Mentally Ill Emergency Response: “Hit the Ground Running” in Providing Care

An image of two MCS employees next to a vehicle.

Mobile Crisis Services employs social workers and mental health professionals to provide appropriate emergency care. Photo by Mark Rose.

Gerard (not his real name), a 28-year-old Middle Eastern man diagnosed as bipolar, financially had everything in life. But recently, during a manic episode, he threatened one of his parents with physical violence over money.  

Linda Miller, staff social worker with the D.C. Department of Mental Health’s Mobile Crisis Services (MCS), got the call from Gerard’s distressed mother. Miller worried about her particularly since she had planned to stay with him alone in his apartment.  

Gerard’s parents were eventually able to calm him down, and his mother agreed to not stay in his apartment. The next morning, Miller and an MCS psychiatrist met with the parents to discuss options. The mental health professionals educated the parents about pertinent psychological issues such as bipolar disorder—with which Gerard was only recently diagnosed—and the psychosis that brought on his manic outbreak. Miller told the parents that an untreated disorder can occasionally lead to violence. 

“You have to set limits and you have to protect yourself,” Miller said about the parents in a telephone interview. “Parents can’t be open to a son’s increasing impulsivity and possible violence. Sadly, families are often shocked by the family member becoming different than his usual social, lovable self.”  

They advised the parents to set more limits about what they give Gerard, who, in his manic periods, wants even more money. The MCS team referred all three to case management services: he already had a psychiatrist but refused to take his medicine.  

MCS, which has operated since late 2008, is the District government’s main responder to people in psychiatric crises. With 17 trained mental health professionals on staff, they can come into a crisis situation, stabilize distressed individuals, counsel them and make referrals for follow-up psychiatric and other social services.  

Crisis Services Director Luis “Lucho” Vasquez, one of three trained social workers on staff, is proud of his team’s efforts to date. “We’ve been able to hit the ground running.”  

“There was such a need for it that it caught on right away; people started calling right away,” said Vasquez.  

So did other emergency responders that are part of D.C.’s mental health community. When it began, MCS was already known to the police and fire departments, social services and other mental health agencies. Vasquez said his team responds to about 10 calls a day. They are on duty in two shifts, providing 16-hour coverage a day.  

Mental health specialist Theresa Gibbs said, “You get to help persons when they’re at their most vulnerable state; you have to build a rapport in the first two or three minutes. That initial contact of caring is very important in that person’s long-term treatment.” Gibbs added that that was impossible at other mental health non-profits, where she spent the first 10 years of her career. “Here you are in somebody’s most private, intimate business. When they let you in at that point to help them, it’s so rewarding.” 

Iesha Edwards, a team mental health counselor, had about six years of mental health experience before joining the crisis unit. She said her MCS interview “didn’t feel like an interview; it felt like … people sitting down to talk about mental health.”  

Gibbs said, “Everybody who works here is my friend.” Gibbs sees a high impact for MCS’ operations. “I think we’ve done a fabulous job in the city; we’ve responded to homicides and other crises, and we respond quickly to every crisis,” Gibbs said. “You make contact with some of the most acute vulnerable individuals who need the treatment but don’t know how to go about receiving it.”  

Gary Yingling, who once served in the Presidential Honor Guard for Ronald Reagan, is a peer counselor on the team. He is also bipolar and suffers from post-traumatic stress disorder. Yingling values the connections he can make with people in psychiatric distress and the trust he can establish.  

“My connection with people is a matter of trust; people with mental health disorders have a hard time trusting people who don’t have a disorder.” Because of this solidarity, Yingling’s patients are more likely to listen to his advice and seek proper medication. Moreover, he is able to credibly convey that there is hope: he overcame his problems and now has a stable job and a house in Southwest D.C.  

“It’s another person [the mental health victim], not a strange person who is mentally impaired.” If police or staffers behave aggressively toward patients, Yingling acts as advocate, explaining their position and what they might need.  

Rosetta Price, another peer counselor with the unit, says her history of schizophrenia helps her connect with clients. “I’ve always wanted a job where I can really help someone. I can identify with them and what they’re going through.” She counsels patients that illness is not a setback, and that they can recover and accomplish their goals. “You are there to help them, to watch them blossom.”  

MCS is part of the department’s Comprehensive Psychiatric Emergency Program (CPEP). It also has a psychiatric emergency room for those in acute episodes and a recovery/ waiting room area. Staff psychiatrists and other medical professionals can stabilize a patient’s condition and give time to recover. Vasquez said that his unit often refers patients there before sending them to out-patient social services. More than half of the patients he brings are brought involuntarily with assistance from the Metropolitan Police Department, he noted.  

MCS treats adults, while a separate unit for children is run by Catholic Charities but funded by the District.  

According to Mental Health Department Director Stephen Baron, MCS has all the financial, staff and facility resources it needs at an annual budget of roughly $1.5 million. Vasquez agreed that his team is well-equipped to fulfill its mission.  

“I think it’s done a great job,” Baron said in a telephone interview. Responding to about 1,500 calls in 2009, the team expects to respond to about 2,000 this year. “I think they’re doing just what they need to do… they’re dealing with crime and grief.”  

MCS has statistics to show for its work. According its own data, MCS worked with 2,243 individuals in its first year, 810 of which resulted in hospitalizations, voluntary or involuntary. A majority of those hospitalizations possibly prevented suicides and/or homicides.  

Vasquez thinks MCS is here to stay. “What’s been important is that we’ve become essential to a lot of different service agencies. It would be hard to go back to not having this. This fills a real gap and need…. We need to be able to continue and hopefully to grow.”  

Vasquez doesn’t expect his and his team’s efforts to be perfect, just effective. “We work so hard to help folks that are so vulnerable. At the end of the day, I’ve learned to be satisfied for giving my best effort.” 


Issues |Health, Mental|Health, Physical


Region |Washington DC

information about New Signature, a Washington DC tech solutions and consulting firm

Advertisement

email updates

We believe ending homelessness begins with listening to the stories of those who have experienced it.

Subscribe

RELATED CONTENT