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Dealing with Mental Health Emergencies

Last spring when a young man jumped off an upstate bridge, he was still wearing the hospital gown he was given at the local ER; after 911 was called, he was transported and since the ER doc didn't determine that he was an IMMEDIATE threat to himself or others, he was released (he couldn't be held without his consent) — unfortunately there had been no mental health support and he left the hospital as despondent as he was when a concerned relative called 911. All over the country 911 is routinely called when someone is in "crisis" and all too often arriving police escalate the situation ONLY BECAUSE OF THEIR UNIFORMS and the effect it has on the patient, and all too often arriving EMS are not trained to deal with mental health emergencies, so they follow their protocol and transport to the local ER… just for the patient to be released without having received any vital help.

A "crisis" situation is one that requires prompt attention, but is not immediately life threatening. By enabling those suffering with anxiety disorders, paranoia, depression and other types of mental illness to receive compassionate help from those who are trained to help, it could help to save them the added trauma of ambulance transport to the hospital and being released with no relief. Of course any behavioral emergency where violence or risk of personal harm or harm to others does need police intervention.

Some areas, such as New York City, have been working on sending Mental Health Teams to respond when callers state to 911 that someone is having an emotional or mental crisis. A few upstate towns working to implement Community Paramedicine for otherwise medically underserved populations allow for EMS teams to arrive at the scene and make determinations for the patient's treatment needs; depending on the "average" call for that specific area the team may or may not be well-versed in that medical or mental health need. New York State currently has no formal criteria for Community Paramedicine, it is currently left up to the specific regional guidelines, but ultimately Community Paramedicine allows for treatment of a patient at home or transported to a facility specifically geared to the patient's needs. An alternative for areas working with standard EMS response might be for medical directors to authorize transport to treatment centers other than just the local ER.

Currently there is legislation in the NYS Senate to approve funding and implementation of a new emergency call number to be implemented statewide to be used predominantly for mental health emergencies. Operators who answer the '988' calls will be trained to assess and handle mental health emergencies and dispatch mobile mental health teams as needed. Depending on the case, teams may be able to talk-down a crisis moment, arrange counseling services, or have the patient transported to emergency mental health facilities. The FCC established '988' as a nationwide phone number for Americans in crisis to connect with suicide prevention and mental health crisis counselors, bypassing police response. Harvey Rosenthal, CEO of the New York Association of Psychiatric Rehabilitation Services, said “This approach will hopefully de-escalate crises rather than leading to avoidable arrests and too often fatal encounters.”

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