Ben Johnson is combing through a list of names, addresses and mental health histories in the driver seat of a Jeep Compass. He works for Austin’s Mobile Crisis Outreach Team, MCOT, a branch of Austin Travis County Integral Care comprised of 18 licensed mental health counselors who respond to mental health crises across the county.
Johnson is deciding who to visit today. Another patient has paranoia. In addition, she's having problems at home, and is in danger of losing her housing.
Most of the crises Johnson handles are related to patients struggling with mental health issues.
“Chronic mental illness is a very large part, very large component of the people we see," he says. "A lot of times it is a situation where someone has a chronic mental illness. They’ve been without medication, they don’t know how to get medication or they can’t afford them."
Until last July, MCOT responded only to people who called their mental health hotline. Then, a year ago, Integral Care received $13 million in federal and state funding – and an additional $1 million from Travis County – to expand its services.
Integral Care is using the money to connect MCOT with Austin Police and Emergency Medical Services and to help people who can’t easily access mental health care – the uninsured, the poor. This means that mental health counselors can now answer 911 calls.
“We as the police have recognized that we are not the best to deal with a mentally ill person who is in crisis but we are by virtue the only game in town at the point of the crisis," says APD Lieutenant Justin Newsom.
He says having police respond to mental health crises ends up clogging up the courts and take up bed space in jails. But, until recently, APD hasn’t had an option. MCOT’s expansion is designed to slow the number of mentally ill people idling in jails and emergency rooms and redirect them to medication and counseling. But the key is to get people at the point of crisis, when someone is hearing voices or threatening to hurt themselves. This is where MCOT Expansion steps in.
“And there’s a psych call right now…We’re not gonna get fuel right now, we’re gonna go to this call…Self-assign with medic, moving west…And we’ll go…” (siren sounds) (:xx)
Jason Castleberry is an EMS responder. He’s navigating his truck through downtown Austin. Tonja Batt, a member of MCOT, sits next to him. Jason wears an EMS uniform. Batt is more casual. She wears jeans, a blue shirt and tennis shoes. Castleberry gets a call over the radio about a woman’s threatening to hurt herself with a knife. Castleberry decides to postpone a stop for gas, picks up the call and the sirens blare.
“There’s a lot of info that comes in through dispatch but you don’t really know until you get to the scene what to expect. Our information is only as good as the person on the phone," says Batt. "We go in with a general impression but certainly nothing specific. [We] can’t diagnose before we get there”
Once they arrive, Batt debriefs EMS and sheriff’s deputies who've arrived first on the scene. After EMS makes sure there’s no physical injury, Batt spends nearly an hour talking to the patient. But she’s unable to convince her to get treatment. Batt will come back in a few hours to see if she’s changed her mind.
“The most important things to assess for at a scene like this is suicidality and homiciality and assessing for a level of risk is really a priority," she says. "And then you move into what the best after care follow up is going to be, or the next step.”
According to data collected over its first year, MCOT's expansion has diverted more than 80 percent of people in mental health crisis from county emergency rooms and jails. The next goal is to keep people out of crisis.
That brings us back to Ben Johnson in his Jeep Compass. On his list are patients he’s following up with people who, days or weeks before, saw a counselor after calling 9-1-1. In his lap is information about affordable housing and psychiatrists who make home visits. Not everyone is responsive, Johnson admits.
“It’s weird to see a stranger come to your door anyway. With us, having that unique tie to APD and EMS which sometimes can be helpful but sometimes people have concerns about us being referred to them by APD," he says. "There’s the concern that they’ve done something wrong or that we’re there because of a punitive measure.”
At the end of each visit, after someone has been connected with a psychiatrist or learned how to access medication, Johnson asks if they’d like him to visit again, or if MCOT should close out their case. If they say yes, that they’d like to close their case, it could mean one less person in the county who’s stranded without mental health care.