It was 8am on a Wednesday when I arrived at the one-story building where the recently created Community Crisis Response Team operates. I had requested to spend half a day with the team to see how the program works. I had no idea what to expect during my visit.
Program Manager Adam Goggins greeted me once I was buzzed into the locked entryway and sat me down with the case manager I’d be spending the day with, Krista Brown.
Having worked as a 911 dispatcher for six years and serving in the U.S. military, Brown is well-equipped to deal with phone calls and people – important skills to have in this program.
The Community Crisis Response Team was created in May 2023 as an improvement to a previous program, the Mobile Crisis Response Team. MCAT was a program that would send a therapist to a 911 call that was more mental health related.
In these cases, law enforcement would reach the caller, then call for MCAT if they thought they were needed. A therapist would then head to the scene, where law enforcement would remain. CCRT’s program allows the team to better respond to mental health crises while freeing up time for law enforcement.
“With our program, we wanted to be able to get them off the call, so they can go to other calls a little faster,” said Brown. “The whole idea is for us to be able to give the police resource back to the community as much as possible.”
CCRT can also offer more well-rounded care, connecting someone in crisis with a therapist, a case manager to help them locate resources or a peer support — someone who has lived experience who can help them deal with day-to-day challenges.
This is done through consistent communication and cooperation between the team and law enforcement. A 911 dispatcher will get a non-emergency mental health or crisis call and immediately loop in members of CCRT, explained Brown.
The crisis team then fields the call to see who it is, what’s going on and assess how they should help. The team looks at whether CCRT has a history with the individual, looking at medical records, or looking at notes the dispatcher has left about the caller and the situation.
Sometimes the team will be able to simply talk to someone over the phone, and other times they will either drive to the person in crisis or refer them to the in-office stabilization center, which serves individuals who need short-term mental health crisis assessment and stabilization.
“The whole idea is for us to be able to give the police resource back to the community as much as possible.” —Krista Brown
As I sat in the office, I asked what we’d be doing while I was there.
“Every day is different,” said Brown. “I feel like it’s hit or miss on if we’re super busy or not. It’s like the saying, ‘crickets or chaos.'” Shortly after, a call popped up.
On the Scene
It was about 30 minutes into the day. After assessing the call, the team decided we were hitting the road. Brown was in the passenger seat and therapist Maryssa Nohr was driving. Aside from me sitting in the back seat, asking questions, this was how a typical crisis response went.
There’s a two-person approach with each response. On a typical call, the therapist is the first to make contact with the caller having a crisis. The case manager is there to connect people to resources. Having both respond to a person in crisis offers the most effective care.
Nohr, who took the call from this individual, was familiar with this person. She had seen them recently and after assessing the state of this individual, decided to respond in person.
The person in crisis was in a manic, overwhelmed and overstimulated state. While the team determined he was not an immediate threat to himself or others, Nohr and Brown decided to have law enforcement come along.
Due to the nature of this call, Nohr planned to do a “director’s custody.” In these cases, the team is advocating for involuntary commitment for the person in crisis, which, in most cases, means they transfer them to the hospital to put them on a hold.
These circumstances occur when the team determines that the person needs help or they are a threat to themselves or others. In this case, Nohr was worried about the individual’s well-being.
Law enforcement will typically go on a call if the team feels they need to be present. By assessing the call, therapists and case managers can determine whether they need law enforcement – if someone is super escalated, if they are aggressive or seem threatening or simply because the caller is someone they’ve never dealt with before.
“We definitely take the time to figure out what’s going on, so we’re safe about it. The team is linked to law enforcement pretty intensively, so even if they do show up and the situation is worse than they thought, they can always, in the moment, call for law enforcement to come to the scene,” said Brown.
Since the team planned to enforce a “director’s custody,” they called law enforcement to the scene to transport the individual to the hospital. After the person in crisis agreed to go, we followed in the car to meet them at St. Charles Medical Center. “I’m hoping that we can advocate with the hospital that he stays for a while,” said Nohr.
Hospital Visits
At St. Charles, Nohr immediately spoke with the charge nurse, who oversees the operations in their unit, to let them know a patient was arriving. Nohr, who knows the staff well, explained the situation – why the patient was there and why they should be placed on an involuntary hold. An involuntary hold lets a patient stay at the hospital for up to five days to receive care.
On this particular day, the hospital was very busy and the patient had to wait for a bed. While we waited, Nohr continued her normal routine. She walked over to the hospital’s psych team, to coordinate about the incoming patient.
The psych team can help recommend that a patient be kept at the hospital or decide whether they are sent to a stabilization center or an involuntary care facility. If none of these are an option, the psych team will make a safety plan for the individual – outlining a plan of action to help support an individual in crisis.
When it comes to options for patients experiencing a crisis, every patient’s needs are different. Some may just need a safety plan that will help them calm down, while others need more long-term care. This is why Nohr’s job, as a therapist, is so important. The majority of the time, the patient doesn’t have the ability to advocate for the level of treatment they need, so Nohr does that for them.
Most patients who need more care are referred to a respite center, a short-term voluntary crisis stabilization program, or an inpatient psychiatric facility, providing solution-focused therapy. Nohr advocated for the latter. “He just needs a higher level of care right now,” she said.
Nohr then went out to find the patient’s doctor and continued to recommend involuntary care. “It’s just a lot of advocating that they need a higher level of care, because they won’t be able to articulate that they need help right now,” said Nohr.
Once a hospital bed was available for the individual, the team received another call.
Access to Care
We drove to the next person in crisis, who was experiencing severe symptoms. On the way to the call, the team assessed the situation and felt that they needed to do another “director’s.” The individual, who the team also had prior experience with, was having delusions, paranoia and suicidal thoughts. The team met law enforcement on the scene.
Since there were no beds at Sage View, the patient would have to stay in the hospital room until a bed became available in the inpatient center.
This person in crisis was refusing to go to the hospital. Considering the individual was aggressive and agitated, the team advised that I stay back in the car. Nohr explained that she tried to make a safety plan with this person, but the individual did not de-escalate.
In attempting to involuntarily commit the person, the individual became aggressive with law enforcement. The team knew it was necessary for this person to get help, so law enforcement was forced to restrain them to bring them to the hospital.
We arrived back at the hospital and went through the same routine. Nohr explained the individual’s condition to the hospital psych team and doctors and felt inpatient care was necessary.
Nohr was informed that the facility she felt was best for this person, Sage View Psychiatric Center, the only inpatient psychiatric center east of the Cascades, was full. This, she said, was not uncommon.
Since there were no beds at Sage View, the patient, according to Nohr, would have to stay in the hospital room until a bed became available in the inpatient center. The hospital would be able to release the patient only if they were able to de-escalate and create a safety plan everyone believed in. “In this very state, they’ll just stay in the room until something comes available,” said Nohr.
When it comes to available beds in the hospital and local psychiatric centers, it comes in waves, according to Brown. “We know that with the system, we don’t have enough beds available,” she said. “There are so many obstacles to get support.”
Oftentimes, the more escalated a person in crisis is, the better it is for them in terms of accessing care. People with worse mental health symptoms are more likely to get the first available beds in a treatment center.
A report, released on Feb. 1, found that Oregon has a gap in statewide behavioral treatment beds. According to the report, Oregon needs nearly 3,000 adult residential mental health and substance use treatment beds to close gaps in the system and to meet the future demand for treatment. The state currently has 4,819 residential beds to treat people with behavioral health disorders.
Closing the gap would represent more than a 70% increase in Oregon’s current treatment capacity and cost more than $500 million over five years to meet the demand. The results of the report come from a preliminary study that Gov. Tina Kotek directed the Oregon Health Authority to commission, according to a press release.
“Too many Oregonians are struggling to get the help they need for a mental health or addiction challenge, and the state needs to lead with a strategic approach to addressing these gaps in health care,” said Gov. Kotek. Over the past four years, the Oregon legislature has invested more than $1.5 billion to expand behavioral health treatment capacity.
Mental Health in Oregon
After taking these calls, lunchtime was approaching, and we headed back to the office. On the ride back, we discussed the program and the idea of having a team of people dedicated to mental health crises.
“I think we have law enforcement who are way more educated than they’ve ever been in the past on how to handle these calls, but they are not therapists, and they are not social workers.” —Krista Brown
Coming from being a dispatcher in Texas, Brown noted the major differences in how mental health is discussed and dealt with in Oregon. “Here, it’s so different because we have mental health resources that were not available in Texas.”
People here are also more open and honest with their struggles, she said. “They’re just kind of raw about what they’re feeling and what they’re experiencing. I think that’s the biggest thing that’s so different — the culture of people being honest about their mental health struggles,” said Brown. “Then, we actually have resources here to help people, so I feel like that makes a big difference, too.”
The job is also a lot different from being a dispatcher, according to Brown. As a case manager with CCRT, Brown can talk to individuals and be honest about her own experiences. She admitted that she, too, had her own struggles with mental health.
“I did not reach out for help for anything,” she said. “Working for law enforcement, you’re not supposed to share that stuff. Here, I can. I get to be open and honest. Being raw and open with them helps build rapport as well,” said Brown.
After spending the day with CCRT, it became clear why this program exists. “I think we have law enforcement who are way more educated than they’ve ever been in the past on how to handle these calls, but they are not therapists, and they are not social workers,” said Brown. “This program is needed everywhere. I think it’s more appropriate to have a mental health professional responding to a mental health crisis.”
After four hours of following Brown and Nohr around, asking questions and experiencing the team’s roles and duties, I felt I had a good grasp on what CCRT is all about.
Still, spending just a few hours with the team doesn’t offer the full breadth of the experience. CCRT is consistently making judgment calls, assessing situations, and figuring out what is best for a person in crisis. “One day just doesn’t show enough,” said Nohr.
This article appears in Source Weekly March 7, 2024.
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Disappointed in @bendsource.com. This article is biased and lacks accurate information. The lack of due diligence is not fair to the community. The journalist did not contact families/individuals who have been on the other side of CCRT services.
I agree with Heather. We had a family member in crisis, so we reached out for CCRT’s help. They were far more interested in collecting as much personal information as possible and then simply dropped the ball without said family member receiving any assistance or help at all. The same happened to a couple other people we knew who had asked for their assistance. Personally I feel it’s a waste of our tax dollars with the way they operate now.