Next year a 911 mental health emergency call won’t automatically bring a Portland cop to the door

From the Oregonian, December 2, 2011

Beginning next year, emergency calls for help from people suffering from mental illness in Multnomah County may not automatically bring a police officer to the door.

The new process is expected to work like this: 9-1-1 dispatchers would do a quick screen to make sure the caller isn’t an immediate threat to themselves or others, and then transfer the caller to Multnomah County’s Mental Health Call Center, a crisis line staffed by 13 mental health professionals.

“We’re definitely breaking some new ground here,” said Heeseung Kang, the call center’s supervisor. “This is why we’re here. Our mission is to try to catch these people.”

Recognizing that sending police officers to deal with people having a psychotic episode can sometimes end tragically and has on multiple occasions in Portland, representatives of the mental health community, Portland police and Multnomah County officials started to brainstorm solutions over the past year.

Portland’s group, called SaferPdx, studied why people in mental health crisis often end up in police custody. They learned that crucial information wasn’t being shared between law enforcement, mental health and emergency dispatch systems. A patient often isn’t able to reach a doctor or counselor at the time of the crisis, and the police are being used by default as transportation to crisis care.

“We work in silos, and it’s not an efficient thing to do,” said Dr. Maggie Bennington-Davis, Cascadia Behavioral Healthcare’s chief operations and medical officer.

In 2010, Portland officers took 1,100 people into protective custody, Chief Mike Reese said. He envisions callers in mental health crisis who have no weapons and are not a threat being transferred to the county call center, without a police response.

“Sometimes just showing up in uniform can exacerbate things,” Reese said.

Police, dispatchers and county crisis line call takers are developing protocol on the call transfers. They’re not sure yet how many calls will be transferred from 911 to the call center, but the center will increase staff at first to handle an expected rise.

“It’s going to increase work for the crisis line” Reese said, “but again I think those are the folks more appropriate to deal with some of these issues…Everybody agrees this is a better model for us, and it’s the right thing to do.”

    “Multnomah County Crisis Line, this is Mark,” answers Mark Cameron, a county call taker.

    The voice on the other end of the line is frantic.

    “I don’t know. These voices! These voices have control of me. I might have to go to the hospital,” the caller yells. “No, I can’t deal with this!”

    “OK, well I’m glad you called,” Cameron tells the caller, addressing her by her first name. “Are you currently in services anywhere?”

    “Can I get your last name to see if we have any information that will help us help you?”

    As Cameron types the woman’s name into the call center’s database, he keeps talking, trying to calm her, suggesting she take a few deep breaths.

    “Julia, Julia, I can hear a lot of anxiety and stress. Find yourself. Focus on your breath. It gets your mind off catastrophic thinking, and it helps calm you.”

    “When it’s been difficult, what has been helpful to you?” he asks.

    “I need help. I need help. Maybe Project Respond. I need to talk to someone,” the caller says.

    Cameron learns that the caller has a phone appointment at 4 p.m. with her therapist. He gets her talking, now more calmly, out of her anxious state.

    “That’s good,” Cameron said. “What are you going to do between now and then? He encourages her to connect with somebody close to her. She says she’ll visit a friend.

    “I might be calling you guys back,” the caller says.

    “Good,” Cameron answers. “We’re here.”

Cameron was a cartographer for the Bureau of Land Management, left to become a Jesuit priest, but instead lived in a community with developmentally-disabled people and went back to school for a master’s degree in social work. He started as a crisis call taker in February 2006.

Mark Cameron answers calls in the Multnomah County Mental Health Call Center where 13 mental health professionals staff the phones to help people in crisis.

Mark Cameron answers calls in the Multnomah County Mental Health Call Center where 13 mental health professionals staff the phones to help people in crisis.

“It’s an important job,” he said. “You got to be quick to think, have empathy, develop rapport with people in challenging situations.”

The call center stands out from other crisis lines in the state in that the calltakers are not volunteers, but full-time staff who all hold master’s degrees with clinical experience.

“We’re dealing with the most vulnerable,” Kang said.

During a 12-month period between October 2010 and October 2011, the county call center answered 57,000 calls. At their fingertips is an immense database that includes records from Cascadia Behavioral Healthcare and Project Respond so they can determine if the caller has a case worker, has been treated in the past and to recommend the most appropriate care.

“I think it’s very appropriate as long as the people who are transferred to the crisis line are then able to get immediate help before it does escalate,” said Terri Walker, president of the Multnomah County chapter of the National Alliance on Mental Illness.

Kang is working with Portland’s Bureau of Emergency Communications and Portland police to develop rules governing how the transfer of calls should occur. They’re creating protocol for what dispatch calls a “warm transfer” — requiring the 9-1-1 dispatcher to stay on the line until the caller is connected to a mental health call taker and conversation proceeds before dispatch disconnects.

As long as there’s no immediate threat of danger, crisis line call takers are recommending dispatch share certain details right away when transferring a call, such as the caller’s name, demographic, location, and their primary concern or request.

“If someone is in crisis, we want to be very careful we don’t lose them. We’re trying to make sure we do it rapidly and appropriately, and get correct training for folks,” said Laura Wolfe, a spokeswoman for Portland’s Bureau of Emergency Communications that runs the 9-1-1 dispatch for the county.

The call center can share information about a caller with police or dispatch, only in situations where it’s necessary “to avert a health or safety risk.” Right now, the crisis line transfers one to two calls a week to 911, if they deem there’s an emergency.

Crisis line call takers may recommend callers visit the county’s urgent walk-in clinic, or they may call Project Respond to send out a crisis worker after hours, make contact with a case worker to do follow-up care, or arrange transportation – whether it’s a cab or a special service – to take the caller to a clinic or a provider.

Kang expects the new system of transferring more mental health-related calls to her staff will help reduce negative outcomes: whether its psychological trauma, physical injury or death from unnecessary contact with police, or wrongful incarcerations of people with mental illness who often need help not punishment. She expects it will also allow 911 dispatch and police to focus on “actual crimes” and dangers.

“It just seemed to make sense,” Kang said.