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Rock County Crisis Intervention in transition

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ANN MARIE AMES
December 4, 2011
— Imagine for a minute that you're getting settled in at work when the phone rings. It's your mom.

Most likely mom is calling to tell you canned pumpkin is on sale this week at Woodman's. Maybe she wants to know if you have enough Scotch tape.


You really need to get to work or you're going to miss your deadline, but you know you have to answer the phone anyway. After all, mom could have a problem and really need your help.


That's kind of like the dilemma social workers faced last year at Rock County Crisis Intervention. They wanted to launch a mobile program in order to address complaints from local law enforcement agencies and meet best practices for mental health care. They just couldn't see how they could provide the service without hiring extra crisis workers.


It turned out the fix was less expensive than they thought.


After carefully monitoring data, administrators in the mental health division of Rock County Human Services found the limitation wasn't a lack of crisis workers. It was the phone.


Time and time again, a crisis worker would be ready to walk out the door for a mobile response when the phone would ring, said Melissa Meboe, Rock County Crisis Intervention supervisor. Maybe it would be someone calling because she felt she was going to kill herself. Of course, a social worker would need to assess the situation immediately.


On the other hand, maybe it would be someone who has lost medical insurance and needs help finding an alternative, affordable source of medication. That can be a frustrating situation, of course, but not imminently dangerous. It's also one that could be handled by someone whose training is less than that of a social worker.


The county tried changing the role of its crisis intervention psychology technicians, who were not answering calls but rather working to support crisis workers. The change freed up crisis workers who were then able to drive to homes, schools, the Rock County Jail or hospitals to assess people in emergency mental health situations.


It seems to be working. Since June, the county has reduced by 20 percent the average number of hospital admissions each month for crisis intervention clients. Rather than meet an expected all-time record number of hospitalizations in 2011, the county at this point is on track to hospitalize fewer people for mental health emergencies in 2011 than in 2010.


If that trend holds, it will be the first time since 2006 that the number has decreased.


"That's despite an increase in volume," said Kate Flanagan, manager of the mental health division of the county's human services department. "Hopefully what our data is telling us is we are making a difference."


Flanagan expects the trend to continue. Not only will this change save the county money, it provides better service to clients, she said.


"If we're responding in the community, we'll be in a better position to maximize our ability to find the least restrictive, safe options for that individual," Flanagan said.


Effective response


It's not jut the volume of calls to crisis intervention that has increased in the 14 years Terry Murphy has been on the job. The calls themselves have gotten tougher.


"They seem to be a lot more complex than the problems people called with when I started," Murphy said.


Murphy said the role of a crisis worker is to assess a person in crisis and how to keep the situation from escalating. Maybe it's helping people find resources or connecting them with a therapist or psychiatrist. Sometimes it's just listening to someone, Murphy said.


Responding to the scene of a crisis is a great tool, Murphy said. A person in crisis has tunnel vision, she said, and he or she might have trouble thinking about options other than unsafe ones.


A crisis worker can more easily work with law enforcement agents or a client's family members to learn exactly what is happening. The worker often can find clues in the home that help him or her brainstorm solutions.


Those solutions might be as simple as a photo on the wall or a book that jogs a client out of dangerous thinking and into safety, Meboe said.


"Seeing an individual in their environment and their community helps you see a broad range of options you might not see otherwise," she said.


The act of meeting with people in their homes or at schools helps Murphy and her colleagues connect with clients, she said.


"It feels like more of an honor to go into someone's world," Murphy said. "They are so vulnerable. You're seeing someone at their lowest. It's really hard to invite someone in to ask for help or even to receive help."


Mobile response also takes some potential stress off the client, Flanagan said.


In the past, police often would respond to a 911 call when someone is suicidal or threatening to hurt another person. If the officer decided the person qualified for an emergency mental health detention, the officer might drive the person to the Rock County Health Care Center on Janesville's north side in order to meet with a crisis worker.


Before crisis intervention went mobile, an officer might drive a severely depressed or suicidal person from home to the emergency room to crisis intervention, and on to the hospital. That can be stressful for a client and sometimes took a patrol officer off the streets for hours.


"It's more comfortable for the client, even if you can remove one leg of the transport when someone's in crisis," Flanagan said. "It takes out a step. It takes out potentially a transport in a law enforcement vehicle."


What's next?


The county plans in 2012 to be even more proactive in emergency mental health care, Flanagan said. In addition to providing around-the-clock mobile crisis services, the county will work to improve stabilization and prevention services with a goal of reducing the number of people who have crises.


Peer support professionals are trained to work with people who have mental illnesses or addictions. More importantly, they are people who have recovered from mental illness or addiction and are ready to share their knowledge and empathy.


The division also will create a management position to oversee addictions programs in Rock County. That person's job will include administering grants, managing treatment alternatives programs, analyzing addiction data and more, Flanagan said.


The position will not be a part of crisis intervention but likely will work closely with the program.


Flanagan is excited to see the number of hospitalizations decreasing despite the continued increase of calls to crisis intervention.


"Hopefully what our data is telling us is we are making a difference," she said. "It does feel exciting, and I would hope it feels exiting for the crisis workers, too. It's good to feel good about how you're serving people."


CHANGES PLANNED FOR 2012

Rock County Crisis Intervention in 2012 will add staff to support the unit's new mobile services. Here are the roles of staff members, as explained by Kate Flanagan, manager of the Rock County Human Services Mental Health Division:


Crisis worker—This clinical professional can make risk assessments and decisions about a client's treatment needs. The county has seven full-time crisis workers and about five part-time or temporary ones.


Psychological technician—This paraprofessional has experience and training but not necessarily the same formal education as a crisis worker. Among other things, technicians deliver medications and conduct other supportive tasks. Part of the shift to mobile crisis response has been increasing technicians' telephone duties. The county has 3.4 psych techs and will hire 2.8 more in 2012.


Alcohol and drug addiction coordinator—This will be a new position in 2012. This person will provide leadership for the county's mental health services that have a substance abuse aspect, "which is all of them," Flanagan said. This person will not necessarily be part of crisis intervention but will work with the unit since so many clients have dual mental illness and addiction diagnoses.


Crisis stabilization workers—The county has budgeted to create two stabilization caseworker positions in 2012. These clinical professionals will support clients in the days and weeks after a crisis and—hopefully—keep them from needing services again.


Peer support specialist—The county has budgeted to contract several part-time peer support specialists in 2012. This role is new for the county. These certified paraprofessionals bring a special skill set to the job. They are people who have survived mental illness or addiction and are able to provide experience, insight and empathy to clients. "What makes them unique is they have been there," Flanagan said. "They can therefore provide a different level of support and motivation than any of us, regardless of our degrees."


To get help


If you or a loved one is experiencing a mental health emergency such as severe depression or suicidal thoughts, call Rock County Crisis Intervention at (608) 757-5025. If someone is injured or in immediate danger, call 911.



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