MENTAL HEALTH MOMENT

                 MENTAL HEALTH MOMENT
                   January 19, 2001

"Nothing in life is to be feared. It is only to be understood." - Marie Curie
**************************************************************************
China Cultural Tour Due to a lack of response, the China Cultural 
Tour will not happen this year. I will try again for those interested to
go next year. You can still go on your own if interested by contacting
Grand Circle Travel. Give them my name, etc. as person recommending you.
http://www.GCT.com
                         * * * * *
February 7-10; LDA Annual (LDAA) International Conference, New York,
NY. The annual meeting of the Learning Disabilities Association of
America is for educators, administrators, social workers, school
psychologists and parents. Contact: LDAA, 4156 Library Road,
Pittsburgh, PA 15234; (412) 341-1515; fax: (412) 344-0224; email:
ldanatl@usaor.net; Wbe site: http://www.ldanatl.org
                        * * * * *
The Social Science Research Council is offering 2001-02 predoctoral
and postdoctoral research fellowships for the study of international
migration to the United States as well as a three-week Minority
Summer Dissertation Workshop for the development of projects and
proposals related to international migration. Psychologists, in
particular, are encouraged to apply. Contact: SSRC, 810 Seventh
Avenue, New York, NY 10019; email: migration@ssrc.org; Web site:
http://www.ssrc.org
**************************************************************************


               CRISIS RESPONSE SYSTEMS

Persons with serious and long-term mental health problems tend to
experience periodic crises. Crises occur even when persons receive
comprehensive and continuous community support services. It is at
these times of crisis that clients most often are re-hospitalized
in psychiatric wards of community hospitals and in state hospital
facilities. This is evidenced by the high re-admission rates among
persons with mental illness. This is often referred to as the 
problem of "the revolving door".

Because of these recurrent crises, the capacity to provide crisis
assistance is a critical aspect of a community support system.
Emergency or crisis services are needed 24 hours a day, seven days
a week to provide an immediate response to individuals in crisis
and to members of the individual's support system.

The primary goal of crisis services is to assist individuals in
psychological crises to resume community functioning. A second and
complementary goal of many crisis intervention services is to
prevent unnecessary hospitalization to the greatest possible extent
through the formulation and implementation of alternative treatment
plans. Through the provision of intensive crisis services, reliance
on hospitalization for acute mental health crises often can be
prevented or reduced.

In order to achieve these goals, crisis services involve the
accomplishment of three major functions. These include:

 * Stabilizing clients in crisis in order to assist them to return
   to their pre-crisis level of functioning.

 * Assisting clients and members of their natural support systems
   to resolve situations that may have precipitated or contributed
   to the crisis, and

 * Linking clients with services and supports in the community in
   order to meet their ongoing community support needs.

The community support system component labeled "crisis services"
is more than a single service. Rather, the component can be described
more accurately as a system of crisis services, including a
range of services that should be in place in order to provide
adequate responses for persons experiencing mental health emergencies.
This system of crisis response services is comprised of five major 
components.

Crisis telephone services are often the first point of contact with
the mental health system for a client in crisis or a member of his 
or her support system. The crisis response system must include 
arrangements for 24-hour telephone crisis services of some type.
Generally, mental health agency telephones are answered 24 hours a
day, either by having staff on site at the mental health facility
or by using various arrangements whereby an answering service can
readily access on-call staff to provide telephone crisis services.
Some communities offer 24-hour hotlines fully or partially staffed
by volunteers who complete extensive training programs which prepare
them for providing telephone crisis services. Most telephone crisis
services involve screening and assessment, telephone counseling,
and information and referral. A primary goal of telephone crisis
services is to assess the need for face-to-face crisis intervention
services and to arrange for such services when indicated.

The second essential component of a system of crisis services is
walk-in crisis services or the capacity to provide face-to-face 
assessment and crisis intervention at a facility. This way, clients
who come in or are brought to the agency in crisis situations can
be seen immediately. In most communities, mental health staff are
available at the agency during working hours to provide walk-in
services. The staff may be specialized crisis staff or regular 
clinical staff who rotate on-call responsibility for handling crises.
Some communities have staff who are stationed at the mental health
agency after working hours, weekends, and holidays to respond to
crises or who will meet clients at the agency when the need arises.
In other communities, staff are stationed after hours at a separate
location where they can respond to crises. Most frequently, hospital
emergency rooms are used for this purpose. Walk-in crisis services
typically involve screening and assessment, crisis stabilization,
brief treatment, and linking the client with ongoing services.

One of the most innovative and effective components of the continuum
of crisis services involves mobile crisis teams to provide such crisis
services on an outreach basis. This component involves going to the 
client and providing services in the setting where the crisis is occurring - 
private homes, boarding homes, nursing homes, work settings, hospital 
emergency rooms, police stations, jails, human services agencies, and 
virtually anywhere else in the community deemed safe and appropriate 
to meet the client. The mobile crisis outreach staff may work with the 
client and significant others for as long as is necessary to intervene 
successfully in the crisis, initiating necessary treatment, resolving problems, 
providing high levels of support and making arrangements for ongoing 
services. Mobile outreach services are provided by individual staff members 
on teams, and law enforcement officers may accompany staff in situations 
which appear to involve potential danger. Some communities provide 
agency vehicles and portable phones to assist mobile outreach staff. Mobile 
outreach services also involve screening and assessment, crisis stabilization, 
brief treatment, and linking the client with ongoing services.

In a few mobile outreach programs, crisis staff or specifically trained aides 
may stay with the client for a period of time ranging from several hours to 
several days. By providing intensive support and supervision, it is frequently 
possible for the client to remain in his or her natural environment throughout 
the crisis resolution process. A member of the crisis staff may stay with a 
client in crisis, or other arrangements may be made to provide extended 
support and supervision to clients in their natural environments. For example, 
some agencies hire professional companions to remain for a period of time 
with a client in crisis, and ex-patients provide crisis support in some communities.

Regardless of the level of support and supervision available, in some cases 
temporary separation from the natural environment may be necessary for a 
client in crisis. Accordingly, the fourth component of the continuum of crisis 
services is crisis residential services. These services involve providing crisis 
intervention within the context of a residential, non-hospital setting. The 
protective, supportive, and supervised residential setting is used to assist the 
client to restabilize, to resolve problems, and to access ongoing services. 
Crisis residential services can be defined as services which provide temporary 
housing, crisis intervention, treatment, and other support services in order to 
assist persons in crises to re-establish community functioning. Residential 
crisis options are provided in a wide variety of settings including family-based 
crisis homes, group crisis facilities which serve small groups of clients, crisis 
beds in longer-term residential facilities, and crisis apartments. They are 
typically voluntary programs which provide intensive intervention and 
support services to clients experiencing acute crises. While residential 
services appear to be the least well-developed crisis component, there is 
near universal agreement that utilization of hospital services could be 
reduced with greater availability of residential crisis beds. Some communities 
provide specialized residential crisis services for children and/or adolescents.

Acute psychiatric inpatient services comprise the final component of a 
psychiatric crisis response system. Inpatient services are ideally used as a 
backup when other approaches to crisis intervention prove insufficient. 
Inpatient services are used to provide intensive, crisis-oriented treatment 
in a secure setting. The hospital setting facilitates the accomplishment of 
psychiatric, neurological, and other medical assessments, and provides a 
highly supervised environment in which to employ chemotherapeutic 
approaches. Community inpatient units increasingly are emphasizing brief 
hospital stays for acute care with speedy return to the community and 
linkage with the full spectrum of community services.

Most communities have a variety of public and private hospitals which may 
be used for persons in psychiatric crises. Contracts or cooperative agreements 
often are negotiated with one or more hospitals to ensure access to inpatient 
services, particularly for indigent clients. Agreements are also used to 
establish agreed-upon mechanisms for facilitating admissions as well as for 
continuity of care between hospital and community programs. Additionally, 
state hospitals are available and typically are used for involuntary admissions, 
long-term hospitalization, forensic services, or when no community options 
are available.

It's important to remember that individual crisis components cannot be 
viewed in a vacuum. Rather, they should be embedded in a system of crisis 
services, offering a range of crisis responses which may be called into play 
according to the needs and wishes of the client. In turn, crisis systems should 
be embedded in comprehensive community support systems offering the 
array of services and supports needed by persons with long-term mental illness.
**************************************************************************
For further information on this topic, go to the following and begin by
trying the following descriptors: crisis, crisis response systems,
crisis services, crisis and community support, crisis services, 
crisis and telephones, crisis and volunteers, crisis support systems,
crisis and outreach, crisis facilities, crisis and work, etc.
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
**************************************************************************

**************************************************************************
        Contact your local Mental Health Center or
        check the yellow pages for counselors, psychologists,
        therapists, and other Mental health Professionals in
        your area for further information.
**************************************************************************