local county may designate a stabilization site as a receiving facility for emergency detention under s. 51.15, Stats., provided that the site meets the applicable standards under this chapter.

DHS 34.22(5) (5) Other services. Programs may offer additional services, such as information and referral or peer to peer support designed to address needs identified in the coordinated emergency mental health services plan under sub. (1), but the additional services may not be provided in lieu of the services under sub. (3).

DHS 34.22(6) (6) Services provided under contract by other providers. If any service under subs. (3) to (5) is provided under contract by another provider, the program shall maintain written documentation of the specific person or organization who has agreed to provide the service and a copy of the formal agreement for assistance.

DHS 34.22(7) (7) Services in combined emergency services programs. Counties may choose to operate emergency service programs which combine the delivery of emergency mental health services with other emergency services, such as those related to the abuse of alcohol or other drugs, those related to accidents, fires or natural disasters, or those for children believed to be at risk because of abuse or neglect, if the services identified in sub. (3) are available as required and are delivered by qualified staff.

DHS 34.22 History History: Cr. Register, September, 1996, No. 489, eff. 10-1-96; correction in (3) (c) 4. made under s. 13.93 (2m) (b) 7., Stats., Register October 2004 No. 586; correction in (1) (a) 6. made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635; CR 23-053: am. (1) (a) 8. a., (3) (b) (intro.), cr. (3) (b) 4., am. (3) (c) 3., cr. (3) (c) 5., am. (5) Register September 2023 No. 813, eff. 10-1-23.

DHS 34.23 DHS 34.23 Assessment and response.

DHS 34.23(1) (1) Eligibility for services. To receive emergency mental health services, a person shall be in a mental health crisis or be in a situation which is likely to develop into a crisis if supports are not provided.

DHS 34.23(2) (2) Written policies. A program shall have written policies which describe all of the following:

DHS 34.23(2)(a) (a) The procedures to be followed when assessing the needs of a person who requests or is referred to the program for emergency mental health services and for planning and implementing an appropriate response based on the assessment.