An Afternoon with Community Mental Health

It’s a quiet Friday afternoon in January on the fourth floor of the County Annex on N. Fourth Ave. In the office of Community Mental Health’s crisis response team, coordinator Melisa Tasker and clinician Tori (the clinicians asked that their full names not be used) sit at desks with multiple monitors on either side of an open bullpen taking calls. 

Another clinician, Michael, had planned to go out to check on a client who hadn’t answered her phone for four days. But he calls again before he leaves, and this time she answers. He decides she doesn’t need a visit.

The team covers the entire county, including Ann Arbor, and operates 24/7. But it’s the middle of a weekday afternoon and only a few calls are coming in.  

“New Year’s Day is usually probably the busiest out of all the holidays,” says Tasker. “Thanksgiving, Christmas are not that busy because there’s so many community services that are in place.” With holiday resources available, “we’re slow during the holidays. But New Year’s Day, man!” With the turn of the year, people are ready to make changes and look for help making them.

“In the winter it’s more family concerns because they’re inside,” says Tori. “It’s cold out. They might be isolating. It’s dark and gloomy.”

“It’s typically family or friends that call,” says Tasker. “They’re concerned about a loved one. And they want us to go check on them.” 

The person might be “acting bizarrely, or they’re suicidal,” says Tori. “They sent suspicious texts. They aren’t answering their phone.” 

When that happens, clinicians will get in a county-owned Ford Taurus and go see for themselves. 

“We’ll talk to them, and assess what they look like,” says Tori. “Like, have they bathed recently? Do they look like they’re eating? 

“What are their living conditions like? Are they oriented to time and place? Are they able to have a logical, linear conversation, or are they tangential and disorganized? And do they have any delusions?”

 

Community Mental Health executive director Trish Cortes explains that the crisis response team grew out of a county program that initially placed social workers in the U-M Hospital’s psychiatric emergency room. 

That wasn’t the optimal place for an intervention. By the time people got there, they were likely to be in a full-blown crisis—one that might have been avoided if they’d gotten help sooner. So, Cortes says, “There was a decision made by leadership to be out in the community.”  

In a 2009 Observer article, the team’s first administrator, Jon Voelkner, laid out the mission: “To gently intervene before it gets to an extreme state … It is much less traumatic for the individuals and families if they’re not dealing with handcuffs or being strapped down to a board.” 

It made economic sense, too: Calls and visits from social workers cost a lot less than ER visits. 

Passage of the county’s 2017 public safety and mental health millage let them expand and offer additional support. “The team now responds to the crisis, stabilizes the crisis, and has the ability to get a psychiatrist involved, provide some therapy, and stabilize individuals,” Cortes says. 

The twenty-member team includes both master’s-level clinicians in social work and clinical psychology and peer support specialists—people whose experience managing their own mental illness or substance abuse gives them credibility with clients.

“You never know what’s gonna happen when you walk in,” says shift coordinator Emily Scheitz. “I’ve had days where I don’t leave the office a single time. I’ve had days where I only went in the office to drop stuff off, and I came back to pick my stuff up when I left for the day.”

 On a typical shift, Scheitz says, the team might have “forty-five to fifty wellness calls to do, plus a couple prescreens and then a few [in-person] outreaches.” 

Prescreens authorize clients for services at county hospitals. Many of the  wellness calls are directed at keeping them stable once they’re discharged—making sure “they’re getting used to being back at home, making sure they’re still feeling safe,” Scheitz says. Others go to people who are “feeling suicidal or just really depressed, and they need someone to call every day and [ask], ‘Hey, did you eat today, did you take a shower, are you getting out of bed?’”

An in-person visit could start with a call from “a family member who’s noticing that their loved one is not taking their meds anymore,” Scheitz explains. “They’re not talking to families much. They seem upset or they’re crying, or maybe they post on Facebook or text them a goodbye message.” 

In those urgent situations, the clinicians are “likely to call an ambulance and ask the caller to meet them at the client’s house. “Then we’ll come [and] sit down with them, be like, ‘Hey, people are concerned about you, people that love you and want you to be safe. What’s going on?’”

Most folks are “usually grateful for us to be there,” Scheitz says, “especially when we’re dealing with a police contact, where police are already on the scene, and we’re showing up to help de-escalate.” 

 

Police are sometimes seen as an aggravating factor in such encounters, but Tasker and Tori say their involvement is often helpful. “People generally respond very well to officers,” says Tasker. 

“They do,” agrees Tori. “Some people who are really sick do not think that they have a mental illness. So sending a mental health professional is going to set them off. But a lot of people have a general respect and trust of law enforcement.”

Not everyone, though. “We’re pretty good at reading the room,” says Tori. “If they are scared of the officers, then they’d probably be willing to engage with us better. And we have the officers stand in different rooms or stand behind us.”

Scheitz offers an example: “Someone who may or may not be homeless is maybe experiencing some psychosis. They’re on the street. They’re yelling at people walking by, [or] something about them is making people on the street call the police.” 

Sometimes the responding officers can defuse the situation, but other times their presence only inflames the person further—“maybe they have a criminal record, maybe they have a warrant, maybe they just don’t like cops,” Scheitz says. 

“They start yelling more. They’re getting really upset.” At that point, she says, “the police usually will step aside and call us.” 

The clinicians handle it by trying “to build rapport. A lot of us carry cigarettes. We’ll be like, ‘Hey, you want a cigarette?’” says Scheitz. “‘You wanna walk over here away from the police and smoke, sit on the curb?

“‘I’ll talk with you about what’s going on. Do you need food? Do you need dry socks? Do you have a case manager?’ We’ll usually do a pretty good job of calming people down enough to where the police can leave.” 

It’s harder “if we’re doing an involuntary intake to the hospital on a pickup order from a judge or a petition. That’s usually a bit more rough,” Scheitz says. “We’re saying, ‘You don’t have a choice anymore. You’re going to the hospital.’”

Scheitz’s past jobs in prisons and hospitals have given her “a pretty good intuition if someone’s gonna get to the point where they’re gonna hurt you or someone else,” she says, and she’s “never felt personally like I was about to be in a situation where I was gonna be hurt” on the job here. 

But that’s also because “anytime we think that something’s gonna be dangerous, we’re pretty good about bringing an officer in. Ann Arbor PD has done a lot of work [on] being able to understand situations that would require us, and they definitely call us a lot more over the past couple years.”

Tasker emails that “we have encountered individuals who have become angry with us, have become aggressive, have made threatening statements toward us, but staff have been able to remove themselves before getting hurt. We have such great partners in law enforcement to help keep us safe.”

 

CMH is working even more closely with the county sheriff’s office in two pilot programs in Ypsilanti Township. 

LEADD (Law Enforcement Assisted Diversion and Deflection) is intended to keep people with problems like mental illness, substance abuse, severe poverty, or homelessness out of court and out of jail. LEADD’s staff includes a coordinator from the sheriff’s office, two case managers from CMH, and a county prosecutor. Since launching a little over a year ago, they’ve worked with forty-one people referred by the jail, the courts, or the public defender and are currently working with twelve more. 

Sheriff’s office coordinator Lisa Gentz says that rather than arrest or ticket people “engaging in what they determine is low level criminal activity—trespassing, panhandling, maybe some substance use-related behavior, petty shoplifting,” deputies now “have the opportunity to divert them to case management to address their mental health and substance abuse issues instead.”

It’s working so far. “We’ve been able to stabilize some individual situations,” Gentz says. “Individuals who were interfacing with law enforcement sometimes multiple times a day are now interfacing with our case management team to have their needs met.”

For the other pilot project, a deputy and a clinician are cruising the township three nights a week in a Ford Explorer with no lights on top. In their first three months the “co-response unit” had 282 face-to-face engagements, and “we’ve had only two people flee,” reports deputy Jim Roy. And one, he says, called back as he left, “Thanks for being cool!”

Sheriff Jerry Clayton says he’s planning to add a second co-response unit early this year. He and Cortes would like to see both programs operating countywide within five years. 

“Let’s not be afraid of having police and clinicians together,” says Clayton. “You cannot separate the two. We interact with the same population.”

 

CMH takes calls locally from the new 988 number for mental health crises. They aren’t getting many clients from it yet, Tasker emails, but they have “been able to transfer individuals to 988 when they are not in a mental health crisis but just want to talk to someone.”

They’re getting plenty of calls on their own access line, (734) 544–3050. Before the millage expansion, the outreach team fielded 5,000 to 6,000 a month. Now they’re getting 10,000. 

But not this afternoon. Looking at the records later, Tasker emails, “we took around 25 requests for the crisis team, and the team additionally made follow up contacts with at least 60 individuals throughout the day and into the evening … this would be considered a pretty slow day for us.”

But day by day, she’s convinced they’re gaining on the problem. “I really do feel like we’re making a dent,” she says, “in trying to get people care before they find themselves in a crisis.”