Crisis center

Chelsea Stevens spends her days registering patients and tracking open beds at the Crisis Response Center while also helping to monitor patients in a 23-hour observation area.

In May 2006, voters approved a $54 million bond package to build a psychiatric urgent care facility and an inpatient psychiatric hospital in Tucson because Pima County officials said far too many mentally ill people were clogging up the jail and emergency rooms.

Both opened in August 2011, on the campus of what is now called Banner University Medical Center South Campus.

By all accounts, the project has been a success.

Every month, the Crisis Response Center on Ajo Way provides mental health services to about 1,000 adults and 200 children.

About half are brought to the CRC by law enforcement officers who would otherwise take them to the Pima County Adult Detention Center, Pima County Juvenile Detention Center or a local emergency room, said Dr. Margie Balfour, chief clinical officer.

Over the last three years, 545 residents from Green Valley and Sahuarita have received services at the CRC. The vast majority are suicidal, the others are depressed, showing signs of psychosis, are dangerous to others or are having issues with their medications.

Prior to the advent of the CRC, the jails were filled with mentally ill patients who had committed low-level misdemeanors such as trespassing, disorderly conduct, urinating in public and shoplifting, said Amelia Craig Cramer, Chief Deputy Pima County Attorney.

Many also suffered from substance abuse issues, but once in jail they didn’t receive help, she said.

Now patients are treated by experts in the field and officers’ time isn’t tied up indefinitely, she said. It typically takes officers just 10 to 15 minutes to drop a patient off at the CRC.

“It gets them back on the street where they can deal with those people who are dangerous and violent,” Cramer said.

Building trust

Paula Perrera, director of Pima County’s Behavioral Health Department, said there’s an added benefit to having a psychiatric urgent care in the city.

“Having the CRC has given law enforcement officers the ability to get familiar with the population and to build relationships with individuals and trust,” Perrera said. “It’s gotten to the point that they ask to be taken to the CRC when they’re experiencing a crisis.”

The CRC has become so well-respected, other communities throughout the nation have looked to Pima County when starting their own urgent care facilities, she said.

Pima County Public Defender Joel Feinman is also a fan of the center.

“It treats people with mental illness who might find themselves in the criminal justice system the way they should be – like they have a behavioral health issue, not like they’re criminals,” Feinman said.

The CRC is owned by Pima County, but the funds used to operate it come from the Arizona Health Care Cost Containment System, Balfour said. AHCCCS provides funding to the Regional Behavioral Health Authority, which has given Banner the contract to run the CRC and the attached 66-bed inpatient psychiatric hospital. Banner, in turn, gave Connections Southern Arizona a subcontract to run the CRC.

Getting there

When someone is in crisis, they can end up at the CRC any number of ways besides a police car, Balfour said. Sometimes, they walk in on their own, other times they come in with a family member or they’re transferred from an emergency room.

Some have called a crisis line and been given a ride by a mobile health care unit. There are also times when the person in crisis is already enrolled with a behavioral health provider and they come in with a case manager, Balfour said. Underage patients are kept separate from adult patients.

Once they’ve arrived, staff will immediately determine if their needs can be handled much like minor medical emergencies are handled in an urgent care facility, she said. Sometimes, they simply need to have their medications refilled and they can be out within two hours.

Other times, the patient is considered a danger to themselves or others, are psychotic, agitated and going through withdrawals, Balfour said.

These patients are placed inside a secure, 23-hour observation unit, Balfour said.

Overall, the “door-to-doctor” time at the CRC is two hours, she said.

While patients are in the observation unit, social service staff are calling families and local behavioral health care providers to get information about the patient.

“Our philosophy is that most people can be stabilized quickly and go on to less-restrictive care than an inpatient hospital, if we start treatment early,” Balfour said. “We have a really aggressive approach toward discharge planning.”

By getting information early, Balfour said the CRC can line up outpatient treatment plans and “figure out, what does this person need to be successful in a community-based setting?”

Patients can start the detox process at the CRC, get helping filling out AHCCCS applications and get connected with outpatient substance abuse counseling or behavioral health providers.

The center has psychiatrists and nurses on staff 24/7, Balfour said. There are nurse practitioners and physician assistants on staff and it’s also a training site for University of Arizona psychiatry residents, nurses and medical students.

The doctor also said recovery support specialists are an “invaluable part” of their workforce. They are people who themselves have mental health issues or are recovering from substance abuse issues, or both. They share their stories with patients to help them get through it.

“Their experience becomes their credentials. It’s a mix of people and everyone has their story and so sometimes we’ll seek out a certain recovery support specialist to engage with a certain patient,” Balfour said.

About 50 percent of the patients who come to the CRC go home within two hours. Of those who are sent to the observation unit, 60 percent go home the next day, Balfour said.

Those who are not sent home from the observation unit are admitted to a 15-bed acute unit because they require further stabilization, she said.

Most stay three to five days; if they require more help they are transferred to the 66-bed unit next door at Banner UMC or another psychiatric facility.

Potential victims

Jails aren’t set up to be therapeutic mental health treatment facilities, Balfour said. They do the best they can, but national studies have shown mentally ill and substance-addicted inmates don’t receive the treatment they need, tend to decompensate, and are more likely to be sexually assaulted.

Emergency rooms often don’t have the means to adequately address their needs, either, she said.

“Usually, for safety reasons they have you in a room by yourself with a sitter who sits there and stares at you and make sure you don’t do anything to hurt yourself, but they’re not allowed to talk to you about anything clinical while you’re there,” Balfour said.

Patients often sit for hours just waiting for a bed to open at a psychiatric facility, she said.

Taking these patients to the CRC allows them to get help more quickly and frees up beds within our hospitals, Balfour said.

Officer training

Pima County residents are lucky that government and law enforcement officials have recognized the need not only for the CRC, but for mental health training for its officers and deputies, Balfour said.

One hundred percent of officers and deputies get an eight-hour Mental Health First Aid training and 70 to 80 percent of officers and deputies have voluntarily taken a 40-hour Crisis Intervention Training.

While most mental health patients are involuntarily committed to psychiatric care facilities in Arizona, more than 60 percent of those taken to the CRC go voluntarily, Balfour said.

“That is really a testament to the really robust and sophisticated approach toward mental health that the Tucson Police and Pima County Sheriff have,” Balfour said. “They’re out there engaging with people and saying, ‘Hey wouldn’t you like to come in for treatment?’”

Feinman, the Pima County public defender, said the rest of the state could learn from Pima County. He pointed out that Arizona Department of Corrections statistics indicate that as of January, 12,254 of the 41,783 people in the state prison system require “ongoing mental health services.”

He would like to see more crisis response centers, but he’d also like to more money spent on research, treatment and education nationwide.

Until that is done, it will remain very difficult to tackle recidivism and crime rates, Feinman said.

Kim Smith | 547-9740

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