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Mental Health Crisis Intervention: Triage Facility August 17, 2011

Posted by Crazy Mermaid in Uncategorized.

Awhile back, our community did something good.  It enacted a .1% increase to our State sales tax to cover mental illness treatment.  Various plans for that money were discussed, and one of the better ideas that came out of this assessment was the need for a “triage facility”.

Unlike the State law allowing up to a 72 hour hold  before making a determination to involuntarily commit a person in crisis, the triage facility allows a hold of up to 12 hours to do an assessment.  At the end of that time frame, the crisis intervention team, skilled in this type of work, will determine the next appropriate step.  Triage will permit sobering up of intoxicated people, but anyone requiring detoxification from drugs will be referred to the proper resources within the community.  Actual treatment services won’t be provided in the triage facility.  The sole purpose of the facility is to assess the person in crisis and determine what to do next.

Until now, a person was picked up by police and dumped on the door of the local emergency room after he had exhibited dangerous behavior. Once there, the person in crisis was (eventually) assessed a by a Designated Mental Health Professional (DMHP). If the DMHP interviewed the patient and determined at the emergency room hospital that the patient was a danger to themselves or others, that patient would be involuntarily committed to a mental hospital.

What changes now is that police and eventually friends and family members will have a choice of where to take people in crisis, and their loved one won’t have to demonstrate that they are a danger to themselves or others exclusively to a DMHP. When family members show up with their loved one in tow to the new triage facility, those family members will be able to give evidence directly to the DMHP instead of having the DHMP obtain evidence exclusively from the person in crisis. Previously, the DMHP was legally obligated to ignore input from those who know best what is happening (the family).

Police and loved ones can now take people in crisis to the new triage facility rather than a busy emergency room hospital. The new triage facility will be manned by professional mental health professionals used to treating those in crisis.  Hospital emergency room personnel, with limited training in mental health crisis management, won’t be expected to hold potentially dangerous patients who are in the middle of a mental health crisis as they try to help people with physical emergencies.

I know that in my case, having the option of a triage facility would probably have made a big difference in the way I was treated during my psychotic break and subsequent treatment. When I showed up at our local emergency room in crisis, they weren’t really equipped to handle a person in a mental health crisis. I was moved to a room all by myself after I took off all my clothes in the restroom and made my appearance in the lobby.  Sticking me in solitary confinement was probably the worst thing that could have happened to me, since while I was in that room my delusions and hallucinations escalated, causing me unnecessary trauma.

While I was in that room for hours in what I perceived was illegal solitary confinement, my tree friends kept me company by drawing a jungle on the white walls of my containment room.  The blood pressure machine talked to me extensively, taunting me that I was going to be hooked up to the hospital power grid, replacing my long-lost mermaid mother who was the hospital’s current power source. Seeing a “Stryker” sticker on the guerney I was sitting on, I came to realize that the hospital was irradiating me, planning to sell my body to Haliburton where my irradiated body was going to be dropped on Iraq as a human bomb.  I was worried that the zombies that had followed me to the hospital had now infiltrated the hospital personnel, planning to capture me since I was a captive target.  All of these thoughts and more coursed through my unwell brain as I sat in that hospital room all alone.

These perceptions  would likely never have happened had I been immediately assessed in a triage facility staffed with professional mental health workers rather than a hospital emergency room staffed by regular nurses with little or no training in mental health Crisis Intervention Training .  The chances that I would have been unsupervised, and subsequently allowed to take my clothes off, would have been minimized since the professional triage team would have taken measures to prevent this from happening.  They probably would never have left me alone in a room for seven hours while waiting for the DMHP to (eventually) arrive.  They probably would have fed me while I waited for the DMHP to show up, disavowing me from the notion that the hospital personnel were trying to kill me.

Had I been at the triage facility, the personnel there would probably have been more closely coordinated with the DMHP, so I would have been assessed in far less time than I was at the emergency room. At Evergreen, I sat in a room by myself (complete with all of my delusions and hallucinations) from 10:00 a.m. until 5:30 p.m., when the DMHP finally made her appearance. Had I been bleeding to death, I never would have been allowed to be by myself for that long. But because my injuries weren’t readily observable by the naked eye, I was allowed to suffer needlessly.

In the meantime, as I waited for something to happen that would spring me loose from my solitary confinement, the hospital had to contend with a “patient” who didn’t want to be there and who was very disruptive to the hospital until they forced me into solitary confinement. While people with physical emergencies came and went, the hospital personnel virtually ignored me for hours, locking me in a room all by myself.

While I agree now that I should have been involuntarily committed, the fact remains that had I not thrown the furniture at the walls as I was cooling my heels in a white room all by myself, I would probably not have been involuntarily committed. However, if the triage facility had been available to me, my husband could have taken me there once he learned the extent of my hallucination and delusions.  He wouldn’t have had to wait for the imminent crisis to occur before I could have been committed.  He would have been able to give evidence to the DMHP directly that established my need for intervention.

What would have happened had I been released from the hospital emergency room is interesting conjecture.  It was at the point I was at the hospital, standing in the admitting line in a damp swimming suit,  when my husband was first clued in on the extent of my delusions and hallucinations.  He learned for the first time that I was hearing voices and that I thought I was a mermaid . Unfortunately for him, neither my hallucinations nor my delusions qualified me as being “a danger to myself or others” according to the old standard.  Thinking you’re a mermaid wasn’t a crime. It was only when I heaved furniture at the wall of my confinement room that I crossed the line into involuntary commitment. How he would have handled having to go home with a wife who thought she was  a mermaid is anyone’s guess.

The only thorn in the side of the triage plan is the lack of mental hospital beds in the State. Washington ranks almost last in the nation in terms of per capita mental hospital beds.  Instead of increasing with the population increase, mental hospital beds are being eliminated.  Just a few short months ago, 9 additional beds were eliminated in Snohomish County alone. So despite the new law’s intent to get people in crisis the help they need, that help will be restricted by the lack of places to put them.

This new Triage facility is a step in the right direction, but until adequate hospital beds are available to treat those in need, the process won’t live up to its potential. And mermaids will be allowed to destroy a family.




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