There are several resources for a person who grew up in a household where schizophrenia was present. This website is a good resource, but I will share others.
He experienced it repeatedly: The 911 operators dispatched police, who often took him to a hospital or jail. “They don’t know how to handle people like me,” said White, who struggles with depression and schizophrenia. “They just don’t. They’re just guessing.”
In most of those instances, he said, what he really needed was someone to help him calm down and find follow-up care.
That’s now an option, thanks to a crisis response team serving his area. Instead of calling 911, he can contact a state-run hotline and request a visit from mental health professionals.
The teams are dispatched by a program that serves 18 mostly rural counties in central and northern Iowa. White, 55, has received assistance from the crisis team several times in recent years, even after heart problems forced him to move into a nursing home. The service costs him nothing. The team’s goal is to stabilize people at home, instead of admitting them to a crowded psychiatric unit or jailing them for behaviors stemming from mental illness.
For years, many cities have sent social workers, medics, trained outreach workers, or mental health professionals to calls that previously were handled by police officers. And the approach gained traction amid concerns about police brutality cases. Proponents say such programs save money and lives.
But crisis response teams have been slower to catch on in rural areas even though mental illness is just as prevalent there. That’s partly because those areas are bigger and have fewer mental health professionals than cities do, said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness.
“It certainly has been a harder hill to climb,” she said.
Melissa Reuland, a University of Chicago Health Lab researcher who studies the intersection of law enforcement and mental health, said that solid statistics are not available but that small police departments and sheriffs’ offices seem increasingly open to finding alternatives to a standard law enforcement response. Those can include training officers to handle crises better or seeking assistance from mental health professionals, she said.
The shortage of mental health services will continue to be a hurdle in rural areas, she said: “If it was easy, people would have fixed it.”
Still, the crisis response approach is making inroads, program by program.
White has lived most of his life in small Iowa cities surrounded by rural areas. He’s glad to see mental health care efforts strengthened beyond urban areas. “We out here get forgotten — and out here is where we need help the most,” he said.
Some crisis teams, like the one that helps White, can respond on their own, while others are paired with police officers or sheriffs’ deputies. For example, a South Dakota program, Virtual Crisis Care, equips law enforcement officers with iPads. The officers can use the tablets to set up video chats between people in crisis and counselors from a telehealth company. That isn’t ideal, Wesolowski said, but it’s better than having police officers or sheriffs’ deputies try to handle such situations on their own.
The counselors help people in mental health crises calm down and then discuss what they need. If it’s safe for them to remain at home, the counselor calls a mental health center, which later contacts the people to see whether they’re interested in treatment.
But sometimes the counselors determine people are a danger to themselves or others. If so, the counselors recommend that officers take them to an emergency room or jail for evaluation.
In the past, sheriffs’ deputies had to make that decision on their own. They tended to be cautious, temporarily removing people from their homes to ensure they were safe, said Zach Angerhofer, a deputy in South Dakota’s Roberts County, which has about 10,000 residents.
Detaining people can be traumatic for them and expensive for authorities.
Deputies often must spend hours filling out paperwork and shuttling people between the ER, jail, and psychiatric hospitals. That can be particularly burdensome during hours when a rural county has few deputies on duty.
The Virtual Crisis Care program helps avoid that situation. Nearly 80% of people who complete its video assessment wind up staying at home, according to a recent state study.
Angerhofer said no one has declined to use the telehealth program when he has offered it. Unless he sees an immediate safety concern, he offers people privacy by leaving them alone in their home or letting them sit by themselves in his squad car while they speak to a counselor. “From what I’ve seen, they are a totally different person after the tablet has been deployed,” he said, noting that participants appear relieved afterward.
The South Dakota Department of Social Services funds the Virtual Crisis Care program, which received startup money and design help from the Leona M. and Harry B. Helmsley Charitable Trust. (The Helmsley Charitable Trust also contributes to KHN.)
In Iowa, the program that helps White always has six pairs of mental health workers on call, said Monica Van Horn, who helps run the state-funded program through the Eyerly Ball mental health nonprofit. They are dispatched via the statewide crisis line or the new national 988 mental health crisis line.
In most cases, the Eyerly Ball crisis teams respond in their own cars, without police. The low-key approach can benefit clients, especially if they live in small towns where everyone seems to know each other, Van Horn said. “You don’t necessarily want everyone knowing your business — and if a police car shows up in front of your house, everybody and their dog is going to know about it within an hour,” she said.
Van Horn said the program averages between 90 and 100 calls per month. The callers’ problems often include anxiety or depression, and they are sometimes suicidal. Other people call because children or family members need help.
Alex Leffler is a mobile crisis responder in the Eyerly Ball program. She previously worked as a “behavior interventionist” in schools, went back to college, and is close to earning a master’s degree in mental health counseling. She said that as a crisis responder, she has met people in homes, workplaces, and even at a grocery store. “We respond to just about any place,” she said. “You just can make a better connection in person.”
Thomas Dee, a Stanford University economist and education professor, said such programs can garner support from across the political spectrum. “Whether someone is ‘defund the police’ or ‘back the blue,’ they can find something to like in these types of first-responder reforms,” he said.
Critics of police have called for more use of unarmed mental health experts to defuse tense situations before they turn deadly, while law enforcement leaders who support such programs say they can give officers more time to respond to serious crimes. And government officials say the programs can reduce costly hospitalizations and jail stays.
Dee studied the Denver Support Team Assisted Response program, which lets 911 dispatchers send medics and behavioral health experts instead of police to certain calls. He found the program saved money, reduced low-level crime, and did not lead to more serious crimes.
Dr. Margie Balfour is an associate professor of psychiatry at the University of Arizona and an administrator for Connections Health Solutions, an Arizona agency that provides crisis services. She said now is a good time for rural areas to start or improve such services. The federal government has been offering more money for the efforts, including through pandemic response funding, she said. It also recently launched the 988 crisis line, whose operators can help coordinate such services, she noted.
Balfour said the current national focus on the criminal justice system has brought more attention to how it responds to people with mental health needs. “There’s a lot of things to disagree on still with police reform,” she said. “But one thing that everybody agrees on is that law enforcement doesn’t need to be the default first responder for mental health.”
Arizona has crisis response teams available throughout the state, including in very rural regions, because settlement of a 1980s class-action lawsuit required better options for people with mental illnesses, Balfour said.
Such programs can be done outside cities with creativity and flexibility, she said. Crisis response teams should be considered just as vital as ambulance services, Balfour said, noting that no one expects police to respond in other medical emergencies, such as when someone has a heart attack or stroke.
“People with mental health concerns deserve a health response,” she said. “It’s worth it to try to figure out how to get that to the population.”
This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.
Below is an excerpt from The Treatment Advocacy Center – Emptying the New Asylums. https://www.treatmentadvocacycenter.org/storage/documents/emptying-new-asylums-exec-summary.pdf
In 2016, nearly 400,000 inmates in US jails and prisons were estimated to have a mental health condition. Of those inmates, an estimated 90,000 were defendants who had been arrested and jailed but had not come to trial because they were too disordered to understand the charges on which they were detained. All but three states authorize evaluating the mental competency of such offenders within the jails or in the community, and some states authorize treatment to restore competency outside a hospital.
Yet, America’s state hospitals remain the default option for providing pretrial mental health services to criminal defendants.
There is no fast or easy fix for the mental health system failures that have taken half a century to develop. In an ideal world, individuals with acute or chronic psychiatric distress should not have to worry about wait times in jail for mental health beds because they would receive timely and effective treatment when they needed it and jail diversion when their symptoms led to criminal justice involvement. Under current less-than-ideal circumstances, reducing
inmate bed waits and ED boarding will require implementing a combination of strategies that reduce forensic bed demand, increase bed supplies or both.
Computer modeling offers policymakers and mental health officials a mathematical tool for developing evidence-based policy and practice to break the logjam of inmates with mental illness who are unable to come to trial because they are too sick. Although it would not address the hospitalization needs of the other populations, this step alone could moderate the nation’s bed shortage, reduce mass incarceration of people with mental illness and make existing beds available to more patients.
That would be a start.
Many decades ago, I was part of a carpool that left San Marcos, Texas and arrived in Austin for jobs we had with the State of Texas. We were not a talkative group, and I was new to the area.
I sat next to a gentleman who helped change my family’s life. He happened to be a member of the Scheib family, which initially did not mean a great deal to me. I must have brought up the need for mental health services, and he told me about the Scheib Center in San Marcos. It was a godsend.
I’m not sure if my father thought my mother’s mental illness would magically go away when we moved near her parents, or if he just felt like he needed to focus on food and shelter for us. It was clear to me that after decades of dealing with her schizophrenia, which included delusions, hallucinations, attempted suicides, multiple traumatic events, multiple stays in Big Springs State Hospital, my mother’s schizophrenia had to be dealt with.
My father retired from teaching in El Paso in 1979. What are the odds that I would end up in a carpool with a member of the Scheib family? I knew very few people in the area. All my friends were back in El Paso where I grew up.
“The Scheib Center was started as a nonprofit 501(c)(3) corporation in 1971 with money bequeathed by Dr. and Mrs. Scheib for the purpose of providing services to the developmentally disabled and emotionally disturbed individuals in the San Marcos/Hays County area. The service programs were in partnership with the Texas Department of MHMR. The Scheib Center provided the buildings and the Texas Department of MHMR provided the money and staff.”
I learned quickly that Scheib Center (https://www.scheibcenter.org) offered several services to not only their clients or patients but also to their family members. Once my father heard it from me, he quickly went into action. My mother’s medications were lined up. We had a social worker. I still remember her first name. She spent time talking with me over the phone, and helped navigate my family through very difficult waters.
It is the first and only place where I talked with my mother’s psychiatrist. “Is it nature or nurture?” I asked him. He laughed a bit and said, “if we knew that we could be of much more help to people. It says in your mother’s notes that without medication, she would need…..”
And with that I close. It was clear to everyone in our family that Mother had to have her medication. Without it, her life would spin totally out of control. In turn, it would affect her entire family.
While the holidays are filled with warm fuzzies for many folks, those who suffer from mental illness are sometimes overwhelmed with it all. If you know someone in crisis, please reach out to your community. If there is not a Scheib type center, maybe you could help start one.
Thank you, Katy. Thank you, Buck. Thank you Dr. ___ but most of all, thank you Scheib Center for being there for the community. We need more places like yours.
Although my stories are sometimes filled with traumatic events, they are also stories of faith, survival, healing, friendship and most importantly, love.
It is my hope that people will have a glimpse behind the curtain of a horrible illness called paranoid schizophrenia. There is no cure. There is little help, so the people who suffer with it and their families cling to any hope they can find.
I could not write any of my stories in any format without the support and kindness of my friends and family.
Brene Brown has been an inspiration in so many ways. “Tell your Story. Be strong and brave.”
I’m trying, Brene. I’m trying.
Many of my stories have never been told, the very definition of secrets.
It pulls from a well that is filled with strength, hope, faith and love for my parents.
I was fortunate to have very stable and determined role models in my extended family. The research I have done on Ancestry has contributed to my well of strength. My ancestors came mostly from northern Europe and Wales. On my mother’s side, they arrived in Jamestown, Virginia in the 1700s. They were honorable, hardworking people. Their stories coincide with the story of our country. They fought for a better life. Sometimes they lost loved ones, cattle and money, but they endured and passed down a hearty, resilient lot. Their descendants became educators, principals, superintendents, parents who loved and raised numerous children.
Given my mother’s history, I wasn’t sure what I would find in the annals of time, but fortunately, it added courage and faith to my well and helped me finally sit down and begin my book, “It Runs Deep”. It is written by a woman who qualifies as a member of the Daughters of the American Revolution.
Below is a true story. All of the names have been changed.
My work day started as I began to listen to my boss’s recording. I took dictation and the earplugs were all set to go. I turned on the machine and heard “Joe” say, “Take a letter. B I N G O.” I took out the earplugs and quietly laughed. Joe was always very serious and professional, especially with any recordings he made. Intrigued, I listened further. I could hear his children in the background as he continued to record nonsensical information, which was not the norm. I put the dictation aside and discovered a little later that Joe was walking towards me with an empty glass. He had an entourage. He said, “Get me water from the good fountain.” I looked at the assistant seated next to me and said, “The good fountain? Is there something I need to know?” As the day unfolded, I learned that Joe was having a nervous breakdown. He was whisked away to a nearby mental facility where he stayed for three weeks. The firm I worked for in the 90s had 4 floors filled with the brightest and smartest attorneys. They were mostly white conservative males. Joe was no exception. He had always been kind and professional to the staff and his colleagues. He had an excellent reputation, and it was an honor to work for him. I talked with Joe’s wife who sounded like she was trying to keep herself together while caring for Joe. I walked around the hallway and heard one of his younger colleagues shout into the phone, “They just took Joe to the mental hospital!” I closed “Sean’s” door. I did not close it gently. Joe deserved the respect that he had always shown others. He stayed at the hospital and received the help he needed. I learned he was bipolar. The first day he came back to work, he looked a bit like a fish out of water. As the days and months went on, Joe conquered any stigmas that mental illness may have had. As the years went on, he became managing partner of the very large, very successful law firm. He could have given up, but he chose to move forward. In doing so, he helped all of us follow his lead.
“Joe” died a few years ago from cancer.
This is my job now. It is a full time responsibility. I sleep well, but when I awake at 6:00, the first thing I think of is my mother’s story.
More of her story will follow and will be compiled by her storyteller, me. It is a story I must tell because her story will affect you one day, and you will possibly not even realize it. I write for my mother and father. I write for my family. I write for your family. Heck, I even write for our government officials who make important decisions that will affect your pocket book. I write for the thousands that will try to rebuild their lives after Harvey has taken everything from them.
It happened on a Memorial Day weekend in Georgetown, Texas. I was vacationing with my husband. We had fun things planned. My mother lived in a small group home in Round Rock, just a few miles from Georgetown. She had fallen, which happens as some of us age. I visited her in the hospital. On my way out, I spoke to the neatly dressed nurse and thought I would double check on my mother’s medication.
“She is on her medication, right?” I asked.
The nurse looked a bit confused, but she tried to hide it. After all, none of this story is her fault.
“She is on her anti-psychotic medications?” I asked again, assuming the answer would be in the affirmative.
“I don’t see anything like that on her chart,” she said with a look of confusion.
“We need to contact the doctor right away,” I said firmly. “She NEEDS her medication. If she doesn’t get her medication, you will have a problem on your hands,” I tried to emphasize as politely as possible.
“Okay, we’ll contact her doctor, but he is on vacation.”
I assumed the hospital, the doctors and the nurses would work in tandem regarding the stelazine and other drugs my mother had to take. I checked with the woman who oversaw the group home.
“The doctor is out of town, and Mother is off her medication.”
Sheri’s eyes widened. “I gave them the list of medications,” she said emphatically.
We both knew a tsunami would hit if my mother was not kept on her prescribed anti-psychotic medication.
I struggled to have a good time with my husband on our short trip to Austin. My mind was elsewhere. It was on my mother who suffered from paranoid schizophrenia since she was in her 20s. Paranoid schizophrenia is a horrible disease. We try not to discuss it in polite society. “Break the stigma,” some mental health advocates say. I wish they would come up with a new slogan. BREAK THE DISEASE is what I would like to do. Find a cure is what needs to be cried from the rooftops.
Three words: FIND A CURE!!!!
Another few words: There is a mental health crisis in America! Most people don’t even know it. Most people will be affected by it and pass it every day on the way to work. The dirty, homeless man wandering the streets of downtown alone, the families torn apart because they can’t find help for their mentally ill loved ones who refuse care because of their mental illness. The overcrowded jails, the tax dollars spent on band aids to fix a much larger problem than any of them realize, are all symptoms.
Four words: It is a travesty.
On our way back home to Dallas, we stopped by the hospital to check on my mother. As soon as I stood at the entrance to the unit, I could hear her screaming. The nurse I had spoken to only days before was running back and forth from my mother’s room to me.
“What do you do when this happens?” she frantically asked me.
My heart sank. Mother had been off her medication for three days. It was evident.
As I listened to her loud, persistent cries, I knew there was no way I could help her. There was no way for the nurse to help her.
What do I do when this happens?
“I don’t know what they do! I can’t do a damn thing! She has to go to the psych hospital when this happens!!” I said stunned that this horrible situation had happened and could have been prevented had the doctor returned the phone calls that the nurses made, but he was on vacation.
That simple event of the lack of necessary medications caused a spiral effect. Mother, of course, continued to spiral down due to more delusions, paranoia and hallucinations. No talk therapy could have helped her at this moment. No amount of prayer was going to cure my mother from the severe anxiety she was going through.
Nothing but medication was going to help my mother. Not only did my mother have to suffer, but so did the hospital staff as they desperately tried to ease her pain. It took valuable resources that could have been used on people who were physically ill. It caused distress on other patients who had to hear my mother’s screams. It caused her family anxiety and depression because there was absolutely nothing that could be done. Nothing! As I bang my computer keys to relive this story and its pain, I don’t care that my apartment is a mess or that I desperately need to bathe and comb my hair. I don’t care about me at all in this moment because I don’t tell my mother’s story lightly. There are repeated events in my childhood and adult years that distressed me, but this story is not about me! It’s about you.! It’s about your neighbor and your family. It’s about your community and the first responders, the homeless who will be walking aimlessly down the street looking for anything to pacify the hallucinations, the people who will end up in jail chained to their bed because all they needed was their medication.
I worry and pray for everyone involved with Hurricane Harvey, but I mostly worry about the mentally ill patients and society’s misunderstandings about the importance of their medication. There are many who will need their medications immediately to survive, but there is also an IMMEDIATE need for the government officials to address those who need their medications to stay sane.