A new mental health triage center in Kansas City is struggling to meet a pressing need: aiding people in severe mental distress whom police in the past too often delivered to the county jail or the nearest hospital emergency room — usually bad choices.
Walkie talkies interrupt. Smartphones buzz with calls.
The women working at Kansas City's 3-month-old mental illness crisis center have too many desperate lines in the water for there to be any pause in the action — even during a staff meeting.
Beyond frosted windows, six people lie in beds or wander about the center's mental illness ward. Five more slump in various states of recovery in the alcohol detox ward. All of them have to be stabilized and out of here, sent somewhere, within 23 hours of their arrival.
So goes another morning at the new Kansas City Assessment and Triage Center, The Kansas City Star reported (http://bit.ly/2jNviIZ ).
The center is struggling to meet a pressing need: aiding people in severe mental distress whom police in the past too often delivered to the county jail or the nearest hospital emergency room — usually bad choices.
Several forces, marshaling $3 million annually, united to create the crisis center to ease the strain on the community and the police.
The first two months of operation have brought 328 referrals including 245 unduplicated patients to the center, and it is preparing to serve more — an effort welcomed by the police who understand this work is hard.
"It's not perfect," said Sgt. Sean Hess, head of the Kansas City police crisis intervention team, "but it is 100 percent better than what we had, which was nothing."
The Star went inside to see the work up close. Here they are, the day shift, in its latest hasty debriefing, facing their biggest problem: figuring out what to do with their wards once they are stabilized.
One of the people on their list needs more intensive care, but a hospital won't take him, says nurse practitioner Theresa Mueller.
Another had been at a group home, case manager Kelly Phillips says, but he got in a fight with another resident over money "and — boom — they don't want him back."
What about the gun owner with suicide plans? They're trying to talk with family about sweeping out any firearms. They're trying to get the patient's cooperation.
Team leader Lily Pavone warns the group, "I just talked to him, and he is denying it all."
Then Phillips, just off her phone, alerts the team. Police are moments away with the next latest arrival. Incoming.
"And he's severely intoxicated," she says. "Severely."
Pavone leans away from the conversation to take a call. Yes, there is a woman ready to be discharged, she tells the caller, "and if someone from your agency could come pick her up, she's OK with that."
The agency person on the phone apparently is somewhat uninformed.
"We're the new crisis center," Pavone answers chipperly. "We're at 2600 E. 12th St. We'd be happy to show you around."
This has been a group effort.
The attorney general's office leveraged funds from the sale of two area hospitals. Nine area hospitals are providing operating funds because they hope to ease the strain on their emergency rooms. And the state, at the direction of former Gov. Jay Nixon, budgeted an additional $2.5 million for follow-up care to help the center break the brutal cycle that lands many people with mental illness back in police cars over and over again.
"These folks have been very sick," said Kansas City Municipal Court Judge Joseph Locascio, who championed the push for the center. "Some are not ready to be discharged even at the 23-hour limit," he said by email. "We are finding that, since these folks need lots of coordination of care, we are running short on case managers to do the work necessary."
They are getting people into services, he said, and the numbers will grow as the center ramps up.
The center can serve up to 18 patients at a time. The biggest concern, as it gets closer to filling more often, is being able to effectively deliver patients to ready services. They've reached out as far as Harrisonville to find help.
"We're in a quandary," said program manager Stephanie Boyer of ReDiscover, which operates the center. When it comes to finding services to help stabilize patients who leave the center, she said, "I am opposed to using homeless shelters."
The police arrive out front now with the intoxicated man with mental illness, and the team inside fears this might not work out. The man seems stuck inside the police van.
"If the police can't get him out," Phillips says, "we're not taking him."
The alternative would be an emergency room, most likely at Truman Medical Center, the closest one that is equipped to secure and restrain disruptive or potentially violent cases.
Truman's chairman of emergency services, Matt Gratton, worried that the opening of the crisis center might actually increase the number of mental illness cases arriving at Truman's emergency room.
Police would be taking people from all over the city to the crisis center, and when some proved too difficult to handle, Truman would be the closest alternative.
But the early results are encouraging, Gratton said. In the first two months of operation, the center sent only 15 on to Truman, he said.
"I expected more."
In that same time, the center reported that police delivered to the crisis center roughly one patient a day — about 60 — who otherwise would have gone to Truman's ER.
After a struggle, the two police officers have walked the intoxicated man into the center, and the staff has settled him into a wheelchair. The center will be able to take him after all.
The officers share their dilemma. The man was not wanted back at the hospital, and the jail wouldn't take him, they say.
Pavone takes the police officers for a quick look at the wards where they treat their patients. The rooms are quiet. The people rest in beds without dividers between them.
"This is what it looks like," she tells them. "I don't have security. I don't want him to start a fight."
The patient has been here before. This time, if it goes better, they'll be able to guide him to a residential treatment program, get him in recovery. But there is also a good chance, once he sobers, he'll simply walk out like he did before. They can't hold anyone involuntarily.
If necessary, they will notify the Police Department's crisis intervention team officers when someone with a severe health risk walks off.
Ultimately, Locascio said, the center's success will depend heavily on partnerships that add more housing — including drafted plans for some renovated apartments, and using vacant Land Bank property to build cottage housing.
The center also relies heavily on the state-budgeted funds — more than $2 million — to support case managers and the follow-up care they can find. It's funding they will have to ask for again from a new state legislature and a new governor.
Right now, with scarce public hospital options, those funds are useful as they call on a private hospital to take on the aftercare of a couple of patients who have no health insurance.
"Tell them we'll pay," Boyer said to Pavone, who is on the phone with the hospital. "We'll pay."
It gets them through their list, at least for now.
"Tomorrow," Pavone says, "we'll have a whole new list."