Mental health crisis team works to relieve pressure on system
BENNINGTON -- A team that works to keep patients suffering a mental health crisis out of the hospital emergency room has a new leader.
United Counseling Service announced this week that Anna Mattison is now emergency services manager for the agency's mobile crisis team as well as the Battelle House, a six-bed crisis center on Dewey Street. Mattison has more than 25 years of experience with UCS and had been the police liaison prior to becoming the crisis team's interim manager.
Funding for the mobile crisis team came after Tropical Storm Irene flooded the Vermont State Hospital in 2011, said Victor Martini, UCS director of community rehabilitation and emergency services. The 54-bed facility was the state's primary location for psychiatric patients in need of in-patient care and its loss has been felt throughout the state.
"I think the issue is really beyond Bennington. The issue is a nationwide issue," said Martini. "It's reared its head here in addition because we've lost the Vermont State Hospital in Tropical Storm Irene, so it put us into a unique position."
The problem is that when a person suffering a mental health crisis needs to be held somewhere, there is sometimes no place to put them and so they stay in the hospital's emergency room for days or even weeks.
The situation is such that Southwestern Vermont Medical Center plans to renovate storage space to make three specialized beds for those long-term psychiatric patients while a more appropriate setting for them can be found.
Meanwhile, the state intends to construct a 25-bed mental health facility in Barre this year and rely on community care options provided by teams like that at UCS to pick up the slack.
Martini said whether those news beds and the community care options will be enough is unknown.
"What we do have, however, is we have now a lot of community resources that we need that are now attached to (Mattison), to the crisis team," Martini said. "We can go out and be mobile. We can go where the crisis is occurring."
The crisis team can be called anywhere in the community for any form of crisis, said Mattison. Often it's a family member who calls that is worried about a loved one, sometimes the person in crisis makes the call, and other times the team is summoned to aid the police.
She said a crisis can be almost anything from a broken-down car, to an inability to find a doctor, to suicidal thoughts or behaviors. Drug addiction is another thing they can help with. The team will meet the person in need on their terms and find out how it can help. Often the team learns the person has deeper problems, which it then works to address.
"If there's a need, we would absolutely send them to the ER," said Mattison, however there are a number of things that can be done before a trip to the hospital.
The crisis team will follow up with a person as often as daily for two weeks to make sure their issues are being handled. During the period the team will help the client find insurance if they do not have it, or simply work through some emotional issue. Mattison said the team can go where a person lives and observe them to better get a grip on what the trouble is, as well as involve family and friends. If things are still bad after two weeks, that time can be extended.
"Now it's easier for me to get a client an appointment with a therapist than it used to be," said Mattison.
Through the crisis team, a person can get three free appointments with a UCS therapist. During those sessions, the goal is to find out if they need more therapy or if there are other measures that can be taken, said Mattison. If three meetings happen and more help is needed the team goes to work once more to find the person insurance.
"We're really well rounded in what we do, it's not one thing," Mattison said.
When it comes to patients who do need to be held, UCS works with the hospital to find them beds. Mattison said open beds are tracked electronically, but it's up to the facilities who run them to report they are open, and the process requires someone to be making regular phone calls. She said she will often make six calls a day for one client in an effort to get them into a facility.
Lack of bed space can create a backup in the emergency room, but on occasion the problem is the patient does not want to go the facility that is open.
"Sometimes one of the issues that comes about is the client is voluntary," said Mattison. "We know that they need a hospital, we know they would be better treated there, we can't keep them safe in the community, but they actually refuse the hospital that's available."
UCS is the designated state agency in the Bennington area for determining when a mental health patient should be held against their will.
"We'll go in and we'll do a determination as to whether or not we should hold you against your will," said Martini. "We have to protect your rights, that's not something we take lightly. The next step is to get you to a psychiatric in-patient facility where they will do another assessment of you to see if we should continue to hold you."
Mattison said sometimes the only two options for a patient are in Brattleboro or Rutland, and the patient might be unfamiliar with those places and afraid of being sent there.
There is another option locally for some clients, the Battelle House.
"We can, if it looks like the crisis requires a little bit more than just sitting down with them and providing them services over the next couple weeks, we can offer them a bed at Battelle House," said Martini. "We have six beds there for crises like this, and that way we're around 24/7. We can provide nursing, therapy, support, case management, get them good, healthy nutrition, we can do an awful lot of work with them at Battelle House."
A benefit of a stay at Battelle House is UCS staff can observe a person for a long period of time and perhaps determine if their medication simply needs adjusting, said Mattison. There is also a seventh room at the facility for those who are extremely intoxicated who are not violent.
Martini said the crisis team has kept people from the emergency room at SVMC in large numbers. In the last six months, it saw 521 people who otherwise would have needed the emergency room and kept them from having to go there. Follow-up services were provided to 181 people, and 374 people were helped enough to avoid going to an inpatient facility. The crisis team assisted the police 197 times.
"And when we do that, it is actually a better outcome, we find, than waiting until someone gets to the emergency room, because that way we treat them right in the community where their crisis is occurring, maybe where all their friends, family, and resources are, and we can incorporate them into what's going on," said Martini. "We can then offer them some services we can do follow-up on, and really keep them stable at the time they're in crisis."
Contact Keith Whitcomb Jr. at firstname.lastname@example.org or follow him on Twitter @KWhitcombjr.
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