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Triage Triumphs




  • A woman had several severe psychotic episodes which were determined to be the result of continued methamphetamine use.  She was hospitalized four times over five months and got evicted from her apartment due to her behavior and destruction of property; in addition, she was in a very unhealthy relationship with her live-in boyfriend.  The general consensus among law enforcement was that eventually she would be found dead.  Each time she went to jail or had contact with law enforcement, the same triage worker was present who built rapport with her.  In mid-October, she and her boyfriend went to jail but she was released.  With the boyfriend gone, the client has since been fully engaged in services, including improved sobriety. The triage worker says the communication and collaboration with the Sheriff’s Department “has had a major impact on our ability to work with this client.”  Lack of affordable housing has been a significant barrier to uninterrupted stability but she now knows that behavioral health is there to help her.
  • A female was threatening to jump from a 150-foot tall metal tower, she would not communicate and was very agitated, moving around a lot. The triage worker arrived and starting talking with her for over an hour—it looked like she was going to fall several times.  Her friend arrived and the worker coordinated communication with himself, the friend and the female.  The triage worker convinced the woman to come down twenty feet to a cross beam; she nearly fell several times but he kept her calm.  He then convinced her to let the fire department raise the ladder and she crawled down to safety. She was placed in a 5150 hold and on the way to the police car, the officer on the scene overheard her say to the triage worker “I’m glad you kept talking to me, thank you.”
  • IN A TRIAGE WORKER’S OWN WORDS:  I received a referral from one of our Deputies regarding a female who was the subject of multiple 911 calls by family due to bizarre behaviors. When I was able to get out to the home, the husband told me that his wife had been placed on 5150 the night before by deputies and was in the hospital. I explained the 5150 process to the husband, my role with behavioral health and the Sheriff’s Department, and gave him my card so that he could contact me if his wife seemed to be decompensating after she returned home. When the wife came back home from the hospital, she was still exhibiting psychotic behavior. Before calling 911, the husband called me and I was able to go out to the home to assess the situation. I was able to convince her to go to the ER without the need for a deputy to become involved. She was re-hospitalized, stabilized, and returned home. While she needed to return to the hospital, I was able to avoid a deputy being tied up with a mental health issue. This story illustrates the importance of letting the community know that this position exists and that I am available to provide support whether or not an individual is receiving services from County Behavioral Health.
  • DATA POINT:  Traditionally in Placer County, 50% of persons in crisis at the emergency rooms are placed on a 5150 and placed at psychiatric facilities/hospitals.  Mobile Crisis Triage data show that only 29% of those evaluated by the MCT team require hospitalization.  These teams also average less than 30 minutes in response time to a mental health emergency crisis after a call is placed to them by law enforcement (Sheriff’s Department and other law enforcement).



    People in a mental health crisis often go to emergency rooms to seek treatment; however, ERs are often not equipped to handle them because of a lack of training and space.  As a result, ERs get overcrowded, patients in crisis wait long periods of time to be seen and ultimately may not get the treatment they need. They may be hospitalized unnecessarily or even discharged without proper treatment or follow up care.  Once released, the cycle often starts again, at great emotional and financial cost to the patient, the hospital and the community. 
    In 2015, St Joseph Hospital in Orange County was experiencing an increase in patients in crisis in the ER, most likely because the hospital has an inpatient psych unit.  The hospital director had a vision of improving mental health care and diverting unnecessary hospitalizations: get patients in crisis seen quickly, link them to services, and then follow up to make sure they receive appropriate care. In early 2016, Orange County was awarded a state Triage grant (Mental Health Wellness Act) which resulted in the hiring of LCSWs, a psychiatric RN, and a part time psychiatric Nurse Practitioner at St. Joseph.  By August of that year, the team was in place and began assessing and treating patients who had come to the emergency room in crisis via police, ambulance, by themselves or with family members. If they’re in crisis, patients go to a separate area which is quieter with softer lighting. The goal is for patients to be seen within an hour, that they receive appropriate treatment, and are then linked to outside resources and services, with a follow up by staff within five days.  The hospital reports successful outcomes:  Since August 2016, almost 900 patients have been served. 60 percent have been diverted from unnecessary hospitalization and 75 percent have been linked to services to help them receive ongoing treatment.

  • “Jane” (not her real name) had a history of anxiety due to past trauma and had been living deep in the mountains for many years.  A park ranger made the referral to a community based organization (CBO) and to local law enforcement, concerned for her mental health and safety.  The park ranger went with the triage worker into the mountains and they worked together to develop rapport with Jane.  Jane told the triage worker that being in public makes her feel like she’s suffocating.  With the collaboration of the park ranger, the triage worker was able to get the woman to agree to services. She used the CBO’s showers after hours when no one was around; she had a mental health assessment and made an appointment for services.  When she didn’t show up at the pre-arranged spot for the initial appointment, they went back to the mountains and talked with her.  She was still able to see the psychiatrist that day, even though she was an hour late for the appointment because the triage worker talked by phone to the psychiatrist who agreed to fit her in.  She is now receiving outpatient case management, medications and therapy (which she requested to deal with her mental health issues).  Jane said she could not have navigated the system on her own and “I don’t know what I would have done without your help.”
  • RISE partners with county libraries to place staff at the library in downtown Ventura a few hours a week because it has the largest population of homeless mentally ill.  The triage worker met with the library manager and asked her to begin keeping track of the number of calls to law enforcement.  From November 2015 through January 2016, they were 15 calls to law enforcement. RISE staff started going out to the library in February.  In that subsequent three weeks, there have been no calls to law enforcement; the library staff calls triage workers to come out to handle any situations that arise.  This is very early to compare, but using the three months of baseline data, this will continue to be tracked
  • From Highland Community News - "Triage Engagement and Support Teams (TEST): In 2015, the Department of Behavioral Health formed the Triage Engagement and Support Teams and placed them in critical entry points where persons in crisis traditionally enter the criminal justice or inpatient hospital systems. The goal is to provide an alternative to consumers in psychiatric crisis who may have traditionally been hospitalized or incarcerated. In the first nine of the planned 17 sites, TEST has reduced unnecessary expenditures for law enforcement and hospitals by diverting 76 percent of crisis intervention encounters from hospitalization. TEST has further saved law enforcement resources by providing transportation to the hospital and accompanying the consumer during their hospital admission process in crisis intervention encounters that could not be diverted. The support provided by TEST, both to avoid unnecessary hospitalizations or incarcerations and after a client’s release when hospitalization or incarceration cannot be avoided, enables consumers to break cycles of intense distress and crises by replacing them with ongoing engagement in the outpatient continuum of care." Read more here: Highland Community News 
  •  After various hurdles, a 25 year old male was finally relieved of homelessness after 7 long years due to the help of the Triage Engagement Support Team (TEST), Arrowhead Regional Medical Center (ARMC), and Central City Lutheran Mission San Bernardino (CCRT). The young man is now placed in a men’s home that provides him with the medication he needs, clothes, food, job training, and transitional housing after completion of their one year program. 
  • During an effort to provide resources to individuals in needy areas by the Community Outreach Program's (C.O.P.) team, San Bernardino County Probation, Rialto Code Enforcement, Rialto PD Parking Enforcement, and the San Bernardino County Behavioral Health Department, a woman was found living in a “birds nest-type structure” and was connected with TEST, who will work to assist her with getting connected to mental health services. 
  • In Rialto, 9-1-1 was called on behalf of a man that was threatening suicide by cop. When police arrived, they received assistance from a Crisis Team Negotiator and TEST in order to defuse the situation. A TEST Behavioral Health Specialist was able to speak to the man, who later agreed to allowing TEST to connect him to professional help.

  • On January 27, 2016, the Los Angeles County Department of Mental Health (DMH) Mobile Triage Team was contacted by the Los Angeles County Department of Public Health regarding a 53-year-old chronically homeless man who had been bitten several times by coyotes. The man was chronically homeless and had been living in the desert on the outskirts of Lancaster since 2015.  The Mobile Triage Team and the Los Angeles County Department of Health Services (DHS) High Desert Health Systems’ Antelope Valley Health Center worked together to do outreach and engagement.  The triage team collaborated with DHS to ensure ongoing care for the coyote bites and then transported him to Olive View Urgent Care for medication management and stabilization of his mental health condition.  The mobile team continued outreach, developing a relationship and connecting him to ongoing county mental health services in the Antelope Valley.  Staff there developed a housing plan and was able to find permanent housing for him on December 20, 2016.  In that year of engagement, through a collaborative effort, he obtained food, clothing, shelter and ongoing mental health services. The mobile crisis team was able to provide continued support and clinical interventions along the way.