by Robert Canning
This week on NPR, two San Antonio mental health police officers were featured in a story about diverting mental health patients away from the criminal justice system, which has become the country’s de facto mental health system.
Also this week, a local man was killed by police after charging them with a knife. The Sacramento Bee has reported that he had a history of mental illness.
And finally, in this week’s Journal of the American Medical Association was an opinion piece advocating for affordable mental health care for all who need it, and recommending that crisis mental health care be available as an alternative to inpatient care.
For many years our public mental health system has suffered from stingy funding by the state. Services limped along with little continuity of care and lapses caused by the rise of managed care. The most needy mentally ill had few resources to call upon in a crisis. The economic collapse in 2008 pushed this system to the brink. In Yolo County the Department of Alcohol, Drug and Mental Health (ADMH) suffered massive layoffs and stopped providing a wide range of services, including active crisis/emergency care. When someone needed help in a dire emergency all they could do was go to an emergency room or call the police.
When someone called 911 for help because of mental illness-related crises, most often the police responded and delivered them to either the emergency room or the jail, depending on their behavior and the judgment of officers. With funding from the Mental Health Services Act, a few departments in the county have participated in Crisis Intervention Training, which is a 32-hour course to teach police officers effective interventions when encountering mentally ill individuals in the course of their work. This band-aid approach probably improved the outcomes some, but the law enforcement agencies were inconsistent in their participation and, at worst, did not participate.
In the next few months Yolo County will begin a new program that promises to change how crisis mental health care is delivered. In 2013 ADMH applied for a grant under SB 82, the Investment in Mental Health Wellness Act of 2013. County mental health programs were invited to apply to increase their ability to provide mental health care in real time as a crisis unfolds, rather than waiting passively at the emergency room or for the patient to be booked.
ADMH’s application attained the highest score of all grants submitted, and the county was awarded funding for a program. And with funds from a companion grant from the California Health Facilities Financing Authority, ADMH has purchased specially modified vans to support the crisis teams.
This fall, Yolo County will implement four Community Based Crisis Response Teams. As currently planned, there will be four teams – one each in Woodland, West Sacramento, Davis, and in Winters (covering rural Yolo). Each team consists of a mental health clinician and a peer counselor. Once law enforcement has ensured that the person in crisis is not a danger to others, they will do a warm hand off to the mental health clinician who will meet with the individual in the van that will have a seating area that is confidential.
The teams will be based out of the respective law enforcement agencies and will operate during the hours that these agencies experience the most calls involving the mentally ill or their families. Teams will be on duty five days a week 3:30 PM to midnight and off on Sunday and Thursday.
First estimates of the number of individuals served by the teams are over 2,200 annually. When a team is called out, their job will be crisis intervention and de-escalation. The core mission is safety and self-care planning – on the spot.
Citizens the team encounters will be offered direct access to emergency mental health services, Safe Harbor in Woodland, “fast track” ADMH appointments, and possibly hospital care. After-incident care will include peer counseling and short-term case management. The county plans to build in other services as the program progresses.
The Community Based Crisis Response Teams will increase the ability of law enforcement and our public mental health programs to provide services when clinics are closed – and when the crises occur. Added to the recently renewed services provided by Suicide Prevention and Crisis Services of Yolo County, our county has turned a corner to providing more light and hope for the mentally ill.
Robert Canning is a clinical psychologist who works for the state and specializes in suicide prevention.