Mental health team goes mobile
May 24, 2023
Law enforcement officers respond to a late-evening call concerning an individual who is undergoing mental health therapy and is feeling suicidal. The individual is not responding well. Family members are concerned.
An officer makes a call, and shortly thereafter a van rolls up containing two members of the Linn County Mental Health Crisis Response Team.
They take charge and, after a while the patient is back on track, avoiding a trip to the hospital.
Though the incident above is fictional, it is representative of many of the behavioral health crises Mental Health Crisis Response Team members handle throughout Linn County – often in person.
Though the Crisis Response Team program is not new – it's existed for more than 30 years, it is undergoing changes that will make it more visible to the public – and more responsive, said Tanya Thompson, program manager and a previous team leader. She said that the federal and state governments have provided funding to boost the team's services "to support a more robust effort."
Previously, the team would respond to emergency rooms, jails and its own walk-in clinic in Albany, but now it has wheels.
That would be a brand new mobile van that will soon be wrapped with the county's logo and other identification and will become a mobile office "so people will actually be able to recognize us in the community," said Nova Sweet, who has led the team for the last year and a half and has been with county Mental Health for six years.
What's also new is that the team can now respond to police calls, she said.
"Seven days a week, from 8:30 to midnight, in teams of two. It used to be that we stopped doing that at 5 and we wouldn't do it on weekends. But now we're set up to do it till midnight, seven days a week."
Sweet, who's led the team for the past year and a half, said they typically hit the road three to eight times a week to visit individuals who need help.
"That's us going into the community and reaching out to either folks (with visits) that were planned ahead or that the call is happening that day."
For approximately the past year, the team has made regular visits to both Sweet Home and Lebanon in an effort to provide "preventative" mental health care – which means working in advance to build relationships that allow team members to respond more effectively when things go south, Sweet and Thompson said.
"All the law enforcement agencies have access to our pager number up until midnight," Sweet said, adding that there's also "our direct email that can put a 'heads up, can you do outreach?' kind of thing."
"We try to go the shelters or we do go to the shelters regularly and just be present," Sweet said. "Just the folks that live there, they start recognizing our faces, and come up to us and chat about things."
Team members regularly visit Sweet Home's FACS homeless shelter and show up at the Lebanon Soup Kitchen at the First Christian Church or at the breakfast served three times a week at St. Martin's Episcopal Church.
"We go there once a week or as needed," Sweet said, adding that the're working on getting a "space" set up at the free lunch "so people can start understanding why we are at their table. It's been kind of awkward, just walking in there and people don't really know who you are."
In the year ending April 30, the team responded to 1,437 situations requiring "mobile" services and saw 768 unique clients (many clients require multiple interactions). About half were in the Albany area, but 23% were in east Linn County areas, and 15% were at Good Samaritan Regional Medical Center in Corvallis, according to county data. The other 15% were in undefined areas.
Sean Morgan, community services officer for the Sweet Home Police Department, is a regular visitor to the FAC shelter and interacts frequently with its clients.
Having the response team is helpful when a situation requires more expertise than a police officer can provide, he said.
"Sometimes callers report that somebody's having issues. Officers respond and do the best they can, but oftentimes we need mental health professionals," he said.
And on a more regular basis, "outreach workers check in here, look for folks they should reach out to, try to see if they're willing to engage."
Dick Knowles of Sweet Home, who chairs the Linn County Mental Health Advisory Board, of which he's been a member for more than 20 years, said that a mobile response "has been needed for a long time."
"This is just the tip of the iceberg," said Knowles, who's been a member of the advisory group for 20-plus years and was a longtime administrator in psychiatric care facilities in the Bay Area of California.
He said that having locations, such as the Soup Kitchen or the homeless camp, gives the team a chance to focus their efforts.
"We're all new at this," he said. "But if things transpire the way we hope, this will provide a place for people to go, those who are homeless or in some type of desperate situation, where they can find help in crisis."
Another advantage of the outreach, he said, is "wherever you go in the community, there's someone who knows you and when you really get in trouble, somebody's going to help."
Those with whom the team is connecting now are "just the tip of the iceberg," Knowles cautioned.
"From my perspective, it's 'thumbs up, go for it.' We've needed this for a long time."
Sweet said dealing with mental health situations often requires an extended process.
"I think the challenge for all of us is that people have free will and sometimes the people that we really want to help don't want help. And so that tugs on all our heartstrings, so you do the best you can – you keep re-engaging.
"There's just some folks that either we can't step in and take away their legal rights, or they're not there yet."
Morgan said establishing relationships takes time.
"Sometimes they're working with some of the harder cases who have the most difficulty engaging services," he said. "They reach out and build trust, build a relationship over time. I know they've engaged with folks who are really trying to make things work and that's sometimes an onramp for them."
Team members also regularly respond to hospitals when patients are feeling "suicidal or homicidal or can't take care of themselves," she said.
In addition to the unplanned or scheduled visits with individuals team members make, "there's way more (visits) if you add hospitals," Sweet said.
"Our regular responses to the hospitals is when there's somebody suicidal, homicidal, or can't take care of themselves. We go in and assess and figure out a higher level of care or safety plans to go home.
"We are consistently getting phone calls about people of concern and walking families or concerned community members through the steps of either filing a two-party petition to have investigators look into something or just coaching on what services are available.
"That's kind of our gamut."
Samaritan Health's hospitals in Albany and Lebanon both have emergency rooms equipped to handle mental health crises, but the nearest inpatient psych unit is at Good Samaritan Regional Medical Center in Corvallis.
Sweet said people who are struggling with mental issues will typically go to the emergency departments, then be transferred to Good Sam or to Eugene, Salem or Portland.
She said she "loves" Lebanon's emergency wing, completed in 2018, which includes three rooms specially designed for mental patients, where they can stay until they can be transferred to a psychiatric unit.
The rooms "on the quieter side of the emergency department, all have locking doors on a quiet hall. They can have cameras and all that good stuff," Sweet said.
Thompson, a 25-year veteran of the Linn County Health Department, said psychiatric care is in short supply in Oregon.
"There is a shortage of higher-level-of-care site beds," she said. "That's something that I know we're trying to communicate to both Samaritan and the state. Because what happens is there's a logjam, like in the emergency rooms and in our communities."
Another challenge is keeping their department adequately staffed, the two said.
"One of the bigger struggles we're dealing with is workforce," Thompson said, noting that as interaction with other agencies increases, so does demand for the program's services.
Although the department includes staff with less education, outreach teams must include at least one member with master's degree-level qualified mental health professional training and the other must have at least a bachelor's.
Currently, the team has 11 daytime members and 10, including Sweet, at night, she said.
"Somebody who has 20 years of experience and, maybe, not a bachelor's degree, can help us on a Q&A level, which is a lot, a lot, a lot of our work. I would say that anybody who has any sort of mental health background, education or experience, should try and apply."
It's a challenge, Thompson said.
"We've seen the increase of intakes and referrals, connections from the crisis team for ongoing services with people. So with a workforce where we can't get that those clinicians in place – again, we want to serve them, ongoing. And we're doing the best we can and many of them are getting in much better than they would if they were in the private sector. But it is a struggle."
"For those folks who are struggling, suicidal, but might have to wait four weeks to see a therapist, we're just seeing them every week," Sweet added. "We're just, like, 'We'll take care of it.' And our team really thinks outside the box; whatever we can do to make sure somebody's getting their needs met. We're doing it."
County Mental Health workers also schedule regular appointments in both Sweet Home, at 799 Long St., and in Lebanon at 1600 S. Main St. Information on eligibility, resources and options is available by calling (541) 967-3866 (press 0), or at the walk-in clinic at 445 3rd Ave. SW in Albany.