 Welcome to this edition of Abel Denonair, the one and only program that focuses on the needs, concerns and achievements of the definitely able. As always, I'm your host Lauren Seiler. Arlene Seiler. And on this program, we speak to Gary Gordon, Director of Emergency Services for Washington County Mental Health. Welcome to Abel Denonair. Thank you, Larry. And Arlene. You're welcome. What are the missions and goals of your department and what is the screener? Okay. Missions and goals. Well, generally, our mission obviously dovetails with the mission of Washington County Mental Health Services in general, which we serve the needs of our population in our catchment area. We cover all of Washington County in three towns in Orange County, Washington, Orange and Williamstown are considered part of our catchment area. And we serve the mental health needs of the people in that area. Generally, our philosophy is based on the recovery model. Which is what? What is the recovery model? Just kind of in brief, based on the idea that an individual's recovery from an illness is there in charge of it. You know, everybody's individual. Their needs are different. We try to work with them to develop programs or within the programs and things that we offer models of treatment that works for them. We're collaborating with them in their efforts to manage and recover from their illnesses. So in general, that's maybe a snapshot of it. There's more information about that on our website at WCMHS.org. If you want to look closer at the mission and there's actually some information about the recovery model just in general, we kind of dovetail with the one that was developed by SAMHSA. And so if you look at emergency services, within that mission, our goal is to serve the needs of people who are in crisis within our area. Define, if you don't mind, because we got lots of time, define crisis. What exactly is a crisis or how does a person get out of or how does a screener or one of your employees help someone get out of a crisis? The interesting thing about that is that it's actually the people who contact us who define what the crisis is. But generally, if we're talking about a mental health crisis just in general, you're talking about a situation where a person may feel emotional distress because of having to deal with the psychosocial stresses of life or of managing their illness. A lot of things can cause a person to become in what we call a crisis in which they essentially become, they have a difficulty managing their lives. They're in a situation where they are not able to cope, not able to manage their lives. They're feeling like they need assistance, that they have no recourse, those types of things. So since you're dealing with your emergency department, what exactly is a screener? And how does a screener help within the process of recovery or help somebody? A screener or a crisis clinician, that's the general term that's being used now, is a person who will... Well, first of all, we have a 10 person team. Okay. Okay. There are always two of us on call. At all times. At all times. 24-7, 365 days a year, the two of us on. And our role is if a person calls us and identified that they have a crisis, then our role is to help that person work their way through that crisis. And we do that a lot of different ways. One of the things we do is we provide a lot of support by phone. We spend a lot of time on the phone actually. We get between 12 and 15,000 calls a year. 12 to 15,000 calls a year. Yes. And most of what we do is by phone. We do still a lot of people face to face, but we spend a lot of time on the phone. You go to the homes, to the homes to meet... Yep. That's another thing that we do. We can. We are a mobile crisis team, so we will travel two places within our area. And we will see people on site and we'll do a crisis evaluation on site. And obviously all of this is confidential. Yes. It is confidential. It is confidential. Unless... does confidentiality sometimes get broken if there's some issues there? No, we don't break confidentiality, but we... There are certain situations where we have to talk to other people, but it's always within the context of the crisis. So if we need to get, say for example, if we need to get law enforcement involved, we obviously have to be able to talk to them. We have to be able to talk to perhaps other partners. And what I mean by other partners, an example might be we might need to talk to a primary care practice if the person is a patient and there's someone involved in a call. We might need to talk... Yeah. We might need to talk to if it's a child and they're at school. We may need to talk to school officials. So the confidentiality rules still apply, but obviously there are certain people in the entities that we have to be able to talk to within crisis. Yeah. And the law does allow for that. Now, in terms of the law... Well, you mentioned law enforcement. I'm just going to ask this to piggyback. Law enforcement is being trained to work with mental and physical... People with mental and physical challenges. Yes. Okay. Do you think law enforcement... Or how can I phrase it? Can law enforcement or does law enforcement get more training when you're working with people that are mentally challenged, that are in mental health crisis? Or has that changed somewhat within the system? Sure. Yeah. So first of all, I don't want to talk too much about law enforcement since I'm not in law enforcement, but I know from my involvement with working with law enforcement that they are received training at the Vermont Police Academy. The Act 80 training, you hear that talked about Act 80, is a course that they take when they're in the academy. Yes. But we also developed, starting around 2013, we developed what we call the Team 2 approach where we bring together law enforcement, mental health crisis clinicians together, and we train together in how to collaborate when we have to respond to a person who's in a mental health crisis. And the reports that we've gotten from the Team 2 training have been very good. There have been several hundred law enforcement officers that have been trained. This is a cyclical, so we go around... Trainings are happening every... all year in different regions of the state. It is funded by, I think, through the Department of Mental Health and the Department of Public Safety. And we've been getting very good reviews from both the trainers, the trainees, and also we're starting to get information back from the public. And it is, we believe it is making a difference. And those conversations are also ongoing about other things we can do. I'm on the steering committee for the Team 2. And we just recently had a meeting where we're talking about other things that we can do to enhance the training of other areas that we need to look at. We take input from consumers. We take input from law enforcement from crisis clinicians. We also had an organization come in and do a survey. And we got the results back from that, I believe, last year. And those were all very positive. So things have been done in Vermont. As a matter of fact, I actually met with... And we've also... Kristen Chandler, who is actually a person who is the driving force behind the Team 2. She's the one who actually does it now. Has traveled... She's gone to, I believe, Seattle, Washington. She's gone to California to talk about the Team 2 model because other people in the country are interested in it. And I just met recently with four officers from St. Anthony, Minnesota, who did a peer review with the Bronson Police Department. And they were interested in the Team 2 model. So we think we're doing some things right in Vermont as far as the collaboration between law enforcement and mental health crisis workers. Does a person ever get violent? Unfortunately, yes. Since we were talking about mental health and screeners, when is the jumping point as far as like, okay, if a person gets violent, how does that come into play? How do you calm a person down? Is there a way to do that? Or do you just have to like, restrain them or something? Well, they don't use restraints anymore, do they? I know, but do they have to restrain them or something? Well, for us... I hope we're not asking bad questions. No, no. In terms of violence, a couple of things happen. So if we get a call to respond to a situation in the community, obviously one of the things we're concerned about is our safety and the safety of everybody around us. I mean, that's paramount in our thinking. And if it comes to our attention or doing our course of inquiry when we're talking to somebody, we realize that there's potential for ongoing violence and we have to involve law enforcement in that. We cannot put ourselves in a situation where we're not safe. Okay, so that means that law enforcement is going to come with us. Sometimes they're already on the scene. And these are the kind of things that we talk about in team two. It is not our responsibility as screeners to stop violence. We aren't trained that way. We're not police. We don't have the authority. We're not going to go hands-on with anybody. We're not going to try to do any restraint tactics. That's really a law enforcement responsibility. So usually we might be witness to it if we have to be there when it happens. A lot of times it happens prior to us being there because, again, once I say we can't involve ourselves in that. The situation has to be safe in order for us to be present because our role is to come in and do the assessment to determine what the crisis is and what the person's needs are. How does the assessment work? Is it a file that you put on the person? Well, it's a procedure. And some of that is defined by Vermont Statue. So when we go to evaluate somebody, we are looking first of all for the presence of mental illness. This person is in crisis, their behavior says that they're in crisis depending on what their behavior is. A lot of behaviors can fall into that definition. For example? An example could be somebody who is walking in the middle of the traffic mumbling to themselves and issuing threats. Really? Sure. We had a case recently where a person was ice-ly in traffic swinging at cars. Oh my gosh. Sometimes throughout the medication, they could be off their medication, right? Possibly. Those are things that we'll try to determine. So what we would do in that case is, first of all, if we see or have information that this person has a mental illness, that's the first thing that we look for. Secondly, we look for is this person a danger to themselves or others? Third, and if they meet those two, then is it a person who needs treatment? Are they in treatment? Do they need treatment? Do they need further treatment? And then, if we determine those three things, then we look at what is the least restrictive, least restrictive means of giving them to the treatment that they need. Define least restrictive. So least restrictive would be, I mean, is it simply a matter of them needing to take their medications that they may already have? Then, of course, our suggestion would be, have you taken your medications? Let's try taking your medications before we do anything else. If you've taken your medications, the behavior is the same. You're still in crisis. Then it might be, do you need to have your medications evaluated? Are there any particular stresses? What was the precipitant? What caused this behavior? What caused this to happen? So we would look at that. And if there's something we can do about that, if a person is in an environment that is particularly stressful, the recommendation might simply be, is there another place you can go to? Is there an alternative place you can go to? So if you had a fight with your roommate and it led you into a crisis, is there a family member you can go stay with? Is there some other place you can go? So we're always looking, and again, when we're talking about recovery and helping people through their crisis and helping them to resolve, and trying to resolve this collaboratively, then we're going to work with them to try to help, to get them to help us to determine what would be useful for them. So in that case, so if they had a family member, then we would contact a family member to see if they'd be willing to accept this person. And then it might be that they need to follow up with their providers. We might contact their providers and say, look, this person is in crisis. They need to get in to see you, or maybe if they don't have a provider, we can arrange for them to see one of our providers. If it's a situation where we try all these types of things where we're working collaboratively with the person and it becomes clear that they're unable to collaborate because of the severity of their symptoms at the time, then we may find that we would need to help them get to a situation where they can be safe and have their, and become stable. And that might involve hospitalization. Or putting the person, I'm sorry, I apologize, putting the person on what they call, well, in New York or other states, the person would go into what they call 72-hour hold where they would stay. Yes, but that's a little late in the process because we're always going to try to get the person, hopefully, to agree to do it voluntarily. So if, you know, if our evaluation, if we determine that the person needs to be on the hospital, then we will talk to them about that and we will say why we think they need to be on the hospital. Or try to get alternative. Yeah, or an alternative. There are alternatives. We have a crisis bed. There's a voluntary crisis bed system in Vermont, a listen over in Addison County. How does that work within the crisis? Well, we would make the referral to them and then they would make the determination whether the person is appropriate for their program. They have their own admission procedures. We'd either put the person in touch with them or we would contact them ourselves. If the person agrees to go into a psychiatric unit voluntarily or crisis bed, then we would make those arrangements. We would help facilitate that. If they refuse and they are danger to themselves or others, then by law we can institute an emergency hold, a 72-hour that you were making reference to. We can do that in collaboration with the psychiatrists. We can't do it alone. We always have to have a psychiatrist. There has to be two psychiatrists and a crisis worker who would initiate that procedure. So let me get this straight for our viewers. A person can accept treatment or not, but if it's an emergency, then you have to come into play and get other people to help within that emergency. Correct. Emergency and they are danger to themselves. That's the key thing here. There has to be an element of dangerousness. Sometimes emergencies resolve themselves without somebody in the end being dangerous. And at that point we cannot compel them into treatment. And that's not unusual. We get a lot of calls and the calls may start out being a crisis and by the time we're done we've resolved a crisis and we've come up with a plan for the person to follow up. Because they're no longer, they've been stabilized and what might be thought of as a danger may not turn out to be such a danger. And we come up with an alternative. Really the idea of putting somebody in the hospital against their will is the absolute last resort. It's the last thing that we do. It's the thing that we do the least. Like I say, we get 15,000 calls. Not even 1% of those go in to a hospital involuntarily. So it's really the last thing that we do. We do it when we don't have a choice. I want to ask this. Myths against mental illness. In other words, if your parent has it it doesn't mean that you're meant to be ill. What are some of the myths that you come across? Someone from the family has them. Does it affect the children? Does it affect children? Does it affect the all? There seems to be some evidence that there's a genetic component to mental illness. I mean we do see it where both parents and children have it. But it's not a given that someone have just like it's not a given that if a parent has diabetes that the child have diabetes. In some cases it happens, in some cases it doesn't. So as far as any stigma attached to that, there may be and I think I can say in my years in doing this I have heard that and people do talk about that. So there's probably some stigma attached to that. And maybe in some cases even some expectation which I think is unfair. What do you mean by that? Well genetics is genetics. I have brown eyes, my sister might have green eyes. It's no different with mental illness. You may have it, you may not have it. I know in some cases where the parents are mentally ill and the child is not. So I think that that is a misconception that's out there. I don't know how prevalent it is. What are some of the misconceptions around mental illness? Because mental illness like deafness and some others are silent disabilities or silent situations. What are some misconceptions that being the factor you're in the field, what are some of the misconceptions around mental illness that people might not know? I think one of the misconceptions is that people who are mentally ill are somehow dangerous or violent or more so than the rest of the general population and the reality is that they're no more dangerous or violent than the general population. That the percentages of people who are violent probably who are mentally ill will match the same percentage of people in the general population. Or they're neither greater nor less violent than people who are mentally ill. But I think that perception is out there because we've had some high-profile incidents with people who have done some pretty horrific things. They've been identified as having mental illness. But that's one that concerns me because the majority of people who are mentally ill are just like everybody else. They're no different when it comes to... In terms of your program. Can a person... I wouldn't say graduate, okay. They have a mental illness now. But can they not have it later in life or does it always stay with them? Or is there a consensus to that? I don't know if there can be consensus. I mean, not consensus, like... I mean, not consensus. Does a person always have mental illness throughout their lifetime? Or can they not have it because your program helps people? So through your program, can they get... Again, I think it speaks to the individual, the nature of the illness, the type and course of the illness. We do have people who are clients and they reach a point in their lives where they have achieved a point in their recovery where they no longer need to be clients. Yeah, that's what I mean. That does happen. In some cases, so if you look at depression, there are cases where people who are depressed can recover from the depression and maybe not have it again. Okay. When I'm talking about depression, I'm talking about clinical depression, you know. As far as other types of illnesses, I just think it depends on the individual, the course of treatment, how they respond to the treatment, all the factors in their lives. So, again, it's a very individual kind of thing. I don't know... I mean, it seems to be that there are certain illnesses that are very difficult to overcome, such as schizophrenia, perhaps, where the idea that people were completely recovered from that exists, but it may not... We don't have the same kind of results like that that we would have with depression, say. Depression seems to be one of the illnesses that we treat pretty successfully, whereas we have more difficulty treating a person with a diagnosis like schizophrenia. But I don't think we can say that because a person has schizophrenia that they will necessarily have it for the rest of their lives or that they can't recover. I think the big issue is that they can recover and, in some cases, live a healthy, functional life. Just like people without... Other illnesses are able to manage their illnesses also and live and be productive. So I think people with schizophrenia, if not a quote of full recovery, they can have a recovery that allows them to live, they can manage their symptoms just like you can manage symptoms of other illness and live a healthy and productive life. Is there anything within a screener's job that is more difficult than others? Is it hard to really be a screener? If someone was to do this... Let's say someone's watching now and they want to become a screener. What are some of the things that they should know about the job? It's a thankless job. It's not an easy job. It's not easy. Is it? No, it can be difficult. One of the things that I think is noteworthy about the job and that I think about sometimes is that we generally don't see people when they're doing well. When we see people, they're usually in probably some of the most difficult situations they've been in in their lives as far as their own health and well-being. Some of the things that we see are things that can really be heart-wrenching just to see how ill somebody can be and the consequences that it has for them and their families. If someone, for example, can't deal with death or someone dying in their family, they kind of crash, right? Or something like that? People who might make a lethal suicide attempt. People who might be really ill and put themselves and maybe the people around them in a position of significant danger. Whether that be driving on the highway on the wrong side of the highway at a high rate of speed. For example, with this whole situation with Anthony Bourdain, the chef who committed suicide, no one saw the signs of that. Suicide sometimes, like I said, can be a silent situation. You don't see signs with certain challenges that you're trying to help somebody with. So how do you deal with that? Can we back up a little bit? We started talking about... I apologize. No, it's fine. If someone was interested in being on the screen, I think you asked me that. If you have an interest in the field of mental health and crisis work, the screeners require a certain amount of both academic preparation and experience in the field. Those are laid out pretty specifically in terms of how many years of experience, how many years of education, and the type of education, generally in human services or in psychology or social work or something like that. There's a third number of years of experience in the field. And then there are just certain personal qualities that an individual has to have. A screener has to be somebody who can really deal with change because things change. Things are never the same. They have to be able to manage themselves in very intense and tough situations. They have to be able to manage, be able to establish rapport with people, and not just with people who are the subjects of our evaluation declines, but also with other providers, with other agencies, with other people who may be involved, such as the staff in the ER, law enforcement, all the agencies that we might have to deal with, family members, those kind of things. You have to have what we generally call good people skills. Customer service, it's more than just customer service. Yeah, it is more than customer service. I mean, that's an element of it. But again, you're also managing relationships with everybody else who's involved. I mean, there can be a lot of people involved in a crisis. You can have the police involved. You can have the... If they go to the emergency room, you have the emergency room staff involved. Their family members may be present in the emergency room. You may have another agency involved. Like if it's a child, the children and families involved, they may be present. So a lot of people can be involved in a case. Social worker. Yeah. So you have to be able to manage and to maintain those relationships and negotiate with all those different... And they may all have different goals in terms of what they think should happen during this crisis and how the crisis should be resolved. And you have to be able to negotiate that and also be able to... Once you reach your conclusion about what should happen, be able to present that to them. You know, whether they agree with it or not. Right. So those are some of the qualities that you would need to have as a screened ability to manage somebody who may be angry. First of all, angry because you got involved in the first place. A lot of times people are just angry because we even show up. Because they didn't call us. They don't necessarily think that they're in crisis. So if they didn't call you, how does the screener then come into play? Someone else calls? Sure. Yeah. Our calls can come from anybody. Really. Family members. Police officers. People passing by on the street. We get a lot of calls from people who just observe somebody with, say, bizarre behavior or behavior that concerns them. I mean, we get people calling themselves from their cars. It can come from a business owner who has somebody in their store that's acting in a way that concerns them. So the call can come from anybody at any time. And we take that information and if we believe that it's a person, you know, if the information on our own says to us that this person sounds like they have an illness in their crisis, then we will go to the scene. We don't have to, you know, and we will attempt to do our evaluation. That doesn't necessarily mean the person is going to be cooperative necessarily. But we do our best to to engender that cooperation. One of the things that people should know is that, and this is interesting to me because I'm always amazed that this perception still exists. The perception that the screeners are looking to put somebody in the hospital and commit them. Say that again. Say that again? Yeah, the perception that the screeners are looking to hospitalize somebody against their will and have them committed. Two things I want to say about that. The first thing I say about it is that commitment is a legal process that can only be done by a judge. So a screener can never commit anybody. What a screener does is that if a person meets the criteria that we talked about earlier, they can initiate a procedure where a person can be hospitalized for 72 hours. Okay? Yeah. But the other thing is that our mandate of screeners, since our very inception, the screeners in Washington County were started in 1974 when when Dr. George Brooks, who was working at the state hospital at the time, actually wrote a grant. He told me this himself. He wrote the initial grant and started what he called the rural screeners. That's what we were known back in the day as the rural screeners. The idea was was to help to keep people out of the hospital. During that time, back in 1974 in Washington County, 30 people stayed out of the hospital per month. Wow. Okay? Within four years, by 1978 with the initiation of the screening team, that was reduced to eight people a month. So it's really our goal to keep people de-instituted. Yeah, this was a part of that process. Yeah, this was a part of that process. And it's really our goal to help people stay out of the hospital. That's what we're trying to do. We're trying to put somebody in hospital against their will. So that's more like a myth. Do people automatically think that when they see a screener, okay, I'm going to the hospital, that type of thing? Sometimes they do. And not only that, but sometimes so do the general public. I mean, a lot of dissatisfaction that we get from the public at large is that they expect us to do that. And they're often disappointed that they expect us to come and take this person away and have them committed. We get those kind of calls. I want my son committed. My aunt needs to be committed. Well, again, we don't commit people. And secondly, we're not looking to do that. We're looking to try to help them manage this crisis and to get them into treatment if that's what they desire. You know, a person has a right to refuse treatment. They can refuse treatment. It's not against the law to refuse treatment. The only time we can again, the only time somebody can be put in hospital and voluntary is if they meet all the criteria that I talked about before. The dangerousness being the primary one that results in a voluntary hospitalization. Okay, now let's talk about some of the myths. Well, some of the situations like suicide, for example. Anthony Bourdain, I'm going to mention again. Right. He was found you know, in his hotel room unresponsive and he committed suicide. But how you know, I mean we can't tell the signs of suicide. We can't tell the signs of certain mental illnesses. Can you break some of that down like I mean, why is it that there are certain mental illnesses that are silent and how does your department come into play with that in terms of counseling or screening or that type of thing. Oh, yeah. Well, to the first part of your question, why I'll tell you I have no explanation. I think if we knew why we would we'd be having a different conversation because the suicide rate would probably be slim to none if we knew why. In terms of how we interact with that as being screeners, we get caused frequently about people who are suicidal. We take them all seriously and that affects how we interact with somebody. So if we get somebody on the phone who's suicidal, then obviously we're going to explore what they mean when they say they're suicidal. We're going to explore what things in their environment may be we call them psychosocial stressors, may be contributing to that. What exactly is psychosocial stressors? Psychosocial stressors are those things that cause you stress that may put you in an emotional situation where you feel like taking your life as your option. So psychosocial stressors could be losing your job it could be Wall Street crashing it could be a combination of things that could be losing your job your wife falling for a divorce it could be I'm tired of being an alcoholic I can't stop myself the only out for me is to kill my I mean there are a lot of things again they're different individuals a lot of things can cause the type of stress it could be things like you don't get enough sleep I mean a lot of things that can contribute to our emotional states and our psychological well-being and so we call those a psychosocial. It could be all kind of family dynamics you could be having problems with your family or your in-laws I mean a lot of things that can be happening that can contribute to a person and then some of them will depend on your history and your makeup you know if you have a trauma history I mean a lot of things that contribute to what can cause somebody to go into crisis and come to the conclusion that they need to kill themselves so those are things that we would try to divine if you were from a person when we're talking to them on the phone you know we're looking for first of all if they're having the thoughts then we're looking for if they have intent do they really mean as best as we can discern do they have the intent to kill themselves then we're looking if they have the means to kill themselves you know if a person says I'm going to shoot myself then the novice question is do you have a gun and they say well no I don't have a gun do you have access to a gun and this is kind of simplified and if they don't have a gun and they don't have access to a gun doesn't mean that they don't have the intent so it still means that we need to follow and try to get them in a treatment in some way it just lessens the likelihood that they're going to be able to carry it out doesn't mean that they won't so those are the things that we go through with a person we look at protective factors what things that they have in their life that will actually help them get through this crisis and then we look at risk factors risk factors could be you know males commit suicide more than females do why is that? I'm not sure you know I'm sure there are theories on it but the fact is the interesting thing about that is that females attempt suicide more than males do but males are more successful more than females are and some of that's related to the fact that their favorite method for men is guns so I can't really answer why men do it I mean I've read some things about it but I don't know if there's a definitive answer I think some of it would probably be sociocultural you know but anyway when we look at all the things involving somebody who is suicidal then then what we look at is trying to help them first of all to ensure their safety as best we can and that can be a lot of things again we're working with the individuals so because somebody's suicidal doesn't mean that they're necessarily going to be in the hospital or that we're going to compel them to do anything it could be as simple as a person is threatened and taken over those because they've had a stressor they broke up with their partner you know it's 9.30 at night so we may and I've done this personally how about if I come and take your medications just for tonight I will come to you you surrender your medications to me I will hold on to them tonight and tomorrow we will arrange for you to see somebody or tomorrow we'll follow up with your therapist if you're already seeing somebody your doctor or I can leave the medications with your doctor I will come up tomorrow we do things like that is there somebody else you can be with tonight who can support you through this and we can work out a safety plan like that in some cases the person may need to go to the hospital and then we will see how they can safely get to the hospital and then once they're in the hospital we go meet with them and if they need to be admitted and they agree to it then we can have we do have a psychiatric unit here at Central Vermont Medical Center they can be admitted to that unit or if necessary they can remain in the ER or they can go to our crisis bed or they can go home if we develop a safe enough plan until there's a psychiatric bed available for them and we will follow up on that so that's kind of how that works and then if they're suicidal and they're refusing our treatment and we're convinced that they're suicidal and we get them to be seen by psychiatrists and psychiatrists is also convinced that they're suicidal then at that point they will be hospitalized involuntarily but again you know it has to be clear that they're a danger to themselves you know and that they have the means and the intent in terms of future goals of your department like okay your department has been around since nineteen in the seventies right the screeners the real screeners started in seventy four yeah okay so knowing that you guys have a vast history and helping people what are some of the future goals of your department and you know future things that you guys are working on to make the screeners much better much better trained well we always we're always as far as we're concerned we're always training I mean you never know everything there's to know we like to stay abreast of the current information and trends we encourage people on the team to go to trainings Washington County as an agency encourages the staff to train we encourage people we send people to trains we bring people in house to train us so we're always looking to do that we're in terms of our goals in terms of trying to expand services we're looking at trying to come up with I think more comprehensive crisis services as far as trying to help people trying to keep people out of the emergency department because right now you know somebody goes into a crisis after five the only thing we really have for them other than us going to them I mean we can travel to them okay we can go to their home or whatever but if that's not appropriate then the only other resource they really have is to go to the emergency room well a lot of times they don't really need to be in the emergency room because a lot of what happens in the emergency room does not address their crisis for example well when you go to the emergency room you sign in you have to meet with a nurse they take your blood pressure you know they go through all the medical procedures and quite frankly what happens is that's a very expensive way to do things because a lot of that you don't necessarily need a nurse taking your blood pressure you don't need to talk to an ERR doc necessarily about who is not a specialist in terms of treating your emotional crisis so the idea is is to be able to divert people away from the ER which we can do during the day because we're in the office so people can come to the office and see us and say we can travel to them when it's appropriate so one of the things that we have talked about throughout the years and still will continue to talk about and try to figure out how to do it is to be able to have office hours if you will after five and on weekends and times when it would be when people can come to us if they need to and have their needs met as opposed to having to go to the ER and there's also a time element involved when you go to the ER you might sit for two hours before you might sit there 45 minutes before you even see the nurse who will even be the ones to call us and say we have somebody for you to see I'll give you an example I'm originally from New York so I was the wife sometimes you're in well I know back in the 70s and 80s you were sitting there like five, six, seven hours and seeing here in Vermont example I have epilepsy I had a seizure soon as I got to Vermont the mountains would bother me I was in and out in 45 minutes it wasn't as long as I thought it would be hospitals obviously are working on changing that with depending on it depends on the emergency crisis right as far as like how long they're in hospital so on and so forth now in terms of that emergency crisis restraining do they restrain people if they become a danger or have they stopped it as far as so the hospital has their own policies around that they do have regulations federal regulations about the use of physical restraints I can't really speak to that what I can say yes they do restrain people what I can tell you about it is that again it's the last resort yeah but they have procedures around that they have federal and state laws that govern their use of that and it's very rare that it happens very rare it's rare so coming away from this discussion today people should a person be like if they see someone in the street who has a mental a challenge should they be afraid of a person with a mental challenge or mental illness I hate saying the word illness but should they be afraid of them I don't think so again in general no because that speaks back to that idea of this perception of people who are mentally ill or are somehow more dangerous than the rest of us and that's not the case before we end is there anything you want to add to you being a screener because I know that there's pros and cons of everything as far as working what is the positive things about the job the negative things that you might want to add the positive thing to me about the job is that I have a job where I'm able to go out and assist people in some of the most difficult times of their lives and I feel a certain amount of gratitude about having the ability to do that and I think that's an honor to be able to go out and assist people in those kind of crises and we have an environment at Washington County Mental Health where I've always felt like the things that I do were appreciated and encouraged so those are the things that I like about the job as far as the things that are difficult about the job or having to help people in a time and in a situation where there's a lot of issues around resources that are available for people in crisis you know and I think it's pretty there's a lot of talk now about what some people would say the lack of resources and the difficulty that we have in trying to help people get what they need to me that's the tough part of the job like I tell people I can deal with the clients all day the problem is that after I make the assessment I'm not sure if I'm going to be able to get them what they need Is it because of lack of finances or money or it's just because you can't help them I don't want to lay it all on money and lack of finances but I think that's an element of it in some of it I think is that it's still evolving I mean we're still trying to figure out how best to do this and yes finances and budgets are part of that because it has to be something that's doable and sustainable so that's the part of it I think another part of it is what we're talking about and kind of alluding to educating the community about people with challenges so that people aren't afraid or so uncomfortable because I think that goes a long way toward helping people with their recovery I think it speaks to that whole idea about stigma and that kind of a thing because I think it's difficult to recover in an environment where you're stigmatized I think that has to create a certain amount of anxiety and discomfort on a daily basis so those kind of things for me those are the kind of things that are frustrating about the job is trying to link people with the resources that they need or that we determine that they need and that's not always available in a way that we feel and sometimes it's not always available in a timely fashion and I'll just throw this in one of the things we've been dealing with at least since Tropical Storm Irene is this idea of people boarding in the ER so we have people who are stuck in the ER for multiple days sometimes waiting for an appropriate psychiatric bed those are the kind of things that frustrate us or is it also not enough staff in the ER because of example certain hospitals like in New York Bellevue I've seen documentaries of horrible things that happened with people with mental challenges in the ER I'm sure it's changed over the years and it's gotten better but you want to speak to that real quick before we... well in terms of staff the first thing I'll say is that an ER is not designed an ER is not a psychiatric unit they weren't designed with that in mind so it puts a lot of pressure on the ER and ER staff the people who work in the ER are not psychiatric specialists you know so they have been some efforts made to address that I think Central Vermont is doing a good job with trying to address that so that gets into the resource issue again and do we need to have alternative and again that's what I was talking about in terms of our goals perhaps we should have and I believe we should have an alternative to people going to the ER you know and there are some states that have alternatives to ERs they have facilities that people can go to in a mental health crisis not really an institution because it's short term so instead of going to an ER you would go to for lack of a better term I'd call it a mental health urgent care and your mental health needs are met and they're met efficiently and all of the people around you are people who are well trained to do that you don't have to deal with the kind of issues that you deal with in an ER look at Ray Charles when he went to he took the drugs and he went to this rehab center where they had to help him get off of it sure yeah so I mean I think it wasn't easy for him but he was like provoking you know yeah and that's part of the problem in these crises aren't particularly easy yes you know well we would like to thank you thank you for inviting me for more information on Washington County mental health you can log on to their website www.mhcs.org www.mhcs.org www.mhcs.org is there an emergency number? the emergency number is 2290591 that's 2290591 thank you again for joining me on this edition of Ableton on Air see you next time