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Person in Crisis Team Underscores General Lack of Mental Health Resources

Patti Singer

Daniele Lyman-Torres, commissioner of the Department of Recreation and Human Services, at a news conference in January 2021 to announce the Person in Crisis team. File photo

The Person in Crisis team, which started in late January with seven teams of two mental health professionals working around the clock, is expected to have 15 teams going 24/7 by the end of April.

Currently at eight teams, PIC has been responding to about 100 calls a week – including all mental health calls that come through 911.

Teams are assigned to shifts and often are dispatched from the road, meaning they go from call to call with little time in between.

“In just over two months that it’s been launched, what has surprised me has been how well-received the service has been in terms of people who we’ve supported,” said Daniele Lyman-Torres, commissioner of the Department of Recreation and Human Services, which oversees PIC as part of the Crisis Intervention Services.

The demand for PIC has exposed a lack either in mental health services or difficulty in getting care.

“I think we all hear about it and know that there’s a gap in services, but the surprising thing is how pervasive the gap in services are to supporting people with being successful at home and successful in their neighborhood and in their community,” Lyman-Torres said. “I’ve been really surprised with that as we’ve gone out. But I’ve also been pleased with the way that we’ve rolled out.”

Lyman-Torres talked with Minority Reporter about the progress and challenges of PIC. The conversation has been edited for length and clarity.

Can you walk through a scenario where PIC is dispatched?

For example, if you call and say that you’re having a lot of depression and negative thoughts, and you’re really struggling and you need help, they’ll ask additional questions. Like, do you have weapons? Who’s with you? There is a resource that’s assigned to come to the address that call came from.

What are those resources? Police, or mental health professionals?

It could be potentially both. … Co-response was always in the plan. We wanted to launch the pilot in a way where we could incrementally add to the work. So we started the pilot with PIC going out on its own work and establishing that protocol and that process because those calls were by nature lower acuity or lower complexity because they didn’t have weapons and they didn’t have people in active suicide attempts.

What happens when PIC goes alone?

If PIC goes alone, they do their assessments with the individual, either resolve the individual’s immediate issue or make connections to services. What we have found most often is that people do have some service provider somewhere. They may just be in between appointments, they may need additional services, maybe the services they have aren’t enough to get them through. So we make those immediate connections and then sometimes people just want to use the PIC team as that resource they need in order to stabilize, um, themselves. … If the individual, either through assessment or through request, needs to go to the hospital, then that is arranged by PIC. PIC team can call EMS to make that medical transport if that’s required.

How does someone know they’re talking to PIC?

They have jackets and shirts that say city of Rochester crisis services and they have an ID badge that has their photo on it. That shows that they’re a city employee and that they work for the Person in Crisis team.

What if the PIC team is on its own and the situation worsens?

The PIC team carry radios and they’re communicating on the police channels and they would be able to radio for assistance. Sometimes they radio for EMS. Sometimes they radio for law enforcement. They would have been trained on how to keep themselves safe in terms of leaving scenes, if things become unsafe, staging and waiting for reinforcements. They do have an emergency button on their radio and they are able to very quickly access support.

What does co-response look like on mental health calls?

PIC communicates with RPD to understand if they need to stage, for any scene to be cleared or any weapons to be cleared before they move forward. They work with RPD the same way EMS would, see if the scene is clear for them to come in. When they do come in, they work with RPD to assess what may need to happen with the individual, how to deal with the crisis. The PIC team lets RPD know what they need in order to do their work, whether they need them to step to the side so they can speak to the person so they can do the assessment.

What’s been a challenge, something you hadn’t expected?

Well, I think, I think the biggest, um, I think the biggest thing that people have come back with is really what do we do to help prevent this for people in the future? Because I think what we have seen in a very significant trends has been the amount of anxiety, depression and suicide thoughts. There are a lot of people, um, struggling with these issues and struggling alone or at home or with their family at home. And so I think the biggest thing that we come back with is, you know, how do we, how do we impact other parts of the system? Because the PICC team is designed to go out and really support people in immediate crisis.

But as we (get) repeat callers (and) repeat issues, we can really see a pervasive reoccurrence of what seems to be a lack of resources or services. The biggest thing that we come back with is, what can we do to stave this off? Or what can we do to not have people get to this level of crisis where they have to call 911 for their anxiety, depression, or thoughts of suicide?

Does that seem ironic, since law enforcement has been saying something similar?

I think the main difference is from what law enforcement and PIC bring. PIC are those clinicians who can deal with some of that on the scene. But there still is a need to deal with the upstream issues. I can’t say enough about that and we really do need to do that as a system, but the difference of the response and being able to spend time with a person from the PIC team who was a trained professional, and being able to have those conversations can mean the difference between you being able to stay at home and be able to be at home successfully until your next visit or you needing to go to the hospital.

What are the qualifications for the PIC team?

We’re looking for people who are licensed master social workers or licensed mental health counselors, or social workers who have many, many years of experience who may not have the license. The training ranges from everything from on the scene, intervention techniques to on-scene assessments. And we put together quite a lengthy training program that is included in our pilot plan. … We will be making sure that, you know, as new members come on, they are assigned to a team to work on a team with a team member who’s been on the team for longer and can help with that orientation.

(PIC members receive the following training: CPR and first aid; mental health first responders; Narcan for opioid overdose; domestic violence trauma; de-escalation crisis intervention; suicide assessment, intervention and prevention; trauma informed care; and crisis intervention. They receive additional training in those areas, as well as working with EMS. Staff will receive ongoing training.)

How do they need to adjust to this work from what they may have seen in an office?

The social work and mental health profession, you know has a wide spectrum of jobs, but there are many people who are working in inpatient or outpatient settings where people are under significant duress. And they’re dealing with people who are inpatient for a psychiatric episode. And so they, while it’s not on the street, they certainly have the experience with working with people who are not in, not in a space of stability who are not just coming for their, their weekly visit but really are in a place of instability and crisis, whether it be in a facility or outside of facility.