It wasn’t until Carson City Deputy Nick Pinochi went through the Crisis Intervention Training that he began to understand, for the first time in his 15 years in law enforcement, what individuals with mental illness deal with on a daily basis.
During one of the officers’ trainings, they had a device that allowed the officers to see and hear what it was like to live as a person with schizophrenia.
“You see what they see and hear the voices they hear,” Pinochi said. “Even for a person with no mental illness you can’t even hardly focus because there’s so much going on. When they say that is their problem that they are hearing voices that are telling them to do things, bad things, you don’t understand it until you go through it. Once you actually go through that and see the visual and audio effects of what their mind is telling them, it’s like holy cow, how can I help you, what is going on? What do we need to do?”
By helping provide treatment resources to the individuals they deal with, the Sheriff’s Office has reduced the number of repeat offenders with mental illness, which has been better for both the department and the community.
“It isn’t a waste of time as long as you are helping someone to get a healthy life. Even if you are spending a lot of time with them, say a month or two, if that is what it took for you to get them help and never have to deal with them for the rest of their life, that is a plus, not a negative factor in the long run,” Pinochi said.
The recent response to mental health has been this idea of a more collaborated, improved response to spend more time treating the root of the problem instead of fixing the surface level problems with a mental health crisis.
The community partners now hold several different meetings per year to discuss specific plans for mental health individuals who are constantly utilizing services, what steps need to be taken to improve mental health response, and how best to serve the mental health community so that people don’t get dropped from the system before services can be utilized and they can be stabilized.
“We all do our jobs really well, but without us creating continuity between each service, people drop off before the next service can take hold,” Carson Tahoe Regional Behavioral Health Coordinator Jessica Flood said. “So it’s really about working to create smooth transitions from service to service. And sometimes it takes coordinated plans.”
“It takes time to change communities. So all the leaders of this region are super motivated. People are kind of on fire about this, in the good way.”
The Carson City Sheriff’s Office has enacted a program for its deputies to help respond to calls for service involving mentally ill subjects.
The Crisis Intervention Training is a 40-hour training for law enforcement and social services in the community in November to both introduce participants in the available resources, what mental health looks like and to hopefully reduce the negative stigma surrounding the issue.
“We have really started to see a great collaboration between the community resources and officers because it has helped them become more aware,” said Carson City CIT Sgt. Craig Lowe. “The whole program is for our officers to be more mindful for opportunities to help people beyond what we are dispatched for… we have to be able to go beyond traditional enforcement capacity to help with resources for the individual or family.”
Throughout the training, the participants learn about the basics of mental health, where they can refer people to while on duty, and even hear from individuals with mental illnesses and their interactions with police as a learning tool so everyone knows how to better handle interactions during mental health crisis.
“We want the deputies to understand that when you get there in those circumstances, you need to take your time,” Lowe said. “…But we also need them to know that just because they have a mental illness doesn’t give them an automatic pass (from jail).”
“But I am so proud of this community and proud of the men and women at social services who work closely with us. None of this would be possible without the relentless efforts of (Carson City Forensic Program Manager) Bekah Bock and Jessica Flood and having a community that enjoys a strong collaboration approach to mental health.”
So far more than half of the department has been certified in CIT, as well as most of dispatch, which Lowe said is an integral part of mental health response for the officers.
“If we can have our dispatchers trained, then they can be on the phone with the individual and start that de-escalation process and that reshapes our encounter on scene,” Lowe said.
Lowe and Bock have also helped roll out CIT programs in Churchill and Douglas County Sheriff’s Offices as well.
“It has been a very positive response,” Lowe said. “And so far this regional concept has been successful.”
The Mobile Outreach Safety Team is a program with the Carson City Sheriff’s Office designed to address responses to psychiatric emergencies and act as a resource to mentally ill individuals.
Patrol deputies, who are certified in Crisis Intervention, ride with Bock, a clinical social worker, conducting outreach and proactive work for mentally ill individuals, follow-up on frequent calls for service and coordinate long-term services for high intensity individuals.
“MOST was started so that deputies could go out and offer resources to people suffering from a mental illness to prevent them from going to jail (unless necessary) and reduce the number of mentally ill individuals calling 911 for non-emergencies,” said MOST Deputy Israel Loyola.
MOST is utilized in a number of surrounding counties including Reno, Douglas and Lyon counties law enforcement agencies.
“It has been really interesting because each program is pretty adaptable so each county has said ‘we want these solutions, but our needs are different from other counties’ so they really have to define their unique way of implementing those programs. It has been really interesting and rewarding to watch each county implement these programs and develop their own system,” said Flood.
The goal of MOST is to intervene with an individual in crisis before psychiatric hospitalization or incarceration and to help stabilize the person in crisis. This in turn also helps reduce the calls for service and utilization of emergency services for local first responders.
“The issue we face is that a lot of individuals don’t think their mental health is a problem because they think their perception is real,” Loyola said. “They think we are the ones who are crazy so you have to be able to talk to them very carefully so that they don’t shut down and you can get them help.”
The Forensic Assessment Services Triage Team is a service for incarcerated inmates to help create a treatment plan and execution both inside and outside the jail walls.
The program began four years ago after community officials saw a gap in services for mentally ill inmates once they were released from jail. Mental health community providers were discovering that once inmates were released from jail, less than 3 percent were following through with appointments, medications and other treatment plans.
“We decided to invite the community of providers who will come into the jail immediately and help create a treatment plan for their departure,” said Dr. Joseph McEllistrem, architect behind the FASTT program. “…We wanted to immediately identify with their mental health needs and come up with a treatment plan to work with the agencies to implement them in the community when the inmate left.”
Every inmate that comes through booking in the jail receives a FASTT referral form, and if completed they meet with a panel of representatives from Carson Rural Clinics, Ron Wood Family Resource Center and Carson Community Counseling will meet with individuals to discuss and start their treatment plans inside the jail as well as meet with them once there are back on the streets. McEllistrem said the purpose is for the inmate to have a familiar face once outside, which will increase their chances in continuing the treatment once on the outside.
“It is a good continuity of care,” McEllistrem said. “…We had to figure out how do we find a way to react quickly yet thoroughly to the need and implement a practice to get them from the jail to the doors of a treatment facility when they depart. We have to work on minding the gap; the gap when they leave the jail and the gap of time between that and their first appointment.”
While inside the jail, the inmates’ treatment plan can include group therapy; individual therapy; addiction; functional, practical and pragmatic needs.
MENTAL HEALTH COURT
One of the first pioneers for mental health treatment programs in Carson City was the Mental Health Court.
Justice Court Judge John Tatro established the Carson City Mental Health Court in 2005. He saw a need in the community to help repeat offenders, who would create strain on the judicial system, the jails and the families.
“The thing that told me we needed it was all the repeat offenders, some people you don’t realize they have mental illness and lots of people you do realize, but what can we do?” Tatro said. “They would end up sitting in jail again and again and again, especially with like the trespassing charges or disorderly conduct. Their life was just total chaos, their family’s lives were…just constantly in big turmoil and it’s just constantly a stress on everybody. So this helps.”
The specialty court is designed to provide supervised comprehensive diagnostic and treatment program for untreated or undiagnosed mental illness that contributes to an individual’s criminal conduct. The program acts as a diversionary tactic to provide treatment instead of incarceration for certain mentally ill individuals.
“It effects the whole community because, for example; if you have someone who is mentally ill renting an apartment and they go unstable, it effects everyone around them in their apartment complex, it effects their family, the effect just grows and grows and grows and I think it has a huge impact on our community,” Tatro said. “And it cuts down on emergency room visits, it cuts down on Behavioral Health Services when people go into crisis and have to go in there for seven days or whatever and get stabilized.”
The program utilizes a multitude of agencies to assess and provide treatment plans and follow-up for individuals. Tatro, along with agency participants from the District and Justice Courts, Carson Rural Clinics, Douglas Counseling and Supportive Services, a psychologist, the Public Defender’s Office, the District Attorney’s Office, Department of Alternative Sentencing, the Sheriff’s Office and Division of Parole and Probation meet weekly to discuss the program participants.
Mental Health participants are referred by jail deputies or attorneys, and are then evaluated to see if they fit the criteria for Mental Health Court. The program is a minimum of a year long, and participants are required to attend weekly check-ins each Wednesday at the courthouse with the agency participants, attend three hour intensive outpatient counseling sessions three times a week, attend a dual-diagnosis group once a week and sometimes a trauma seeking safety group.
They have a strict guideline they need to follow while in the program including drug testing, strict attendance requirements and strict medication regimes. Participants can either be rewarded for good progress or sanctioned for violations—which could include increased testing, counseling or jail. If participants are following the program, they can also fail out.
Each week, the agency participants host a roundtable discussion before Mental Health Court to talk about new possible clients and treatment progress of existing clients. Then all of the Mental Health participants meet with the agencies to each talk about how their weeks have been going and what the participant needs to do for the following week. The hope of a multiagency participation is to be able to help the client before they digress into another mental health episode or criminal activity.
“The great thing about it is, its like ‘oops they are slipping a bit,’ and we will catch it right then as opposed to waiting until they have another episode and they get arrested and it starts over again,” Tatro said. “We are trying, that’s the great thing to the team approach.”
The program is funded through the state, which provides Carson Rural Clinics with $100,000 a year to cover the cost of the clients’ counseling. They also get a part of a $50,000 fund from the Supreme Court for specialty court funding that provides drug testing or additional money for the courts to use toward motel costs for when a client gets out of jail.
Tatro said that running this program is one of his favorite parts of his job.
“It’s why we all love it, we have seen so many people (get better and live happier lives) and it makes you feel good,” Tatro said.
Many of the participants were grateful for the program; excited to talk with Tatro and discuss the good things they did and thankful for the opportunity to get help.
“It has been wonderful because it gives you the tools to live a clean and sober life and it has been over a decade since I have been able to do that,” said Connie Kelly, one of the participants in the Mental Health Court.
She said that while the program was difficult at first, it was for the best.
“I feel worthy of myself again and I feel part of my community again, and that is huge for me,” Kelly said. “…You feel like you are working your way back into the community and into society and they give you the tools to do so and it’s awesome.”
“I haven’t wanted to give up because you start to feel so good about yourself and you want that to continue. You learn to handle your triggers and there are tools you learn to cope with those encounters and it’s just amazing.”
Kelly is half way through the program, after decades of time spent in prison and jail for drug, shoplifting and fraud charges that all stem back to her mental illness. She said that without the intensive programming, she probably would have relapsed again and not have been able to go back to being clean.
“It has saved my life,” Kelly said. “I’m just glad it happened.”
Recently, the Carson City Juvenile Justice System has implemented a new program to address mental illness for youths in the community.
Officials agree that one of the biggest gaps in mental health treatment is treatment for youths—one in 10 youth suffer from mental illness — so Juvenile Services created the Juvenile Justice Assessment Triage Team in August 2016 to attempt to try to divert juveniles struggling with mental health out of the juvenile justice system when possible.
“We try to keep them off of probation and divert the youth to the best of our ability,” said Chief of Juvenile Services Ali Banister. “Most mental health youth do not fit the criteria to be placed in juvenile corrections because they need treatment options.”
The child is paired with a juvenile probation officer as well as a mental health clinician from Carson Counseling and Supportive Services to meet and work with them to create a probation diversion track focused on treatment of the illness.
“The majority of youth under 18 will benefit from treatment, counseling and community based programming, especially youth suffering from a mental health diagnosis,” Banister said. “Placing youth in a secure detention facility isn’t the solution. They need a clinician or therapist to help implement changes.”
Nationally, it is estimated that 85 percent of kids have experienced trauma, which is a strong factor in the development of mental health and/or substance abuse problems for children.
“That trauma can be all the way from sexual assault or domestic violence to being bullied at school or a bad divorce,” Banister said. “But we don’t know what that is until we sit down and have a conversation with the kid. Trauma can impact a kid in one way or another depending on that kid, but we need to make sure we are assessing them and seeing how it impacts that kid before they get deeper into the system.”
The program is a six-month contract with the clinician and probation officer where the child will set up a treatment plan for meeting with both entities to make sure they are progressing positively. JJASTT has had 18 referrals since August-- with six graduations and nine currently in the program. Three students were unable to complete the program due to the necessity of a higher level of supervision.
“If all the terms of the treatment plan are met and they are progressing with therapy they will graduate, and our hope is that they will continue therapy even when it isn’t overseen,” said Linda Lawlor, chief deputy of juvenile services. “…Sometimes the family doesn’t know what services are out there so we can help connect them with those services.”
Youth are referred to the JJASTT program by juvenile services. Juvenile services also receive referrals from the Carson City Sheriff’s Office arrest and referral process. Lawlor will get the arrest reports and see if there is any indication that the child could benefit from treatment rather than detention. Banister said that it is nice to have those partnerships with the community to help their children instead of just putting them into detention.
“This program is beneficial to our community and youth in several ways,” Banister said. “Most important, juvenile services doesn’t want to place youth on probation that don’t meet the criteria. If we can divert them and keep them out of detention we can hopefully avoid long-term incarceration. This way, we can better serve the youth and families in Carson City.”
“It is important to understand that certain youth do not belong in the corrections system. If a youth has a mental health diagnosis we can work with them and get them the necessary help.”
Carson Tahoe MALLORY CRISIS CENTER
In response to the ever growing mental health population winding up in jails and emergency rooms, the Carson Tahoe Behavioral Health Services created the Carson Tahoe Mallory Crisis Center to house and treat individuals in a mental health crisis.
The Mallory Center, located at the BHS campus, is a chemical abuse and psychiatric treatment facility designed to assist those in immediate crisis. The idea for the facility came about years ago in talks between Carson’s Sheriff, City Manager and the state.
“We wanted to try to open a unit to serve people in crisis instead of going to the jail or emergency room, which isn’t always a good place for a person who is suicidal or in crisis or detoxing,” said Christina Sapien, director of Carson Tahoe Behavioral Health Services.
The center houses 10 beds and has served nearly 500 patients since its opening in January.
In addition to helping patients receive the proper treatment, the Mallory Center also helps alleviate the amount of time a psychiatric or chemical dependant patient spends in the emergency room at Carson Tahoe Hospital, thus clearing room for those in the community members that need the ER beds.
“This allows the ER to treat people who come in for real ER issues instead of psychiatric care or chemical dependance,” said Marlo Conroy, nurse manager with Carson Tahoe Behavioral Health Services.
Conroy said that often times, the psychiatric patients would take up almost 11 of the 18 emergency room beds. In 2016, the Carson Tahoe emergency room had 11,271 total hours of psychiatric care, averaging about 939.25 hours a month. Now, since the start of 2017, they have only had a total of 625 hours of psychiatric boarding total, averaging about 156,25 hours per month. They were also able to reduce the amount of time a patient is in care, from averaging about 54 hours before release for alternative treatment options or home, to just about 23 hours with the Mallory Center.
Patients come into the center via referral from the Sheriff’s Office, EMS, social workers or nurses or can come on their own accord. They have taken referrals from Winnemucca, Tahoe, Douglas and Lyon counties as well as Carson City. Sapien said they have had referrals come in daily from first responders.
Once at Mallory, patients will be evaluated by a nurse, assessment counselor or social worker and are started immediately on treatment. They are then admitted to the hospital and see one of their three psychiatrists as well as a nurse practitioner or doctor to make sure they are medically stable.
The Mallory Center is the first of its kind in Nevada because of the fact that instead of being just a holding area until individuals are out of crisis, they are able to provide immediate treatment to patients and are able to treat Legal 2000 holds for individuals who may be a harm to themselves or others or can’t take care of themselves. Sapien said they don’t consider the facility to be a holding unit.
“We are lucky in this area that it is a topic that people are willing to meet and work on these solutions and that is exactly what this was because (jail and the ER) aren’t the place to put people who are already in crisis, it doesn’t address the issue,” Sapien said. “...this fills a need.”
Some resources in Northern Nevada also make sure to focus on the family as well as the individual with mental health.
The National Alliance for Mental Illness is a volunteer based organization that provides classes, tools and resources for individuals and families deal with mental health. The Northern Nevada affiliate covers northern and central Nevada.
“NAMI is a support system for individuals with mental health and their families and is a place to go with no stigma where there is lots of understanding,” said NAMI education coordinator Linda Porzig.
“Including the family is an integral part because the individual isn’t going to make it without their family,” said NAMI president Sarah Adler. “So a piece of our mission is to educate to destigmatize mental illness because it is just a brain disease and it isn’t anyone’s fault.”
The organization tries to get into the rural communities to help with those who may not have as much access to resources. They offer counseling and support classes, education classes and social opportunities to help as well as normalize living with mental health. Classes include family support groups, peer-to-peer classes, classes designed for military families and caregivers and basic programs for families living with juvenile or adult mental health individuals.
“NAMI is the biggest grassroots organization for mental health individuals and their families,” said Porzig. “We have a huge stigma around mental health so when we have social environments for them to be in, it is really welcoming to them…. People like our programs because they can come in and talk about their issues and won’t be judged. Where else can you go and talk where people understand?”
Porzig said they want to share with others that having a mental illness isn’t a the end of the world for the individual or their families. All of the volunteers with NAMI have mental illness in the family to provide a different perspective for their clients.
“We want to show how common mental illness is,” Porzig said. “It isn’t a death sentence, and people have this fatal view of it, so it is good to provide that safe place to go to for support and it helps for people to see that they have so much hope and even though they life they are living (with mental illness) may not be the one they pictured, it can still be a good life.”
NAMI also partners with the Nevada Suicide Prevention, military organizations and churches to try and help expand their resources to faith based individuals and veterans.
The organization is always looking for more volunteers to expand their services. For more information, visit namiwesternnevada.org.