A MENTAL HEALTH NEWSLETTER FOR LAW ENFORCEMENT PROFESSIONALS
 

Mental Health Association of Greater St. Louis A United Way Agency

In this issue . . .

“Call the police!” This is a common response for people who are having a problem or are involved in an emergency situation. It is also not unusual for a person with a mental illness to call the police when they are having a difficult time coping. They are looking for help and police officers can provide that help or connect them with someone who can. However, when someone “calls the police,” their initial contact is often not with a police officer, but is with a dispatcher, call taker or 9-1-1 operator. Like police officers, these communications officers should be prepared to speak with persons with a mental illness or with their family members, begin to assess the situation, and provide them the help they need. It is just as important to train communications officers in this initial contact, perhaps more so, than police officers. That is why the Mental Health Association of Greater St. Louis and Behavioral Health Response developed a training program for dispatchers that is presented at the St. Louis County & Municipal Police Academy. This program can help call takers recognize that a caller may have a mental illness and not only be able to provide information to the responding officers, but also provide needed resources more quickly. See the Street Report column in this edition for more information about this training. 

One of the tools discussed in the Dispatcher Training Program is a set of charts that outline various aspects of the three major mental illnesses: bipolar disorder, schizophrenia and depression. These charts offer a “cheat sheet” of information on the illnesses, common symptoms, tips on how to recognize that a caller might be suffering from a particular illness and ideas on how to handle the caller until help can be provided. An abbreviated version of these charts is provided in this edition of the newsletter for your convenience. The expanded charts are provided and explained in more detail in the Dispatcher Training Program. These charts are one set of tools to help communications officers provide much needed assistance to their callers, as they are the real “first line” of assistance in times of trouble.  

If you would like to receive an electronic version of the expanded charts, please contact either Sgt. Barry Armfield at barmfield@stlouisco.com or Officer Karl Streckfuss at kstreckfuss@stlouisco.com. 

Dealing with Mental Health Crisis for Dispatchers and Call Takers will be offered again on April 9, 2008. Dispatchers, call takers and 9-1-1 operators who are interested in attending this Continuing Education course should contact the St. Louis County & Municipal Police Academy at 314-889-8600 for more information.

Return to Top of the Page

Training for dispatchers is valuable, particularly when dealing with mental health crises. Public safety dispatchers are frequently the first people that someone in crisis will contact. How they treat the caller can have a major impact on the outcome of the call – not only for the caller, but also for the officers responding to the call. A recent training specifically for dispatchers focused on how to deal with suicidal and violent callers, as well as recognizing and dealing with calls about mental illness. 

Dispatchers at the recent training represented the departments of Hazelwood, Jefferson County, Perryville,
St. Ann, St. Charles County and St. Louis County.

One of the most difficult calls a dispatcher will receive is a call from a suicidal person. There are five basics steps that will help dispatchers when dealing with suicidal callers:

• assess risk,

• take the necessary action,

• establish a rapport,

• maintain control,

• and help the caller develop a plan for resolution.

By following these guidelines and using active listening techniques such as emotional labeling, paraphrasing, reflective mirroring, effective pauses, minimal encouragers, “I” messages, and open-ended messages, the dispatcher will be able to provide responding officers with valuable and necessary information.   

Equally challenging are calls from someone with mental illness or calls from their family members. As dispatchers learned at the training, it’s important for them to recognize the symptoms of the different types of mental illness, to learn communication strategies to use with callers in psychiatric crisis and to become familiar with commonly prescribed medications and the negative side effects they cause, including non-compliance. Public safety dispatchers are also often unfamiliar with the many community mental health resources that are available to help deal with these types of calls. Also included in the training were presentations on insight into family dynamics of mental illness, legal aspects and an overview of key mental health agencies as resources. 

It is important for dispatchers to be prepared to handle calls from suicidal subjects and people suffering from mental illness. They will handle numerous calls of this type during the course of their careers.  When a dispatcher has the necessary training to successfully handle these types of calls, it will help ensure the safety of not only the person in crisis, but also the safety of the responding officers.  

The training, Dealing with Mental Health Crisis for Dispatchers and Call Takers, will be offered again on April 9, 2008. Dispatchers, call takers and 9-1-1 operators who are interested in attending this Continuing Education course should contact the St. Louis County & Municipal Police Academy at 314-889-8600 for more information.

Return to Top of the Page

CIT Corner appears regularly in Street Talk.

St. Charles County Area CIT Council is holding its first 40-hour basic CIT training during the week of October 1-5, 2007. Lieutenant Dale Dothage, Wentzville Police Department is the Chairman of CIT Council and Lieutenant Mark O’Neil, St. Charles County Sheriffs Office, is the chair of the Training Committee. Together they have put together a training curriculum that will be applicable for the St. Charles County Area. Good luck!   

The 4^th Annual Crisis Intervention Team National Conference was held in Memphis, Tennessee. Several representatives for the St. Louis and St. Charles Area CIT Councils attended the conference. All attending had positive comments about the workshops provided and have brought back new ideas for our programs. The St. Louis Area CIT Council had two representatives who received national awards for their contributions to CIT.   

St. Louisans Receive National Awards 

The “Advocate” award was presented to Jacqueline Lukitsch, Executive Director at National Alliance on Mental Illness (NAMI) - St. Louis. She was recognized as a strong leader in advocacy initiatives for the St. Louis Area CIT Program. She conceptualized and generated multi-organizational support for a broadly collaborative project that resulted in a $1.1 million three-year grant funding CIT in 42 jurisdictions in three St. Louis Area counties (St. Louis City, St. Louis County, St. Charles County) and which has now trained more than 1,000 police officers. Recognizing access to mental health services is a cornerstone of CIT, Ms. Lukitsch established the Missouri Partners in Crisis, recruited into it leadership from law enforcement and criminal justice, and helped direct it in a successful campaign to persuade the Missouri Legislature to fund five new best-practice Assertive Community Treatment (ACT) programs statewide. These ACT programs provide intensive case-management for individuals with mental illness who are most difficult to serve. One of these five new ACT programs is to be specifically designed for clients referred to it by St. Louis area CIT officers. 

The “Judge or Court Official” award was presented to Joyce Kelley, Associate County Counselor, Chief Prosecutor, St. Louis County Municipal Courts. Joyce Kelley has been active in St. Louis area jail diversion programs. Beginning in 2000, she served on our initial multi-agency steering committee to help implement the St. Louis City/County Mental Health Court initiative, funded by Substance Abuse & Mental Health Services Administration (SAMHSA). When that project concluded, Ms. Kelley successfully advocated for the continuation of the court, supported by County tax revenue. In 2003, her involvement expanded to include CIT when she became active on the multi-jurisdictional St. Louis Area CIT Coordinating Council and its executive committee. She has lectured in all 12 St. Louis County CIT Training Courses, informing 800 officers about the Mental Health Court and its accessibility by CIT officers. When municipal police departments expressed interest, Ms. Kelley helped make it possible for municipalities to contract with the County to access its Mental Health Court. About 500 individuals have now been directed to the court by CIT officers for case management services. 

CIT, a program for law enforcement officers, is growing fast in the state of Missouri. There is a lot of talk about making CIT available statewide for all law enforcement agencies. For more information about CIT, please contact me at 314-628-5509, or barmfield@stlouisco.com.

July, 2007 CIT Graduates

In July, 2007, approximately 70 officers completed the 40-hour CIT (Crisis Intervention Team) program. In preparation for the first St. Charles County training, officers from several departments in that area attended the July session to become even more familiar with how a successful week’s training is delivered. Congratulations to the newest CIT graduates and best of luck to St. Charles County as it begins a new CIT program.

Return to Top of the Page

Difficulty Finding Mental Health Services by James E. House II, Executive Director, Mental Health Association of Greater St. Louis

The following question appeared in the Mental Health Association’s weekly newspaper column, Open Mind. Officers may find the discussion about inadequate psychiatric services helpful in understanding some of the systemic and practical obstacles individuals face when seeking treatment. Additionally, the At Your Service column in this edition identifies five community resources that may be helpful when assisting persons who have mental health concerns.  

Since February, I've been trying to find a psychiatrist to accept my Medicaid insurance. My 32-year-old son also needs a psychiatrist, but doesn't have health insurance. Although my son works, he cannot find a psychiatrist who will see him for an affordable fee. Neither of us have been able to get the appointments or prescriptions we need for our illnesses, which only get worse without treatment. I fear my son's symptoms will get so bad that he will lose his job. Why is it impossible to find a Medicaid psychiatrist and why are there no affordable psychiatric services in the St. Louis area for the uninsured? 

We, at the Mental Health Association, have increasingly run into similar problems in matching care to people with mental illnesses. We have always felt St. Louis has been blessed with psychiatrists who were willing to provide some services at no charge. However, state policies that do not value mental health services cause services throughout the system to be more difficult to attain. 

Medicaid traditionally has reimbursed doctors less than the doctors’ costs for all types of care. At some point, doctors began restricting the number of Medicaid recipients they would serve or, worse yet, began refusing to take any more Medicaid clients. Additionally, over 100,000 people were eliminated from Medicaid rolls, thus causing stress in other parts of the system, i.e., emergency rooms. 

The public mental health system has also been restricted by the diagnoses they can accept for service and is restricted even further by the funding appropriated by the Legislature and the Governor. The Department of Mental Health, through its own admission, can only treat about 20% of those people meeting diagnostic criteria. 

From fiscal year 2000 through fiscal year 2006, state-funded community-based providers of mental health services  received no increases by the state, while utility costs, insurance costs and almost any kind of cost imaginable has increased over those years. While one could point to the ongoing budget crisis as the cause, the legislature, in that same period, was able to increase funding to Medicaid Managed Care companies by 58%. 

In the past few years, St. Louis County closed its mental health clinics and contracted with a group of community-based organizations to try to meet the need. A very limited amount of psychiatric services are available through this service – not nearly enough. 

In the past, we were able to refer people to clinics at the universities, but they, too, have tightened the criteria for services. Without at least some financial means, people are able to access these services less and less. 

You also mention medications. The Mental Health Association has worked closely over the past several years to advertise the Partnership for Prescription Assistance Program (1-888-477-2669 or www.pparx.org). If you already have a prescription and can find a doctor to renew it, you might quality to get your medication at a reduced price or, possibly, free. 

I realize this is not a pretty picture I have painted, but the fact is without some outpouring of community support, treatment for mental illness is not going to be accessible to growing numbers of people with mental illness. This will result in people using higher-cost treatment or possibly other parts of the state system. More people with mental illness are in our prisons than ever before. Many of them would not be there had they received treatment in the community. If you or anyone you know has had a hard time accessing services, you should contact your State Representative or Senator.

Return to Top of the Page

As the above Q & A article in this edition discusses, mental health treatment can be difficult to obtain. What follows are descriptions of five agencies that offer a diverse range of services.  

• Behavioral Health Response (BHR) offers Next Day Urgent (NDU) appointments at the Community Mental Health Centers (CMHC) that serve the metropolitan area: BJC Behavioral Health, Comtrea, Crider Center for Health and Hopewell Center. A person’s zip code determines which CMHC will be used. NDUs allow the client to be screened at the CMHC for psychiatric services. However, it is not a guarantee that the Center will admit the client for services, nor does it guarantee that a psychiatrist will see the client. In order to get an NDU, a person must be in a psychiatric crisis that requires assistance within 24 hours, but does not require hospitalization. If a client has straight Medicaid or is un-insured, they may meet criteria for psychiatric services through the Community Mental Health Center. If a client has private insurance, they may not be appropriate for ongoing services at the Community Mental Health Center, but may benefit from referrals or further assessment. If a client does not have transportation, a cab will be provided only for travel to and from the initial NDU appointment. You can talk with a crisis counselor at Behavioral Health Response for more information about NDUs by calling the 24-hour hotline at 314-469-6644. 
   

• Access to mental health services is an important component of the Crisis Intervention Team (CIT) program. To accomplish access, our St. Louis area CIT programs benefit by several services made possible by a Treatment or “Bridge” Fund. Many individuals subject to a CIT police intervention were experiencing a mental health crisis because they stopped taking their medicine, possibly due to lack of insurance. CIT departments can have such individuals referred to St. Louis University Psychiatry Clinic for an assessment and short-term treatment. If medications are necessary, the “Bridge” Fund can pay for prescriptions to be filled for up to six months by a Walgreen’s Pharmacy. To access this fund, send a CIT Report to Sgt. Barry Armfield, CIT Coordinator, at (barmfield@stlouisco.com). This fund is made possible by a grant to National Alliance on Mental Illness – St. Louis (NAMI) from the Missouri Foundation for Health.
   

• Counseling and Psychology clinics at three universities offer very affordable services. Potential clients need to be aware that the treatment providers are candidates in either a masters level counseling or Ph.D. level psychology program and are working as interns in the clinic. While these students are not yet licensed, they are supervised by licensed faculty and can provide initial assessments and/or short-term therapy for a variety of concerns. These clinics do not provide psychiatry services or medication, and cannot provide treatment for persons who are suicidal or homicidal.

St. Louis University

Center for Counseling and Family Therapy                       314-977-2505
Psychological Services Center                                           314-977-2278 

University of MO-St. Louis

Community Psychological Services                                   314-516-5824 

Washington University

Psychological Service Center                                             314-935-6555 

• The Family Mental Health Collaborative (FMHC) is the psychiatric and counseling referral source for the St. Louis County Health Department. Knowledge of the FMHC and its functions can be a valuable asset for law enforcement officers managing crisis situations in which a citizen needs mental health assessment or treatment. Services offered through the FMHC include crisis intervention, therapeutic counseling, psycho-social assessments, case and care management, psychological testing, psychiatric evaluation, and follow-up. In addition, clients can be referred to other programs run by FMHC-affiliated agencies. 

  Comprised of accredited, non-profit organizations located throughout the St. Louis area, the FMHC’s primary focus is meeting the mental heath needs of those unable to receive such services because of being uninsured, under-insured, or because of geographic inaccessibility. Anyone living in St. Louis County is eligible, regardless of ability to pay (some services are free; others are offered on a sliding scale).   

  The centralized call number is 314-729-4035. All mental health services can be accessed by calling this number or by contacting any of the three St. Louis County Health Centers. 
   

• Life Crisis Services (LCS) has been answering its 24-hour crisis hotline since 1966. The agency receives over 150 calls a day from persons struggling with suicide, depression, relationships, abuse, caregiving concerns, employment, addiction, health, finances and other life crises. 

  In addition to the local crisis hotline,

  • LCS responds to calls on Lifeline (800-273-TALK), a national suicide prevention and crisis hotline
  • LCS provides counseling and referrals to persons who call 888-BETSOFF, the problem gambling hotline for the state of Missouri.
  • The Rainbow Youth Hotline (877-LGBT-YTH) provides crisis intervention and information to youth throughout Missouri who are lesbian, gay, bisexual and transgendered.
  • LCS conducts community education for groups interested in learning about suicide prevention.
  • A Survivors of Suicide support group meets weekly for persons who have experienced the suicide of a family member or friend.

  For more information, call the LCS hotline at 314-647-HELP.     

  Return to Top of the Page