Outreach aims to keep mental health cases out of jail
This is not the way they wanted it to go.
The young woman’s hands are cuffed behind her back, and a case manager and a special police officer are walking her into a Kansas City Municipal Court room.
A long-awaited mental health crisis center that could have changed this scene for the better isn’t ready. Not yet.
So here she is, for the moment chattering with her escorts, seemingly unaware of where she’s headed for the night.
The woman, in her 20s, is one of the Kansas City police’s top 10 most problematic mental health cases.
They need to help her somehow while they wait for the center — named the Kansas City Assessment and Triage Center at 2600 E. 12 St. It had originally been planned for a July 1 opening, but construction and rehab delays mean it won’t be ready until Oct. 31.
Recently, she dialed 911 with rambling calls for help 18 times within a 24-hour period, and disappeared each time from whatever street corner she’d called from by the time police arrived.
She’s pretty, with pink lipstick, an unfailing smile and a hard tan. And she’s constantly in danger as she plies familiar Kansas City streets for methamphetamine on top of her battle with schizophrenia.
“I think I might be Indian,” she said during the car ride with the center’s outreach case manager, Amy Shaffer, and the Kansas City police’s Crisis Intervention Team Master Patrol Officer Aric Anderson.
“Native American Indian?” Anderson asked, going along with her pleasant and random conversations.
“Something South American,” she said. “Maybe I’m Incan.”
Then, with only passing curiosity, she asked, “What are we doing?”
“We’re going to court,” Anderson said.
“I thought we were going to find out if I’m Indian.”
“We can do that after court.”
The crisis center will provide a 16-bed stabilizing haven where mental health professionals will have up to 23 hours to rein in people in mental health crises. Police officers and paramedics will bring their cases there instead of taking so many to jail or to emergency rooms.
The problem at this moment is that the center isn’t yet available, and the woman has worn through the other options deployed by police and caseworkers.
She has missed her mental health court appearances. She needs to get a shot of anti-psychotic medication, and they need to get her off methamphetamine long enough to see if the medication can work.
Now the moment Shaffer dreaded is happening. The judge lets the woman know she will be held in jail to get that treatment.
“It’s not fair!” the woman shouts as a bailiff collects her. The change from the smiling chatterer was chillingly sudden. “It’s not fair! I didn’t do a (expletive) thing!”
Center will bring hope
It’ll be better once the crisis center opens. All the players in this work — doctors, caseworkers, cops and judges — believe that.
Kansas has already been experiencing some of the benefits of a crisis center with Wyandot Inc.’s RSI clinic.
That’s why Missouri Attorney General Chris Koster worked a settlement with Ascension Health over the closing of two hospitals to dedicate $2 million a year over 10 years to fund the center’s operations.
And it’s why nine area hospitals are delivering $1 million a year for two years, and why the state legislature and Gov. Jay Nixon budgeted $2 million to the Department of Mental Health to fund follow-up care for the center’s patients.
But that doesn’t mean the work will be easy. Shaffer knows that.
She’s gotten a head start, trying to help police manage their hardest cases while the opening is delayed.
But she’s also piloting the kind of intensive follow-up care and street work that the center’s planners think will be essential if the crisis center is to succeed.
Follow-up care is the piece they think was weakest among some of the strongest and best-known crisis centers they visited, including sites in San Antonio; Oakland, Calif.; and Phoenix.
“They became a revolving door,” said Lauren Moyer, a vice president with ReDiscover, which will operate the center.
“That’s the reason for the outreach staff,” she said. When patients come through for help and leave with treatment and housing plans, “that outreach worker will go out with them.”
It’s imperfect work. A lot of trial and error.
When Shaffer goes out on her own, she keeps baskets in the trunk of her car with peanut butter sandwiches, hygiene products and clean socks. Small things, but they can help build rapport and earn trust.
“The work is about trying to get to some type of relationship,” Shaffer said. “It may start with sitting with them on the street while they drink their vodka.”
That is, if you can find them.
Shaffer and Anderson at first failed to find the woman they sought, knocking on the doors of two of her known addresses, then checking in at a convenience store before homing in on her.
“There she is,” Anderson said, spying her walking toward a bus stop.
They never found another woman they went looking for that day.
“I haven’t seen anyone there for three or four days,” a neighbor said, passing by while Anderson listened to the silence inside the door after his heavy knocks.
“But it had been pretty chaotic,” the neighbor added. “Cops and fire have been around here every weekend.”
If they had found her, Anderson said, they would try to learn by talking to her if her problems were because of mental illness or drugs.
They’d talk someplace like the stoop here, or on the street. Not a good setup. The crisis center will be a better scene for those kinds of inquiries, too.
The center will have at least four outreach case managers among an overall staff of about 40, said the center’s program manager, Stephanie Boyer.
Registered nurses, licensed social workers and counselor aides will be working in two triage rooms and two eight-bed units — a stabilization unit for people in mental crisis and a sobering unit for patients who are intoxicated.
They expect to save the community millions of dollars because hospitals today are strained by mental illness cases.
More than 60 percent of the hospitals responding in a Missouri Hospital Association survey this year reported having to hold mental health patients in emergency rooms while staff struggled to find the patients an appropriate setting elsewhere.
Forty percent of those patients stayed in the ERs longer than eight hours and 9 percent for more than 24 hours.
And among those patients hospitalized for induced mental disorders or substance abuse, 65 percent were either uninsured or on Medicaid.
Many of them cycle through again and again, said Evie Craig, the executive director of reStart, a Kansas City homeless shelter.
Some of the people who wound up in the shelter had been in contact with police or paramedics as many as 60 times in 90 days, she said.
“I see ambulances coming,” she said, “and I think of the money we’re spending.”
A better chance
Shaffer can’t help but feel some regret outside the courtroom. Through the walls, they can hear the woman shouting.
She remembers how easygoing the woman was, how cooperative, before they gave her over to the judge.
Shaffer thinks the woman would have gone willingly to the crisis center, given that choice.
The CIT officers and the outreach case manager want to avoid being involved in arrests.
“I’m afraid she won’t trust us next time,” Shaffer says.
And their concern goes beyond the reaction of people who are arrested. They will be back on the street and will talk to others.
Anderson’s consolation to Shaffer is that he doesn’t think the woman will remember what happened. Her drug use and mental illness seem to have scattered her memory.
The last time Shaffer had been with her, it had been for four hours. And the woman had taken down Shaffer’s phone number, writing it in lipstick down her arm.
But on this day, when they caught up to her by the bus stop, she didn’t recognize Shaffer.
They think she can be whole again — or nearly whole — if they can get her away from the meth and steadily on medication. They think the crisis center will give her and the people trying to help her a better chance.
Look at this, Shaffer said, showing the graceful picture of a woman from a Facebook page.
“Is that her?” Anderson said.
It was. Before her psychotic break, not that long ago.
“If we can get her stabilized,” Anderson said, “she’ll never call police again.”
“We can get her housing,” Shaffer said. “We can get her treatment. We can give her a productive life, which she deserves.”