by William Skink
Missoula is getting ready to launch a mobile crisis unit pilot program and I can already tell you where this program will have problems.
When I appeared on Talk Back Missoula earlier this week I discussed my time as the Homeless Outreach Coordinator for the Poverello Center. One of the insights I shared was how law enforcement has, in the past, asked service providers who they are supposed to call at 2am when there is a crisis.
This mobile crisis unit will not solve that problem because right off the bat they won’t be responding to crisis calls 24/7:
According to Jordan, existing data shows there not being a need for a 24/7 service, but as they “tailor it to the community’s needs” based on what the local data reveals, that could change when they make the permanent budget request to the city and county in the spring.
Not having 24/7 response capacity is the first glaring problem. The second problem is also well-known: where to take them?
Almost a decade ago, when the 10 year plan to end homelessness was being developed, one of the biggest needs identified was an alternative to the ER/jail for people in a mental health crisis. That infrastructure has not materialized in the nearly ten years since the plan was finalized, and that could be a big problem:
Jordan said there would be immediate benefits to the mobile crisis team, including a reduced need for incarceration. It costs Missoula taxpayers $115 per defendant per night in jail. By intervening, the crisis team could save $3 to $7 spent elsewhere and offer better crisis care in immediate situations.
However, the mobile crisis team could face problems with the lack of available residential centers addressing mental health in Missoula. Missoula has the largest number of admissions to the Montana State Hospital by almost three times, council member Bryan von Lossberg noted.
“We need a Dakota House (a Missoula-based crisis residential center) times 50. If the crisis can’t be resolved, we don’t want to take them to jail and we don’t want to take them to the hospital. They just need to go to some place for observation. We are going to fall short in that space,” Jordan said.
To exemplify how this will be a problem, allow me to share an anecdotal story.
When I was the Homeless Outreach Coordinator I was called to a motel room by a motel manager. The homeless veteran who had been renting a room was very, very intoxicated and being kicked out for his behavior. As I talked to him about his options he said he would prefer to kill himself. This is called “suicidal ideation”.
Since I had a vehicle and a good relationship with this individual I was able to talk him into a ride to the ER (saving the cost of an ambulance ride). After checking him in, he was assessed by a nurse where he again expressed suicidal ideation. This triggered the need of the hospital to keep him until he could be assessed by a mental health professional.
This is where alcohol comes into play.
I spent about an hour trying to keep this man from causing problems in the ER. He kept trying to get off the gurney and would start yelling and making a scene. After an hour of this I found the nurse and asked her how long before he could be assessed by a mental health professional.
I remember distinctly how the nurse gave me this cynical look, then she explained to me that he couldn’t be assessed until his BAC (blood alcohol content) was below the legal limit of .08. This man’s BAC was around .42. The nurse estimated that it would probably be about 24 hours before he could be assessed.
That’s 24 hours being held in the most expensive form of medical treatment just so he can sober up for a mental health assessment.
Because we haven’t closed this giant gap in services the mobile crisis unit will be significantly hampered. But don’t worry, Missoula, they will be COLLECTING DATA!
“We’re going to be collecting data to hopefully find how many times we weren’t able to take someone to a Dakota House because it was full or for some other reason.”
Isn’t it nice how the systemic failure of our elected leaders and the problems they keep circling like dirty water going down a drain can somehow always be tempered by well-intentioned efforts at data collection?
I know, we could do a public listening session of stakeholders, then fund a study with TIF money (is Spider busy?) then, after the study is compiled into recommendations, a plan can be formed (is that Florida consulting firm busy?). After a few years, when the plan proves to be ineffective, just start the process all over again.
This is how Missoula operates and I see no reason for the people in charge to change. When confronted with their failure, like I said on the radio, they just circle the wagon to protect their little rackets from exposure.
I couldn’t agree more with your predictions of, not just ineffectiveness, but perhaps outright failure of what could/should be an important new approach.
I dont know what data was collected to show that 24/7 wasn’t needed but it doesnt represent “boots on the ground”! Perhaps they should have examined run reports from MPD/MCSO, MFD and MESI over the past 5-10 yrs to see the volume of calls that occur “after hours”. To mimic your cynical cop – after a few incidents of requesting mental health in the wee hours and getting no response emergency crews will lose faith in this unit. It will then probably result in an antagonistic relationship between agencies needing to cooperate.
Once again, it seems the people actually going to do the work were left out of planning/decisions so that the thought leaders, sitting in a room, could craft “their” data driven ideal
I was wondering where they got the data from as well.
your comment has me recalling the very first HOT call I ever got, from the United Way ironically when they had that little office by the Xs on north Higgins. they were concerned about a Native American woman passed out in the shade behind their building. I was able to rouse her and move her along, but she was so unstable I ended up having to call 911.
after the whole siren show came and went I was later told (I think by the downtown officer) how she had overheard the cynical suspicion from first responders during the call that this new homeless program would just result in MORE CALLS for assistance.
it took me a long time of demonstrating ON THE GROUND effectiveness and consistency so that law enforcement and first responders knew I could actually make their jobs slightly less infuriating and maddening if I was brought in to collaborate. I was also always very clear about the program’s limitations and the need to have a 24/7 response ability.
Good evening, Mr Skink and TC, my name is Kristen Jordan and, Mr Skink, I am the one you have quoted throughout your article. I have a few comments in response:
1. Planning for the MCT lasted for 8 months and included key, if not executive, representation from 911, MPD, Sheriff, Poverello, NAMI, MESI, City, County, City Fire, and Rural Fire.
2. 24/7 is NOT required at this time. TC, you mentioned data that speaks to run reports, which I have not heard of, but we did look at 911, MPD, Sheriff, Fire, and MESI call volume related to mental health calls and made the decision to NOT run a 24/7 team based on this data. Teams will be available based on data from these first responders and Law Endorsement. As I have said before, if data shows that we need something further at the end of the pilot project, we will restructure the program to accommodate this after the pilot. This is the whole purpose of a pilot project- to try something and see what works and what doesn’t’ work and then to make changes based on that information.
3. Mr Skink, you seem to have a lot of experience. I’d like to add to that experience, the hands on knowledge and experience that was brought to the planning table by 911, MPD, Sheriff, Fire (City and Rural), The Poverello, and MESI. Added to that, is consultation with national service providers, including staff at CAHOOTS in Eugene, Oregon and other key Mobile Crisis service providers from across the country. You need to know that all of these folks disagree with you on the 24/7 rollout and ensuring things are “perfect” before starting. They disagree with you because they know that getting a Mobile Crisis Team up and running is essential, regardless of whether or not our community has a perfect social service network.
YEs, mobile crisis will move part of the problem. Have you thought about all of the problems it will solve? Reduced jail bookings, reduced ER visits, reduced involuntary commitments, and for those who are committed, reduced time of commitment. Check the research related to this in peer reviewed, published articles.
It is easy to sit back and heckle subject matter experts and electeds, from local and nationwide networks. Simply because you do not agree, does not mean that extreme care and planning was not involved in creating this AMAZING program.
It baffles me that folks like you both are not happy that something different is being done, even if you don’t think it’s perfect. It’s better than what we have now.
Did you know that the data collected from this pilot will be used to create a better program? How is that bad or wrong? Did you google something to try and make your point here? Are either of you data or policy analysts? Are either of you doing anything but complaining? Are either of you reaching out to electeds and agency executives to offer your “insight’? Are either of you doing anything other than sitting at your computers and heckling folks who get the big picture and are busting their butts to make necessary changes? Where do you get your expertise from? How do you know we need 24/7? Do you know what data analysis entails?
This blog does nothing but stir the poop pot of division in this community. I guess that’s what you need to do to get readers.
Feel free to email me at email@example.com if you’d like to engage in meaningful dialogue. I am available and happy to discuss all of the planning, analysis, engagement, and scope of this project.
I will respond to this comment in tomorrow’s post.
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