Rescue Teams Send Out Private Help for the Public’s Pain : Mental Health: Three emergency response programs in Orange County respond to 911-type calls of a psychiatric nature. It’s community outreach, but it’s not operated by public agencies.

The 18-year-old cowered in the corner of a cot pushed against the wall of the school nurse’s office, playing with the silver rings on her fingers and thumb.

She looked dazed and listless, her gaunt face framed by long, brown hair.

“Did you eat today? Did you keep it down?” she was asked.

Aleen Hazelip, a member of a mental health emergency response team and a registered nurse who has worked in psychiatric units for 20 years, questioned the girl about her symptoms and desire for treatment.

In response to delicate prodding, the girl said in a barely audible voice that she had recently begun having flashbacks of molestation by her father and cousin. Over the past few months she had lost her appetite and sometimes went days without eating; she had only been sleeping one or two hours a night.

The school nurse had called for help from a mental health emergency response team after the student fainted at school and was taken to her office. The nurse said she had watched the girl deteriorate since August.

After a consultation with the school nurse, Hazelip arranged for the student to be checked for physical problems and referred her to a psychologist who could provide out-patient care, a course of treatment that would be covered by the girl’s insurance.

Hazelip’s visit to the Santa Ana high school was among hundreds of calls fielded each month by three mental health emergency response teams operating in Orange County.

The teams are something of a psychiatric 911, but they are operated as part of private community outreach programs rather than by public agencies.

The on-site evaluations--often made in an emergency room, at the site of a police crisis, in a school or at a business--are provided at no charge to the party requesting help. Team members are paid by the sponsoring private hospital or mental health center.

When a call for help comes, a team member drives to the psychiatric emergency, assesses the problem and determines a course of action--which might range from involuntary hospitalization to a referral to an out-patient counselor. While team members go to a many locations, they do not go to private homes because of safety concerns. They can arrange to meet someone at a hospital or other location.

The teams, which are on call 24 hours a day, are a mix of registered nurses, licensed social workers, marriage and family counselors and other mental health professionals. All are qualified to institute the involuntary hospitalization of a person who is gravely disabled or presents a danger to self or others. (By law, police officers and county-approved physicians or technicians are authorized to take away a person’s liberty for psychiatric evaluation for up to 72 hours.)

The largest of the three programs in the county is operated by Community Psychiatric Centers, which fields 700 to 1,000 calls a month. CPC has three hospitals in Orange County--in Santa Ana, Brea and Laguna Hills--and specializes in mental health and chemical dependency care. Patty Dennis is director of the 40-member Psychiatric Assessment and Triage team.

Also operating a psychiatric evaluation team is College Hospital Costa Mesa. The 12 members of the crisis response team field about 150 calls a month, according to program director Leslie Mills.

The newest team operating in the county, established last summer, is Crisis Care at Yorba Hills Hospital and Mental Health Center. Its seven team members handle about 50 calls a month, said program director Rob Renno.

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Determining the course of action in a crisis requires a balance of the patient’s level of need, willingness to get help and ability to pay for services, say the program directors.

Getting involved in providing free emergency evaluations has made sense for the hospitals in several ways. It allows them to make their services known to those who need them and can sometimes channel paying patients to the facility that employs the team member.

The program directors are all quick to point out that the response teams make referrals to a variety of mental health providers, not just their own facilities.

While some people in and out of the mental health field are concerned about the potential conflict of interest in having evaluations made by those with a vested interest in attracting patients, others say the teams are providing a much needed service in a time when public agencies are stretched to the limit.

“In general (conflict of interest) is not a problem, but there is a potential to be exploitative,” said Dr. Chuck Faltz, chair of the California Psychiatric Assn.’s Hospital Practices Committee. Faltz said that hospitals have suffered with the weak economy and are looking into every possible area to provide added income. The problem, he said, is that most people don’t think of hospitals as being for-profit, and it is important that hospitals make clear to patients the costs of service.

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Among those who regularly call on the response teams are law enforcement agencies.

La Palma Police Chief David Barr said his department uses the CPC response team about once a week and is grateful that his officers are relieved of the responsibility of making psychological evaluations.

“It’s a great service to us; we use them every chance we get,” Barr said. “I remember having to send officers to spend their entire shift at the (UCI Medical Center) trying to get someone into a 72-hour detention. It’s expensive, in terms of manpower, but there was nobody there but us.”

There is little question that balancing the cost of services with the level of an individual’s need can be difficult. With budget cuts in state and county mental health services, more people in need of psychological help are out on the street.

“The service is in answer to the community needing help with psychiatric patients,” said Renno of the Yorba Hills program. “Hospitals can justify the expense because it provides a service to the community, helps public image as well as fills beds. It gets the hospital known as a resource.”

Renno said his team members provide more referrals to other agencies than they bring in--fewer than 5% are admitted to Yorba Hills. And, out of fairness to patients, anyone to be hospitalized on an involuntary basis is provided two other choices, he said.

Mills of the College Hospital program says about 5% of the individuals seen by its response team are placed in their own hospital--about the same number referred for admittance to other hospitals. Most are referred to out-patient programs.

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Individual insurance policies and HMO restrictions often dictate where an individual will be sent for help, which may or may not be the team member’s employer.

Those without insurance are typically referred to treatment programs that accept patients on a sliding fee scale; those who are indigent are referred to publicly funded care.

CPC’s Dennis said team members often try to place patients with no insurance in the county mental health facility, which is usually full. But she stressed that the uninsured do get treatment. A person in a severe crisis--such as one who is suicidal--will be hospitalized until the danger is passed.

“We don’t boot people out on the street if we can’t place them elsewhere,” she said. “We stabilize them, then get them into out-patient treatment on a sliding (fee) scale. We follow up, and set them up with some sort of appropriate care. We don’t discharge them unless they are ready to be discharged.”

About one-third of calls its team responds to are hospitalized, said Gary Dunn, assistant vice president of community services at CPC, and half of those are uninsured. Ninety percent of the hospitalizations are involuntary, he said, and the average length of hospitalization is five days.

Each of the three psychiatric response team directors says success in handling difficult situations is what keeps the calls for help coming in--when law enforcement and health care workers see that a team has handled a call well, they are likely to call again.

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Day and time of calls are unpredictable, Dennis said, although more people tend to call “if there’s a full moon and the Santa Anas are blowing and it’s Christmas Eve.” She said calls from suicidal college students increase during spring final exams.

Although team members say the crisis work can be draining and frustrating, they also find it rewarding.

“We’ve had lots of calls from schools,” said Hazelip, the member of the CPC response team who answered the call for help from the Santa Ana high school nurse. “Junior highs, high schools--kids have depression, or are into drugs and alcohol. There is also a lot of incest . . . “

“There is help out there,” Hazelip said. “There’s the Orange County mental health system, private help and 12-step programs. I get frustrated with people who don’t want to help themselves.”

Hazelip is hopeful in the case of the student she has just seen.

“I feel there’s hope--I can direct her toward help, she doesn’t have to hold it in anymore. She can learn different coping mechanisms, so it’s not so overwhelming.”