© J. Adrian Wylie

Defusing Mental Health Crises

How CCRT keeps people out the hospital

by Yma Johnson

posted 7/7/2009

It’s a weekend night, and Ann Arbor police respond to a call about an agitated man expressing homicidal thoughts. When they get to the scene, though, they realize he’s doing nothing illegal—he’s made no specific threats against another person. Yet he’s obviously deeply troubled.

A few months ago, their only choices would have been to leave him in that condition or take him to the U-M Hospitals psychiatric emergency room. Instead, they call for backup—not from the AAPD, but from the county’s new Community Crisis Response Team. CCRT immediately dispatches a social worker to the scene.

The county has long reached out to support mentally ill clients in the community. CCRT, which became fully operational in March, takes that to a new level by providing 24/7 emergency response. Its mission: to intervene in crisis situations like this before they escalate to “mental health emergencies.”

In this case, the social worker successfully calms the man then logs his case history. It turns out he has a drug problem, is being victimized by dealers in his subsidized housing unit, and is about to be evicted. Yet because he’s not an obvious danger to himself and others, he does not meet legal criteria for involuntary hospitalization.

Instead, the social worker makes an assessment and dispenses medication on the spot. (CCRT’s social workers and psychologists have been trained to dispense medication; psychiatrists are always on call.) Through ten in-home visits over ten days, CCRT then initiates a series of “warm handoffs,” taking the man to meet with care providers who help him secure new housing, treatment for his addiction, and psychiatric help.

CCRT was formed after a study found that Washtenaw County was spending 8 to 9 percent of its health budget on inpatient hospitalization, compared to 4 to 7 percent for its regional peers. The Washtenaw County Health Organization funds its $1.8 million budget as an antidote to expensive hospitalizations. Most clients are referred by the police, hospitals, or shelters.

The mobile response team includes both

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professionals and “peer supports”—people who are successfully managing their own mental illness or substance abuse issues. That experience can help them defuse volatile situations before they end in emotionally disastrous and socially expensive situations.

“Some people have to be in the hospital—we’re not just trying to save money,” stresses program administrator Jon Voelkner. “The goal is to gently intervene before it gets to an extreme state.”

Voelkner points out that clients as well as the county benefit when CCRT can spare them an arrest or a trip to the psych ER. “It is much less traumatic for the individuals and families,” he says, “if they’re not dealing with handcuffs or being strapped down to a board.”   

[Originally published in July, 2009.]

 

 

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