Tuesday, December 23, 2008

Primary care

Last week, I received a nice email from an acquaintance who volunteers at a local free clinic. Her email concerned an incident that happened at the clinic recently. A client experienced some suicidal ideation, and needed help beyond what the clinic could provide. The police were called, and she was incredibly impressed by the work of the officer who responded, Mike Muff. She didn't know his name, but wanted to pass on her appreciation.

I wanted to determine who the officer was, so I could pass the compliment on to the appropriate supervisor. Since she gave me the date (Dec. 9), I thought it would be a simple matter, and looked up the mental health investigations for that day. There were nine. Think about that for a moment: the Lincoln Police Department responded to nine mental health investigations on a Tuesday. We've handled 2,147 so far this year, an average of over six per day. That's more than all the violent Part 1 crimes combined.

During those investigations, we took 345 people into emergency protective custody, and helped make other voluntary placements or arrangements for hundreds of others. We have become, in many respects, the default provider of mental health services. It's increased over the years: back in 2001 it was 1,550 cases. Not a complaint, just an observation: we are relying upon the police to provide the care and services on an increasing variety of personal and social ills that were once provided by others.

I'm not certain to what extent these problems have increased, and to what extent these other providers have just backed away. Some of both, I suspect.


Anonymous said...

I'd think that the most that a reasonable person would expect LE to do is to control a situation (that the citizens were unable to control themselves), until LFR could get there and take custody of the relevant individual. Maybe that's the problem - some who call you just aren't reasonable, and don't try calling LFR themselves, which yould probably get the person properly restrained in a medical manner much faster than using LE as the middleman.

LE restraints have a side effect of causing pain to those who aren't compliant, and as you've written before, that's not what you want for someone who has gone off the rails (my wording, not yours). In such a situation, having EMTs on-site is a big plus.

P.O. said...

Chief, correct me if I'm wrong, but according to statute, aren't leo's the only people with the authority to epc someone? If so, unless the law is changed to also allow professionals in the medical/psychological fields make the determination, I don't see much of a change. If I, as a professional with concern that a person is suicidal, I don't have much choice but to call law enforcement. I can't transport the person, so if I don't report it, I could be liable (ding ding ding, I think we have our answer as to why things are different now).

Anonymous said...

As a teacher and a member of our school's SCIP team I see that schools and teachers take care of many social problems and that those social problems are becoming more difficult to solve. Folks don't have just one need, they have several.

My advantage is that we get to see things improve in some cases - as usual the police just get to see the crisis and seldom get the pleasure of seeing a good resolution.

Tom Casady said...

P.O. -

You're right. The Emergency Protective Custody process, though, is not the only way that a mentally ill and dangerous person may be involuntarily committed. The Act contemplates the filing of a petition by the County Attorney, notice and hearing before the Mental Health Board, and a determination of whether the patient requires involuntary custodial treatment.

EPC is supposed to be used only in emergencies, where there is a likelihood of harm is immediate, and "is likely to occur before mental health board proceedings under the Nebraska Mental Health Commitment Act or the Sex Offender Commitment Act may be initiated to obtain custody."

It seems to me that the emergency protective custody process has increasingly been used by mental health professionals and others as the defacto gateway into mental health treatment. Sometimes it's hard to understand where the emergency is when the patient is already hospitalized voluntarily, or under the care of a group home providing services and supposedly staffed with mental health professionals. That is probably why only a small percentage of the mental health investigations resulted in an EPC certificate.

At any rate, we do what needs to be done to protect patients and the public. My point is simply that the police have become the gateway and provider for lots and lots of issues. Crime is just a small part of what we are called upon to deal with.

Anonymous said...

I would have to agree that Mike Muff is one of the best of LPDs best.

Anonymous said...

Are suicide attempts or expressed suicidal desires (meaning someone calls LPD and reports that a friend, acquaintance, etc says they want to hurt or kill themselves) that result in an LPD dispatch counted as mental health investigations?

Tom Casady said...

4:02 -

Yes, 335 of those are included.

Anonymous said...

That officer Muff is a fine young man, when I was a young man and my back was feeling a little pinchy, he once helped me carry my groceries out to the car. I see he still helps people, even now that he is an officer of the law.

Anonymous said...

I agree with the other posters, I also am a big fan of Muff, always have been! It's good to read about it this sort of thing once in a while.