Mental Health Support: Anyone, Anywhere, Anytime

[Jaunty Guitar Music]

Mike: Welcome, everybody. This is Avoiding the Addiction Affliction brought to you by Westwords Consulting and the Kenosha County Substance Abuse Coalition. I'm Mike McGowan.

Mike: Mental health crises don't occur on a schedule. They don't always occur in an office or when a mental health professional just happens to be present.

Mike: Our guest today, Amber Heil, is a clinician with the Milwaukee Mobile Crisis Team in Milwaukee, Wisconsin. Today, we're going to talk about that work and what one county is doing to help those in need. Welcome, Amber.

Amber: Hey, good morning. Thank you for having me.

Mike: Well, thanks for doing this and thanks for the work before we even start.

Mike: So tell us about the Milwaukee Mobile Crisis Team.

Amber: So the Milwaukee Mobile Crisis Team, we're a multidisciplinary team. We have family and marriage therapists. We have counselors, we have registered nurses, and we have social workers all on the team. I think that's unique in that we have both the nurses and clinicians.

Amber: So if somebody is experiencing kind of some medical issues, a nurse could go along to see if medical care is needed. We do provide mental health crisis intervention to anybody within Milwaukee County of any age. We see children, we see adults. Our clinicians are dispatched anywhere within the county seven days a week.

Amber: We offer mobiles Monday through Sunday. And then our team has actually positively impacted the community resulting in significant reductions in adult inpatient admissions, psychiatric crisis visits, and emergency detention visits.

Mike: You know, I, I think it's so important that you're including anybody of all ages because what I'm finding in my work is that there's whole counties where you say, "Oh, so and so's in crisis. Well, we can help. Well, they're an adolescent or they're a child. Oh, I'm sorry. We don't have services."

Amber: Yeah.

Mike: So this includes children.

Amber: Yes. Yep.

Mike: So walk us through. So if somebody, first of all, we'll, we'll listen to the phone number at the bottom of the podcast on the blurb, but give us the phone number and tell us what happens.

Mike: Walk us through the process.

Amber: So the phone number for the crisis line is 414-257-7222. You'll call that number and you'll actually get a 211 dispatcher, but it comes through on 211's end as the crisis line, so those calls are prioritized. From there, they contact us and then whoever's available will take that call.

Amber: We talk to the people. We listen. We provide supportive listening. Sometimes people call just to talk. Just to have that supportive listening. Sometimes people will call because they don't know where to go with their family member who's experiencing a mental health crisis. And all they're looking for is like a phone number to call or an address or a place that they can take them.

Amber: Other times it's people who need a little bit more support and who would like us, like we can come out to them and we can talk to them. We can talk to the family members. We can talk to the person in crisis. As long as they're willing to talk to us, we can do that.

Mike: Now, you're not, this part of the response, when you listed your team members, this isn't law enforcement, right?

Amber: No sometimes we do, law enforcement will call the crisis line and request that we come out, but we're not a law enforcement response. We drive county vehicles, we don't have squads or anything and people have to be willing to talk to us.

Mike: What does that mean?

Amber: They have to be voluntary. So they have to want to like get treatment, get help, whether it's the person in crisis or if the family member needs support, we'll go and just support that family member.

Mike: You know, you just said something. I think that's kind of interesting. Law enforcement is better trained than they certainly used to be when I was a kid, but they come upon a lot of different circumstances that perhaps are beyond their expertise.

Amber: Yeah.

Mike: And so they can call you if they say this seems to be above our, our

Mike: grade, so to speak.

Amber: They can and they and they do.

Amber: And we will go and respond.

Mike: So how does the triage work? What comes after the initial phone call?

Amber: So the phone call, like I said, we kind of listen to what's going on. And then if we feel like a mobile would be appropriate, we ask some follow up questions. We ask if there's any weapons in the home. We ask if there's any pets.

Amber: We ask who else is in the home with you. So when we send a team, so we send a team, two, two clinicians, two nurses will go together. So there's two of us that go on each call. We don't want to send a team into an unsafe environment. So we always, we always ask those follow up questions as well. And then the team will go there, they'll talk to the family, provide resources.

Amber: Every now and then, if we feel it's a, it's a safe situation, it's kind of up to the clinician's discretion. We do provide transportation, but that's not a guarantee for anybody. But yeah, that's kind of what it, what it looks like when the call comes in and when we think a mobile is appropriate.

Mike: You know, nationwide, almost half the young people who get to an emergency room, let's say for mental health crises, don't receive any follow up care at all, almost half. So how does this system help the transition to ongoing care that may be needed?

Amber: Yeah. So I actually just had something similar to this happen on a follow up call I did yesterday.

Amber: So I had somebody call into the line. It was a mother concerned about her son who was threatening to harm himself. Her and I called the police together. The police responded, the police took him to a hospital. He was released that morning and there were no like follow up appointments scheduled or anything.

Amber: So I had scheduled a follow up with the mom the next day because it was a pretty serious situation. I was going to be calling her anyways. So I called her and I was able to give her phone numbers that she can call for follow up care for him and addresses, places she could take him to get those appointments scheduled.

Mike: You know, that must have been a huge relief for her because it's, you know, when for her to make that call is difficult and then to have nothing happen on the back end is disillusioning, right?

Amber: Yeah. Yeah. And that's also a very important piece of our work is that when we do meet with people, we always ask, would you like a follow up call in a few days just to make sure you're doing okay, just to make sure you don't need any additional resources.

Amber: That is part of our work as well as are those follow up calls.

Mike: So the people on your team, go back over them again, they're, who are all on your team.

Amber: Yeah. So we have registered nurses, we have counselors, social workers, therapists, all are on the team.

Mike: And you always need more?

Amber: We always need more. So yesterday, for instance, we were pretty short staffed, the phones were ringing off the hook.

Amber: And it was very hard to navigate yesterday. Cause we didn't really have enough people and it would be good for us to have more clinicians on the team. That way we can go out to more mobiles, we can provide more services and we can spend more time with the families. Cause I think that's always in the back of our mind is our coworkers in the office who are getting all these calls and like, they're overwhelmed with everything.

Amber: So, you know, kind of keeping that in mind while we're talking to families as well, it'd be nice to have a little bit of relief from that and have more clinicians on the team.

Mike: Well, and for those of you who are listening, who are looking for certifiable hours, which is a huge deal for people who want to get licensure, you, you also provide that, right?

Mike: This, these that's a component you have covered.

Amber: Yeah. So we do have licensed individuals who do provide onsite supervision. You, we can get our onsite supervision hours. So that's an hour of weekly supervision and I'm. I'm included in that. I do a group supervision every Wednesday. So you do get your supervision hours on site here.

Mike: And we'll include the recruitment website also at the bottom of the podcast.

Amber: There are also some incentives right now to applying to be a clinician. There's a $7,500 sign on bonus for full time people and a $3,500 Bonus for part time individuals who sign up to be, to be part of our team.

Amber: And there's also shift differentials. So like, say you sign up for a second shift, you get an extra $5 an hour. If you sign up for a weekend shift, that's also an extra $5 an hour.

Mike: Cause you're 24/7?

Amber: 24/7. Yep.

Mike: And, and so you're on call, you're on call, right? You, do you have to be in your, in an office?

Mike: Are you in a home, your own home?

Amber: Yeah. So we have an office that's located downtown.

Mike: So if I'm on, if I'm working third shift, I'm, I'm at the office.

Amber: Well, we have one person that answers, we just do phones over third shift and we have one person, she works from home on third shift, but otherwise we're, we're all in the office.

Mike: So do you keep track? I'm not trying to catch you with something you don't know. Do you, how many calls do you take?

Amber: So from my understanding between January and September of this year, we received just over 24,000 calls and we were physically, physically involved in. About 4,000 mobiles from those calls, 4,000 resulted in mobiles where we went and met with the family or client.

Mike: So about a sixth of the time you're actually taking a call and then going out?

Amber: Yeah.

Mike: So 4,000 mobiles and in nine months, that's many times a day.

Amber: Mm hmm. Yeah.

Mike: Wow. How long does the average call take when you go out on?

Amber: Well, that's kind of dependent on the person and what's all going on and if like how long they want to talk. We always take that into consideration as well.

Amber: Like what's going on, how serious is this call? What kind of resources do they need? So it's hard to have like a concrete time that that one will take.

Mike: What do you do if somebody is calling with substance abuse issues?

Amber: So. I've been on the team since August. So I'm a relatively new member to this team.

Amber: From my experience, a lot of times people with substance use issues, it's family members who are calling who are concerned about them. And those are always really hard calls because there's actually not too much we can do without the person willing to go get help.

Mike: Right.

Amber: So like a call that I took from a mom concerned about her daughter who's sleeping outside in her backyard. Me and a coworker went to meet with this mom. We provided a lot of supportive listening while we were there. We brought harm reduction materials. So we brought her fentanyl strips. We brought her Narcan. And we brought her resources, places that she could take her daughter if her daughter ever changed her mind and was willing to get into treatment.

Amber: So we can also provide harm reduction items as well.

Mike: Wow.

Mike: You have a partner program for Milwaukee County called CART, right? C A R T.

Amber: Yeah, so that's the crisis assessment and response team and that's a team, a clinician is dispatched with a police officer, so they go to the more like violent calls that we get if we ever get a call on the crisis line and it feels like it's unsafe to send us because we don't, we don't have.

Amber: Like the conditions with the CART team, they have bulletproof vests. They go with in a squad car. We don't have all of that security. So if we ever feel a call is unsafe, we do encourage the family to call the non-emergency police department and let them know that there's a mental health component to the call.

Amber: And then the police will dispatch CART as, as needed.

Mike: Well, because right, one of the reasons for developing programs like this is that you don't want a violent response to a mental health crisis.

Amber: Right. Exactly.

Mike: So for those of you who are listening in other parts of the country and world, Milwaukee County closed their mental health complex.

Mike: So keeping people in their homes is important since there's less treatment alternatives out there.

Amber: Yes. So like I said, I'm relatively new to the team, so I don't really have that perspective of what the crisis work work look like when PCS, the Psychiatric Crisis Services was open. We do have members on our team who work there in the past.

Amber: I think for me, it was, well, I know that the county put a lot of time into researching, like, what does this community need? What would benefit them? And they found that residents, they wanted services closer to where they lived, like in their communities. So instead of having this institutional approach, they're taking a more community based approach.

Amber: And they have, like, now they have the Mental Health Emergency Center. They have Granite Hills that they just opened up. These places are places that people can go for treatment. I think part of the problem that I'm seeing personally, like on calls that I'm getting, it's really hard to get calls from families that are struggling with their family members who are like manic or having like an, like they're actively in psychosis because these people, a lot of times they don't necessarily think anything's wrong.

Amber: And they don't necessarily want to get help or treatment and we can't force anybody to go.

Mike: Right.

Amber: So then it's a law enforcement call again if they're aggressive or if they're threatening family. And I don't know. I'm not sure how well that's working either, I guess.

Mike: Yeah.

Mike: What do you know, what is the current definition of law?

Mike: Is it over 14 you have to volunteer?

Amber: What do you mean?

Mike: At the age of 14, you can say, I don't want to go?

Amber: At the age of 14, yeah, you do have a little bit of say into what's going on and if you want treatment or if you don't want treatment.

Mike: So what percentage of your calls, of the 24,000, I'm still awed by that.

Mike: What percentage of that number are parents who are concerned about their children or for that matter, children who are calling themselves.

Amber: So I don't know what percentage that is. I know a lot of times it's not the kids who are calling. It's schools there. We get a lot of calls from schools that are calling with kids who are hitting staff, who are verbally assaulting staff, who are running out of school.

Amber: We take a lot of calls from schools and from guardians, from grandparents, from parents. Yeah. I mean, it's, it's a pretty big part of our work.

Mike: Well, and those people are like "Help!" Right?

Amber: Yeah, right. Yep. And that that's also kind of, I think sometimes we go into those and like the kid, the kids at school are, are, are like.

Amber: In this moment in this mental health crisis, they're like escalated, you know, they're like way up here, but by the time we get there because our response isn't necessarily like we're going to be there in five minutes. Sometimes it takes a minute for us to get a team together. So a lot of times we get there and the kid is fine, you know, it's all calm down they're tired from, from the last half an hour to hour of, you know, threatening people and.

Amber: Whatever they're doing at the school that we don't necessarily always see. So it's more of us supporting the school staff. It's more of us supporting if the parents are there, there, we support the parents. We connect them to resources if they need it. If the parents aren't there, we will leave a folder with resources for the school to give to the parents.

Amber: So yeah, it's, it's not really the kids that are calling it's more of the schools and the parents and guardians.

Mike: What are the resources that are available to?

Amber: Yeah. So for kids, it's Wraparound. Wraparound is like a case management. They can get crisis stabilizers. They can get therapists, psychiatrists through Wraparound.

Mike: And these are county people?

Amber: This is a county resource, yeah. The Mental Health Emergency Center, they do take children as well. So that's a resource that Craig Yabuki Walk In Mental Health Clinic at Children's Hospital is another place that people can take their kids. There are other ones.

Mike: Wow.

Amber: Yeah.

Mike: How is this different from, I mean, if I don't know about your number I think I'm calling 911?

Amber: Right?

Mike: So you must get calls diverted from 911 or how's that different?

Amber: We usually don't get calls diverted from 911. We do get calls occasionally from 988, the suicide hotline.

Mike: Sure, right.

Amber: Yeah. But I think this is different from 911 because we do a lot of listening. We do a lot of that supportive listening is key to what we do. We do connect people with resources. So we will do like alternative to inpatients. So sometimes going to, going and talking to people helps them and they feel better.

Amber: So they don't need to go in. We can refer people to case management. We can refer people to peer support specialists. We can help them make a call to the crisis resource center where they can stay for a few days to kind of get stable. We also have the crisis stabilization home where people can say for up to six months, if they need to, to get, to get stable.

Amber: And we provide a lot of psychoeducation, like coping skills, safety planning, things of that with families.

Mike: Wow. And you don't necessarily want somebody waiting until they're experiencing a life threatening emergency to call you, right?

Amber: Right. But I think a crisis is defined by the person. So if somebody feels like it's an emergency situation and they call us, we will walk them through that.

Amber: We will support them. We will help them. We contacted police. We contacted the police if it's needed to be done. We will go with the police, like I said, if we need to. But yeah, I, I think that if somebody is in an emergency, if they think it's an emergency situation, we will call and listen, but if it's definitely, if there is an imminent danger to self or others, a call the 911 is more appropriate.

Mike: It's got to, you know, It's got to be rewarding.

Amber: Yeah, yeah, it is. I can see the difference we make by simply answering a phone call. You know, I can think of this mobile I went on with a coworker and it was a 12 year old boy and he... he broke my heart. So this was actually a call from the police.

Amber: They asked us to come out there and support the family and the police, the police didn't know what to do. So we went he was sitting in the back of the squad car. When we got there, the police officers asked us where we wanted to talk to him. So we went back in the house with him. We removed everybody else from the situation.

Amber: So it was just me and my coworker and this, and this boy sitting there talking. And he like just broke down. He was crying throughout the assessment. He was saying he's feeling hopeless. He's talking about bullying. He's talking about gang related things. He's talking about suicide. The parents were primarily Spanish speaking.

Amber: He did have an older sister that was there. So we were able to a encourage the police to take him to the Mental Health Emergency Center. So they did that. And then I actually did a follow up with a sister a few days later. And the sister said, "He's hospitalized. He's doing great. His parents have been checking in on him. He loves the program that he's in. He's feeling a lot better." So, and actually that was. Something else. I feel like there's a gap with Spanish speaking clients in the city. So the sister was saying how the dad who didn't necessarily think there was any issue finally like notice, like, "Hey, I think our family needs help."

Amber: So the dad was agreeable to go and get help, but she couldn't find anywhere, anywhere that had family therapy with a Spanish speaking family. So I was able to provide her with some, some resources, some phone numbers to call, to see if they could help her out with that.

Mike: Wow, that's wow, that's, that's actually amazing.

Amber: Yeah.

Mike: And you answered the second part of my question, which is follow up. Do you, are you, how long do you wait until you call and say, "Hey, we were out the other day? How are you doing?"

Amber: So I think every clinician has their own judgment call with followups. I typically, like, if it's kind of a serious situation, like that was, I called the next day to make sure they were okay.

Amber: Some people wait a few days. So it's like, I'd say between two, three, four days, we'll follow up.

Mike: Well, you know, Amber, we've talked a lot here about how difficult it is for people in general to access the system.

Amber: Yeah.,

Mike: Let alone people in crises. And, you know, as I'm listening to you and all of the different resources you have, I'm visualizing, well, mainly because I'm old, you know, a notebook in front of you that has all of these numbers, and you got to know which page to turn to.

Mike: I wouldn't know how to do that if I'm just living in the community.

Amber: Yeah. So, like I said, I've been here for two months and I have a lot of addresses and phone numbers memorized, so it's relatively easy. We do have a nice handout with a lot of these resources on a one page handout that we can give people.

Amber: And then there's room on that handout for us to write additional, like if they need things that aren't necessarily on the handout, we, we will write like addresses, phone numbers, places that they can call.

Mike: If people want to learn more, we will obviously include the phone number the emergency phone number and the recruitment number.

Mike: People want to learn more. What should, where, where could they go?

Amber: So for recruitment, you'd have to look on the county's website. They do have the job posted, I believe, on the Milwaukee County website. So in order to become a member of the team, you do have to be licensed as an advanced practice social worker through the state of Wisconsin.

Amber: Have a master's degree. Sometimes they do accept people with bachelor's degrees, but they have to have like pretty, pretty close work with in, within like a crisis organization or crisis team, that kind of thing. But all of that information can be found on the Milwaukee County's website.

Mike: And we will give you the link to that at the end of the podcast.

Mike: Amber, I really appreciate the work that you're doing and I appreciate you being with us and talking about it today.

Amber: Yeah. Thank you for having me.

Mike: Well, that's great. Thanks for your work. You know, all of you are listening. We invite you to listen next time and until next time, this is an appropriate thing to say today, stay safe and please, if you need help, reach out.