After the Webinar: Creating a Continuum Ecosystem of Crisis Response. Q&A with BJ Wagner

Webinar presenter BJ Wagner answered a number of your questions after her presentation Creating a Continuum Ecosystem of Crisis Response: It’s Not Either-Or. Here are just a few of her responses.

Audience Question: How can a civilian-only response team respond to a mental health crisis when the risk of danger may require law enforcement? So, kind of to add to that, what protocols or processes or procedures should be put in place to protect those responders?

BJ Wagner: I would encourage a civilian response team to partner with their law enforcement neighbors and ensure that they have a relationship with their local police, sheriff, or Marshall’s office so that they can arrange to have that scene cleared or covered prior to going to anything that may have a risk of danger, so that you’re not directly responding with another danger and that you do have a relationship with the public safety partner first.

Audience Question: In your opening, you mentioned the difficulty to build mental health responses and communities, and that the stigma still exists around mental health services. Is culture at the community, and even national levels, also an obstacle to community health response?

BJ Wagner: I think it depends on when and where you are organizing your response. I think that we have a vast and varying landscape across our country, so culture varies from the north-east to the west, to the deep south, to the central areas of our culture, of our country. I think culture also differs from disciplines. So, the culture within our mental health profession, and how it sees emergency mental health responses are very different from medicine to emergency departments and law enforcement. I think once we begin to work together holistically, we began to understand how that response is important for a person-centered response, and it can overcome any of the stigma or silos, no matter where we’re coming from. But I think you can’t really uniformly say culture as a whole. But culture pockets, yes.

Audience Question: What does the typical model look like for rural or frontier communities? And if there isn’t a typical model, could you talk us through how do rural, very tiny towns, address this?

BJ Wagner: Coming from very rural Texas, because even though I am fortunate enough to work with some of the larger cities in our country, always really want to go back and work in some of our more rural areas. I’ll say the first line of defense for any rural area is training. Train and train everybody. Train your dispatchers, your law enforcement officers, your sheriff, your police chief. Take a community-first approach and train your teachers, train your librarians, train everybody. But then also take advantage of tele technology. If you have a public mental health partner, partner with them and put tele technology, either on a cell phone or an iPad in every ambulance and every police car in that small town, you don’t have to have a clinician sitting in your police department in your fire department, in your ambulance, or in your police car. But she can have an iPad that’s connected to a clinician, that’s miles away from her but does just as good.

Audience Question: When a call comes into 911, who is determining whether or not police are sent? It would seem that there’s a fair amount of responsibility or liability in making this decision. So, BJ, can you talk us through how that decision-making process happens?

BJ Wagner: It varies from PSAP – public safety answering points to answering points, so from 911 call center to call center. Typically, it is the person answering 911 and based on his or her training and the call tree that he or she is given. So, they are given training on how to identify the risk and the needs in that call, based on a specific structure, script, a triage tree on the software that they’re using, or any identifying factors within that phone call. Some 911 call centers have integrated clinicians, whether it be virtually. So, adding a clinician to a call, much like you would add a foreign language translator. Or they have a live clinician in the call center that they can add in to the call that’s sitting there with them. And if they have a mental health clinician, then that clinician can consult and advise on who should go. Other than that, it is the call taker who is making the recommendation based on their training, the call scripts, the call trees, and the triage training that they’re given.

Audience Question: BJ, Using the data that you used from Austin, those are huge, huge reductions and calls. I mean, just amazing results. But how do you staff up from those mental health calls with mental health professionals when there’s an existing shortage of those very professionals?

BJ Wagner: It looks at face value that suddenly there were a lot more mental health calls than there had been before. But in actuality, the mental health calls were caught at a different part of the system than they had been before. In a data world, we’ve not yet claimed to identify how many of those mental health calls would have been caught at the police level. So, police contact, at the emergency department, or at the jail. So, are they really new clients or did we save that client from an arrest? So, do we need new clinicians? Or was this person connected to a clinician, at a better point in the system? And so, we can’t really say we have 4,000 new mental health clients. But did we have 4000 phone calls? And out of those 4000 phone calls, this many mental health clients didn’t have to get arrested to see their caseworker.

Audience Question: So, are you saying that we won’t necessarily need more mental health clinicians, or are we going to have to get better at sourcing those clinicians?

BJ Wagner: Right. I’m saying that we’re not identifying more people with mental healthcare needs ————- clinicians at a better point in the system, so we don’t necessarily need more mental health care workers, were using the mental health care workers in a better way.

Audience Question: You talked about the importance of involving victim services. How do we close that loop and make sure that victim services is involved proactively, and at the best time what does that operationalization look like?

BJ Wagner: At first, I think it’s making sure that police officers and clinicians and medics alike, but chiefly police officers working on specialized programs such as this know now to look for signs of victimization in this population. And they are tied in directly to victim services, much the same way that they would be with any other person who has been a crime victim. So, we have to develop the thought process and the training that somebody who’s having a mental health emergency. Maybe a crime victim, just as if somebody who had been a victim of the ——, or somebody who had been an assault victim. And so, ensuring that our victim services division is also trained in mental health symptom recognition and de-escalation, and also trained in active listening, first with somebody who has a mental health care condition. Because that active listening is going to be very different than active listening in a therapeutic format.

Audience Question: Can you talk about the HIPAA requirements and how do we ensure everybody within this continuum of care is aware of and knows how to apply HIPAA?

BJ Wagner: As, you know, we come across HIPAA quite a bit. We have to really remember that 42 CFR is created to ensure that information is shared in a structured way or shared in a way that is permissible. And if we in programs for mental health emergency responses HIPAA is not. And this is a much longer answer, I’m afraid than we have time for. But if you look at 42 CFR, the allowable agencies, and the recognized agencies – police departments, fire departments, and social service agencies are allowed to work together in emergency situations for the purposes of continuity of care. And if we’re working under a business associates agreement for continued care, so for case management purposes, business associate agreements or BAAs easily cover dispatch, or 911 center operations, and easily cover long-term staffing situations. And anybody who’s ever wanted to share information for these types of programs has been able to do so easily.

Audience Question: What types of domestic violence cases could feasibly be handled by clinician-only responses?

BJ Wagner: In domestic violence situations, I would never recommend sending a clinician-only team into an active domestic violence situation that has not been cleared by a public safety team first, just because of the sheer volatility and lack of predictability in this situation. So, I would recommend as a criminologist, I would recommend civilian-only teams as a follow-up team for domestic violence calls.