“How CIT Works in a Small Rural County”

““How CIT Works in a Small How CIT Works in a Small Rural County”Rural County”

Sheriff Kevin FryeAvery County, [email protected]

Ann RobinsonEmergency Services CoordinatorCIT Coordinator, [email protected]

Smoky Mountain Center

1-800-849-6127Crisis Line

Reporting to the Hospital Reporting to the Hospital EDED

Going to the MagistrateGoing to the MagistrateContacting First Responders Contacting First Responders

(Mental Health Provider)(Mental Health Provider)

Calling a DispatcherCalling a Dispatcher

The consumer might contact their mental health provider who is called their “First Responder”

First Responders are expected to handle emergency cases involving their consumers up to the point of requesting authorization for the state hospital system

First Responders are expected to make their consumers aware of how to reach them in a crisis

• First Responders then meet with the consumer and activate the consumer’s crisis plan

If there is no First Responder, Mobile Crisis Provider must be contacted.

• The consumer might contact a dispatcher at 911

• Depending on the acuity of the situation the Dispatcher then contacts: - Law Enforcement and/or - First Responder or Mobile Crisis Team

• Law enforcement, the consumer’s First Responder, or Mobile Crisis Team may be deployed to go out and meet with the

consumer – not necessarily at the ED

1-800-849-61271-800-849-6127

The consumer may then be assessed and a crisis plan The consumer may then be assessed and a crisis plan may be initiated to divert the consumer from the may be initiated to divert the consumer from the

hospitalhospital

• The Involuntary Commitment (IVC) process is invoked• Law enforcement has 24 hours to find the individual and

bring them to the hospital ED• Hospital staff are required to assess the individual and

draw lab work• Only a physician can nullify the IVC order• Law enforcement or their delegate sit with the consumer

until a placement is found• This is by far the most dangerous method for the

consumer and law enforcement

This process often ties up valuable time and resources!This process often ties up valuable time and resources!

• Hospital staff are required to assess the individual and draw lab work. Mobile Crisis/First Responder may be contacted.

• If an IVC appears to be needed, the magistrate must be contacted. Law enforcement involvement is required once involuntary commitment is issued by magistrate.

• The IVC requires an assessment (First Examination) by a mental health clinician and MD/Board Eligible Psychologist

• Paperwork is completed and a placement is found if inpatient psychiatric care is required.

This process can tie up valuable time and resources!

Psychiatrist 24/7/365(by Phone)

Nurseor

LCSWor

Psychologist

LCASor

CCSor

CSAC

QDDPor

ADDP

Para-Professional

NR responders are licensed or license-eligible LPC, LCSW, LPA, LMFT and LCASMC teams are organized differently across the state. Contact your local MC team to determine

how your team responds in your area.

Expect responses to new consumers within these time frames:

Emergent-immediately by phone, 2 hours for Face to FaceUrgent-10 minutes by phone, 48 hours for Face to FaceRoutine-10 minutes by phone, 7 days for Face to Face

• It is not clear whether an involuntary commitment order is needed

• If you would like to consult with a mental health professional.

• If you would like to make a referral for services.

• The consumer’s Crisis Plan has failed

• The person is requesting or agreeable to speaking with Mental Health Services

• Emergency dispatch can be reached at: 1-877-492-2785

Law Enforcement must contact the MC team personnel in their county to determine how the CIT and Mobile Crisis can compliment one other in

the community.

• Develop a dialogue and keep an open line of communication.

• Law Enforcement and Mobile Crisis work together to develop a protocol outlining expectations

• Meet once per month to review CIT cases with Mobile Crisis involvement.– Discuss areas of potential improvement.– **Identify what did work**

First Responders or Mobile Crisis to the consumer as soon as feasible

Deploy

Delay involuntary commitment actions until the consumer has been assessed by the First Responder or Mobile Crisis Team

Divertthe consumer from the Emergency Department when possible

This saves time and resources for you and frustration for the consumer!

Avery CountyAvery County

BackgroundBackground

• Avery County Population 18,000

• 247 square miles of territory

• Seasonal population of about 25,000 per day

• Population over 65- 17.6%

• Median Income- $36,068

• Person below poverty – 17.6%

Critical Incidents that led to looking for Critical Incidents that led to looking for new ways to deal with involuntary new ways to deal with involuntary

commitmentscommitments• Sworn in as Sheriff on Dec 4th, 2006

• On 01/08/2007 while trying to serve an involuntary commitment, deputies after a five hour standoff, shot and killed armed person.

• 2008 report from NAMI ( National Alliance of Mental Illness) of Wake County stated that Avery County ranked first in NC for time spent on involuntary commitment transports based on population

Steps TakenSteps Taken

• Developed relationship with local mental health facility, New River Mental Health and Smoky Mountain Center

• Initially sent 2 deputies out of a total road staff of 12 to C.I.T, since then we have sent 6 more and hopefully by the end of 2011 will have all deputies C.I.T certified

ResultsResults

• Improved community relations

• Improved officer safety

• Improved team approach with local mental health facility and regional organization

• Improved information on people in the community with mental illness

Most ImportantMost Important

• In one year the Avery County Sheriff’s Office has:

• Decreased involuntary commitments by 26%

• Decreased costs to the citizens by $16,245.00

• Increase time on patrol instead of sitting at a hospital.

Questions?Questions?

Education

“How CIT Works in a Small Rural County”