County rolls out 24/7 mobile crisis response
The Daily Astorian, June 27, 2018
Police and sheriff’s deputies in Clatsop County who have to make life-and-death decisions about people in mental health crisis will get some backup.
Mental health experts will be on call around the clock to advise law enforcement about whether someone who is acting out can be contained or needs to go to the hospital. The guidance could defuse often frantic, emotional confrontations in the community and avert unnecessary hospitalization or arrest.
“We really want to do as much as we possibly can to keep people out of the emergency room,” said Amy Baker, the executive director of Clatsop Behavioral Healthcare, the county’s mental health contractor.
Oregon promised to expand mobile crisis services statewide by July as part of an agreement with the U.S. Department of Justice to resolve a federal civil-rights investigation into the state’s treatment of the mentally ill.
The state has committed to a community-based mental health approach that emphasizes treatment over institutionalization and criminal justice. Some counties have paired mental health experts with police for the past few years and have seen promising results.
Yet many rural areas, like Clatsop County, have lacked the resources to adequately respond to people in mental health crisis or offer treatment locally.
Teams of two mental health experts from Clatsop Behavioral Healthcare will cover 12-hour shifts and answer police calls in the community. The outreach could give law enforcement deeper insight into people who are already on the county’s mental health radar, as well as provide a point of contact for people with undiagnosed or untreated mental illness.
“In many ways, people don’t access services until they’re in crisis,” Baker said.
Brighter lines
Clatsop Behavioral Healthcare, the target of intense criticism by some families over treatment decisions, has tried to use the rollout of mobile crisis services as an opportunity to draw brighter lines of responsibility with hospitals.
In an April letter to Columbia Memorial Hospital in Astoria and Providence Seaside Hospital, the mental health agency outlined the risk of legal liability in participating in the discharge and safety planning of patients.
Over the past few years, disagreements over whether patients brought to hospitals in mental health crisis should be released have led to confusion over who is ultimately responsible.
In May, Samuel Dickson, the civil commitment coordinator for the Oregon Health Authority, visited the county and stressed the importance of professional boundaries between a mental health agency and hospital.
“Hospitals are ultimately responsible for the admission and discharge of their patients, per state and federal regulation,” Saerom England, a spokeswoman for the Oregon Health Authority, said in an email. “The community mental health program can work in partnership with the hospital to conduct mental health assessments and to connect consumers to services in the community; however, hospitals are ultimately responsible for stabilization and discharge.”
The process can be confounding for families, especially when a patient released from the hospital slips further into mental illness or harms themselves or others.
Police can detain someone in mental health crisis and take them to the hospital. Medical staff can evaluate patients and determine whether they should be placed on a hold for mental health reasons. Clatsop Behavioral Healthcare can consult with both police and hospitals on treatment options and place patients on what is known as a director’s hold, a path to transfer to a psychiatric hospital.
The mental health agency also does investigations for civil commitments, where judges determine whether patients should be committed for mental health treatment.
Columbia Memorial and Providence Seaside do not provide psychiatric care, so tension often builds over how long to keep patients brought to emergency rooms in mental health crisis once they appear to stabilize.
“CMH has worked hard over the years to develop strong, collaborative relationships with CBH in support of mental health services in our community,” Nicole Williams, the chief operating officer at Columbia Memorial, said in an email. “We believe that mobile crisis response is an essential component of the portfolio of outpatient mental health services and are pleased CBH will continue to provide those services.”
‘Gravity’
Law enforcement has at times been frustrated after repeatedly taking people in mental health crisis to hospitals, only to see them released. A crisis respite center in Warrenton that was supposed to be an alternative to hospitals or jail does not have secure beds, so the respite center functions as a residential treatment option.
In 2015, Astoria police pulled a woman with a history of schizophrenia and depression from the Astoria Bridge and took her to Columbia Memorial, where she was evaluated by a mental health crisis worker and doctor and released. A week later, the woman jumped off the bridge to her death.
In March, Warrenton police took a young woman in crisis to Columbia Memorial in the days before she killed her dog.
“If you’re standing up on the bridge with somebody and they’re telling you, ‘Look, this is my plan. I’m going to end my life.’ And you remove them from that situation to the hospital, I think there are times when the gravity of what that really is gets lost when they’re in a more controlled environment,” Astoria Police Deputy Chief Eric Halverson said.
“And so I know there has been frustration in the past by officers when folks have been released. But, at the end of the day, we’re just one part of the process. And the process exists to make sure that people’s rights are protected and that people are getting the kind of help that they should be getting.”
After a management shake-up in 2016, Clatsop Behavioral Healthcare has tried to build stronger relationships with law enforcement through regular discussions to talk through situations that pop up in the community. Having mental health experts in the field with police could improve understanding.
“We all want to work together regarding this current issue which is a huge drain and strain on everyone involved,” Sheriff Tom Bergin said in an email. “We already work closely with them, so no special guidance to our deputies. However, I am sure this is an asset that will be used regularly and widely amongst those of us connected to the current mental health crisis.”
With limited training in mental health, police officers and sheriff’s deputies have to make judgment calls about whether someone who has not committed a crime should be detained and taken to the hospital.
“Any additional services that we can get to assist people in mental health crisis would be very valuable to us,” Astoria Police Chief Geoff Spalding said. “There’s clearly a shortage of that in this community, and most communities, so anything is going to be beneficial.”
Mobile crisis services might improve the odds law enforcement can de-escalate outbursts that could easily descend into violence or end in suicide.
A 2015 study by the Treatment Advocacy Center, a nonprofit in Arlington, Virginia, found that people with untreated mental illness are 16 times more likely than others to be killed after being approached or stopped by police.
“Anything that can allow my officers to get somebody the help they need without taking away personal liberty,” Warrenton Police Chief Mathew Workman said.