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Mobile crisis unit counsels, comforts area's mentally ill 'The feelings, the misery - I can't fix it myself.'
January 22, 2003
Dallas Morning Star News LogoBy ED HOUSEWRIGHT Dallas Morning News Staff Writer.
January 22, 2003
Marilyn Lewis' brother lies in bed, curled up under two blankets, moaning slightly. In recent days, he has talked about suicide, and he's not eating or drinking, she tells a nurse who just arrived. He has no history of psychiatric problems, she says, but his mental state has suddenly deteriorated. He won't get out of bed and rarely talks.
"You've got to do something," Ms. Lewis says to the nurse. "He can't continue to suffer like this."
"He's going to get some help," Maurice Simmons promises.
He calls an ambulance, and within five minutes paramedics take Ms. Lewis' 50-year-old brother to Parkland Memorial Hospital for medical and psychiatric assessment.
Maurice Simmons, LVNMr. Simmons is part of a 24-hour mobile crisis unit that handles mental health emergencies in Dallas County and six surrounding counties - the only unit of its kind in the state. The team of licensed counselors and nurses receives about 1,200 calls a month, more than twice as many as when it began two years ago with state and county funding.
The calls come from desperate people of all ages and their family members, along with officials from schools, jails and nursing homes. Some people threaten to commit suicide. Some are psychotic, out of control. Others may not pose a danger to themselves or those around them but are severely depressed and unable to function normally. Callers suffer from all types of mental illness, including major depression, bipolar disorder and schizophrenia, officials say.
Crisis team members evaluate a person over the phone, asking questions, listening and relying on their instincts. If they determine that a person needs immediate help, a staffer jumps in one of three unmarked Toyotas with a GPS mapping system and heads out. They may stay at the scene several hours.
Ideally, the crisis team member can soothe the person, offer hope and refer him or her to a nearby mental health provider for follow-up care, staffers say. However, they often must call law enforcement officers to take people against their will to a psychiatric hospital for evaluation. Some people have a history of mental illness; others are suffering their first symptoms.
"We do our best to screen people," said Lynnie Smith, administrator of the program. "If there's any doubt, we arrange for them to go to a hospital for observation. We don't take any chances."
NOT THAT COMMON
More than half the states have mobile crisis units for mental health, but usually in only one or two areas of the state, as in Texas, said Oscar Morgan, senior consultant for mental health policy and programs for the National Mental Health Association.
"I really applaud the staff members who are willing to go out in the middle of the night to respond to a crisis," Mr. Morgan said. "They are going into unknown situations. It takes a very skilled person."
The Dallas mobile crisis unit offers assistance at no cost, regardless of income or insurance coverage. Besides Dallas, the unit responds to calls for help in Collin, Ellis, Hunt, Kaufman, Navarro and Rockwall counties.
The program has an annual budget of about $1 million. The cost is "well worth it" because it saves money by reducing emergency room visits and hospital stays, said Carole Matyas, vice president of public programs for ValueOptions, a company chosen by the state to manage public mental health care services in the seven-county region.
Dorothy Williams, QMHP, Doris Wilson, LVN, Shirley Poeck, LPHA, Kevin Rosado, LPHA"We've been very pleased with the service they provide," she said.
ValueOptions takes state funding allocated for mental health care in Dallas County and the six surrounding counties and contracts with a range of psychiatrists, clinics, therapists and other providers to deliver care.
For the mobile crisis service, ValueOptions contracts with Telecare Corp., a company based in Alameda, Calif., that offers an array of mental health services in California, Texas and Oregon.
In Dallas, the crisis unit responds in person to about a quarter of the calls, about 300 per month, Ms. Smith said. Some callers are simply lonely and want to talk. Staffers say they will listen as long as they can. But if an urgent call comes in, they'll try to end the conversation, explaining the purpose of the crisis line.
Team members get dispatched to all areas. One day, they may pull up in front of a mansion in Highland Park. The next day, they could visit a mobile home in a rural area. Callers tend to be low income, and their mental illness often gets in the way of taking care of themselves or their home.
"Some homes are just God-awful - the odor and the filth," said Vida Yarn, a counselor. "You don't even want to sit down." One time, a staff member came out of a house, jumping around strangely. "He had fleas all over him," Ms. Smith said. "You see things that are difficult to see - animals neglected, people living in really filthy places. One guy had feces smeared everywhere."
OVER THE EDGE
Often, a person's mental health crisis results from a decision to stop taking psychiatric medication against doctor's orders, Ms. Smith said. Other times, a traumatic event - death, divorce, loss of a job, financial pressures - drives someone over the edge.
The largest number of callers are between 41 and 59 years old, and many have a history of drug and alcohol abuse, records show. More calls come in during the day than at night, and more during the week than on weekends. Holidays also tend to be slow. "There's more family support during the holidays," team member Mr. Simmons said.
After each visit, team members fill out paperwork that includes an assessment of the person's condition when they arrived and when they left. A recent call sheet describes a visit with a 17-year-old male. A cousin had called, saying the youth had been in a fight and vowed to get revenge.
"He wants to kill and beat up the guy who hit him in the face with a bottle," the caller said, according to the report. A crisis team member talks to the 17-year-old about nonviolent ways to solve conflicts and suggests that he see a therapist. The staffer also gives family members the telephone numbers of mental health providers. The teen calms down, and the team member leaves. "I will not hurt anyone because I don't want to put my family through that," he says, according to the report.
Some people with serious mental illness improve quickly after getting the proper medication. Other callers may spend a lifetime battling mental illness, even with medication and therapy.
The crisis unit, which operates out of a small office at Stemmons Freeway and Motor Street in Dallas, answers five telephone lines around the clock. Callers never get voice mail.
People typically find out about the crisis unit from community presentations by the staff or from others who have been helped, officials said.
At the call center, it's rare for an hour to pass without a call. Sometimes calls come in furiously, and team members fly from crisis to crisis without returning to the office.
Team members say the job is adrenalin-charged and stressful, but rewarding. Turnover among the staff is low. "We can deal with pretty intense situations at times," said Bonnie Athens, a nurse. "But I love it. I like helping people. It's amazing how many people out there, even families of clients who have had mental illness, know nothing about it."
EVERYONE ON THE CRISIS TEAM HAS WAR STORIES.
Shirley Finnell, RN and Les Beddoes, QMHPMs. Athens once went to a home where a man had been dead on the couch for three days. His mentally ill wife, drinking a 40-ounce beer on the back porch, was convinced he was only asleep.
Another staff member, Angie Byrd, responded to a home where a young man had been fasting for days, over the objections of his parents. He said he was doing so for religious reasons and didn't appreciate Ms. Byrd being there. "He said, 'Out, Satan!'" she said.
Ms. Yarn, a counselor, once listened to a man describe over the phone how he was slitting his wrists.
"I kept him on the phone until I heard 911 knocking on the door," she said. "They took him to the hospital." He survived. No one has carried out a suicide threat after calling the crisis unit, Ms. Smith said.
Team members, who do not carry weapons, say they routinely face danger. But no one has been injured, other than a couple of minor dog bites. At night, staffers normally respond to calls in pairs to ensure safety. They stay aware of their surroundings at all times.
"You should never leave yourself with no way out," Ms. Athens said.
SOBBING, SOOTHING
On a recent night, Ms. Byrd took a call from a 55-year-old man at a South Dallas boardinghouse. On the phone, he had difficulty talking between sobs. He seemed severely depressed.
When Ms. Byrd arrived 20 minutes later, the man shuffled in from a back room. He was gaunt and had a long, scraggly gray beard. He wore a dirty Texas Rangers cap.
"You said you'd been depressed, right?" Ms. Byrd said, beginning the conversation. "Extremely," Larry Lightfoot replied. "Are you having thoughts of wanting to hurt yourself?" she said. "I hate to say that because they'll lock me up and take all my clothes away." "But you're having those thoughts?" "Yes, ma'am. It's crossed my mind."
Between puffs on a cigarette, he says he has a heart problem that keeps him from working. He's also suffered a stroke. He says he has no family members to turn to for help. Mr. Lightfoot says he's been down before, but never like this.
"It doesn't feel like it now, but depression is a short-term problem," Ms. Byrd tells him. "Suicide is a pretty long-term solution." She suggests that he go to Parkland hospital for a physical and mental evaluation. She says she'll drive him. He consents.
"I want some help," Mr. Lightfoot said. He said he really didn't want to call the crisis line. "It's kind of embarrassing," he said. "But I have to do something. It's not worth taking anymore - the feelings, the misery. I can't fix it myself."
E-mail ehousewright@dallasnews.com
Photos by MONA REEDER/Staff Photographer
Reprinted with permission of the Dallas Morning News.
Telecare Mobile Crisis
24-hours-a-day, 7-days-a-week.
(866) 260-8000
Business Phone: 214-267-0545
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Learn more about the Telecare Mobile Crisis program in their latest annual report. Adobe Acrobat required to view.
Telecare Mobile Crisis Program Annual Report: Febuary 1, 2001 to January 31, 2002. Explains program structure and results for this innovative program.
