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spiritual_emergency · 02:35 PM

The re-solve program in Pittsburgh...

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Crisis Centers vs. Emergency Rooms

The first time Mike became psychotic, I drove him to a hospital emergency room. We didn’t know any psychiatrists and Mike needed immediate help. Taking him there turned out to be a mistake.

Emergency rooms are where everyone goes nowadays whenever they have any kind of health-related crisis, but many are poorly equipped to deal with psychiatric patients in the midst of a mental break.

Some patients are turned away, as Mike and I were, without getting help. Or a patient might be held down and given a shot of Haldol or another strong anti-psychotic that will help stabilize him but also can turn him into a walking zombie for days.

How a person is treated when they have their first major breakdown is important. If the first time you went to see a dentist, he pulled one of your teeth without giving you novocaine, how eager would you be to ask him for help the next time you had a toothache? The same is true about a mental breakdown.

This is why many progressive communities are shifting the focus from emergency rooms to crisis clinics specifically designed to help people who are experiencing some sort of behavioral or emotional breakdown.

Jewel Denne directs a clinic for re:solve Crisis Network in Pittsburgh, which is part of the University of Pittsburgh Medical Center, and last weekend she explained to an enthusiastic audience attending a conference hosted by the Southwestern Pennsylvania chapter of the National Alliance on Mental Illness how her clinic operates.

The first step the clinic’s planners took was talking to persons with mental illnesses and their families. They asked them what sort of services might be needed in the clinic and what was the most effective way to offer those services to persons in need. The clinic’s directors asked them to describe good and bad experiences that they’d had. They even asked for ideas about how the building should be designed, down to what color the walls should be painted.

Asking families and consumers (persons with mental illnesses) for their opinions may sound like an insignificant thing, but it isn’t. One of the biggest myths about mental illnesses is that persons, who are sick, are psychotic all of the time and therefore can’t be trusted to know what’s good for them. This attitude dates back to days when a patient had no voice in how he/she was treated.

Who better to ask than someone who has been through treatment and their family members about what works and doesn’t? All to often, family members are cut out of the process or seen as enemies.

Because of the input of family members and consumers, the center ended-up looking like a neighborhood Starbucks rather than a hospital.

Denne said her clinic receives an average of 8,000 calls a month and 770 walk-ins seeking help. The clinic has medical personnel on duty but its primary job is plugging people into the right services that they need to recover. The clinic also operates a mobile crisis team that goes anywhere in Pittsburgh to evaluate someone who is having a crisis. It doesn’t matter if they are in their home, a park, or on a street corner.

The mobile crisis team performs about 800 evaluations per month and in 85% of those cases, it is able to help the person without admitting them into a hospital.

Open 24 hours per day with a staff of 130, the crisis center’s credo is “engagement is the key.” Denne explained that her counselors try to develop a trusting relationship with clients. When that happens, the chances of getting someone to agree to treatment and comply with medication and other services greatly improves.

Peer-to-peer specialists are a crucial part of the center’s staff. Pennsyslvania has become a leader in training and hiring peer-to-peer specialists and now boasts more of them on the payroll than in any other state.

A peer-to-peer specialist is someone who has a mental illness and is now stable. The idea of having a person with a mental illness help another person with a mental illness was met with much skepticism at first. But the impact it has had in Pennsylvania is phenomenal, according to Joan Erney, the state’s outgoing deputy secretary for Mental Health and Substance Abuse.

Peer support is not much different from having someone who is a recoverying drug user or alcoholic help another addict. Someone who has been down the same road is a better guide than someone who hasn’t.

More than a year ago, I visited a similar crisis clinic in San Antonio, Texas, and was impressed not only with the emergency services that it provided but with its cost effectiveness. An audit showed the city was saving significant sums by using its drop off center rather than emergency rooms.

Of course, if a person is psychotic and doesn’t believe he is sick, the job of helping him becomes much, much more difficult. This is why a few of the persons who come to the clinic end up in a hospital involuntarily.

In a twist, Denne said that the 911 operators in Pittsburgh often referred calls to the clinic. She also said that calls to the center came in many different forms. One caller said he was in crisis because he couldn’t get dog food for his pet. When Denne’s workers investigated, they discovered that the caller had schizophrenia and not only was out of food for his pet, but also had no food for himself.

Crisis centers are gaining in popularity, especially with family members. Too many of us have needed help only to have the police arrive and watch as someone we love is handcuffed and driven away to an emergency room.

Source: Pete Earley's Blog