Take Note: Patricia Best & Leslie Laing On Improving Mental Health Crisis Services In Centre County
A task force spent a year looking at mental health crisis services in State College and Centre County. Members of the task force Patricia Best and Leslie Laing talked with WPSU about the current state of those services, the challenges service providers face and the recommended changes for reform. Here's their conversation.
Min Xian: Welcome to Take Note on WPSU. I’m Min Xian.
The fatal police shooting of Osaze Osagie in State College nearly two years ago prompted community discussion about mental health services, race relations and policing.
The Borough of State College and Centre County teamed up to create a Task Force on Mental Health Crisis Services. Thirty-two members representing local government, healthcare and law enforcement spent most of last year assessing the current system and recommended changes in a report.
Patricia Best is the chair of the task force and a former superintendent of the State College Area School District. Leslie Laing is a member of the task force as well as a community activist with the 3/20 Coalition, a group which formed in the wake of the killing of Osaze Osagie.
Patricia and Leslie, welcome to Take Note.
Patricia Best: It’s good to see you, Min.
Leslie Laing: Thank you.
Min Xian: Patricia, you and I talked in March 2020, when the task force was beginning its work to map out the different pathways of how crisis services are delivered, from when a contact is first made to when someone in need is given a treatment plan. And that was the first task. Why was that important?
Patricia Best: One of the essential parts of the charge, and at that time, Min, you and I also talked about the charge to the committee, which was really very specific. It was to look for the strengths of but also enhancements to the mental health crisis system in Centre County. In order to do that, we had to know what the continuum of services looked like from the view of the consumer, the person in need of help and in need of service. And so as with any complex entity, it was really very useful to take it from the view of the person from the point of entry to the system, as they walked through.
There are a couple of essential items for that. One, we looked at that, from the point of that there's no wrong way to get into the system. And so we wanted to see that there were multiple pathways for a person trying to get from needing help to getting help. And the other part of that is, we wanted to see if there were gaps in the systems, we wanted to see whether the functions overlapped, we wanted to see where the transition points were, we wanted to look at outcomes at the other end. And most of all, we wanted to look at where the communication points were along the way.
So interestingly enough, what we thought was going to be a rather technical activity in terms of creating this continuum of services, a map for these four areas - And I'll mention the four areas. Because the mental health system is a very complex system, we were looking at one aspect of it, the mental health crisis response. And so that involved the Center for Community Resources. That was the first one, the secondary was a delegate service, the delegate is responsible for participation in the 302 processes, which are in fact, part of the regulations for involuntary warrant procedures. Law enforcement - In the law enforcement area, we have six municipal law enforcement entities, we also have the state police, we have the Center County Sheriff's Office, we have Penn State police, the prison system as well. And then of course, we have Mount Nittany and the emergency department. So those are the four entities that we were looking at in terms of putting the map together.
I should also mention just for people listening to our description, the map was not meant to be a map for someone who needs services to try to follow it. This is really for our task force to try to problem solve. It also was for elected officials who requested the report, and also stakeholders who then could look at it in terms of how can these individual services be improved and enhanced? How can the whole system as a whole then come together as well? So that's a bit of a lengthy answer to what should have been, I think most people thinking a very simple question about why did we start with a map, but the map truly formed a basis for our initial graphic representation of this system. And it truly then gave us a jumping off point for the next work of the task force as well.
Min Xian: Were there any things you learned about how the mental health crisis services are delivered that surprised you? Leslie?
Leslie Laing: Yes, as a community member, I was totally unaware that the police are always called for mental health. That didn't make sense to me. I think we have community resources, we have Can Help lines. We have all these people. And for some reason, my assumption was that a mental health specialist would be the first point of contact. So learning that that was not the case was a little disturbing to me. And the fact that there are laws governing that requires officers to attend to these very delicate situations armed, and I was not aware of that process. So that was startling to me.
Patricia Best: And it's an important point Leslie was making. One thing I did want to add to that, when we talked about no wrong entry, specifically has to do with 302s, if a person goes voluntarily or with a family member, they can go directly to the emergency department, there's not a police officer involved in every mental health crisis. But when there is a 302, that's the area where as Leslie was saying, quite correctly, that's where the regulations expect that that would happen. But there are other ways of entering the system.
Min Xian: And one of the things that jumped out to me reading the task force's final report was that there are many, many entrance points to getting care, like you have described, when someone is in the mental health crisis. And in that same vein, the pathways from crisis to care can look very different based on each person's unique circumstances. And my question for you, Patricia, is that what are the strengths and weaknesses that come with a structure like that?
Patricia Best: That's a very good way to put the question, because in some ways, and this can happen in general, sometimes your strengths can also be the flip side of, if you don't take advantage of them in a very useful, productive way, also a built-in weakness to the system. And one of the things that we did hear over and over was contacts with caring providers, people provided anecdotal information about that. And so that was a strength that people within the system are committed to providing good care, we want the system to support those good intentions.
I think another area was the new emergency department. It's not so new anymore recently, in the last few years, the changes in the emergency department, enlarging that and making it more private, for people experiencing a mental health emergency, having case managers 24/7, who are part of that entry through exit part as well.
So another one I should mention is the crisis intervention training, the consultant who worked with us cited that in his report that 97% of Center County officers have received that kind of training, that's one of the highest in the Commonwealth as well. Those were some of the strengths that we noticed. And again, each one of those lead into opportunities to build on those, and you find those very much in the recommendations.
Leslie Laing: I think those weaknesses, and they're the same as the barriers and like you said, Patricia, they sometimes are our strengths and our weaknesses, they're both the same.
When we think about the lack of funding, right? For mental health programming, our recruitment and retention of licensed mental health professionals is sometimes problematic, especially when we're seeking diversity in those fields. Thinking about the lack of cultural diversity among the providers, and even the distributors of the services.
We talked about some other weaknesses: our ability to collect data appropriately. We're not really collecting that data and using those stories and experiences of people even in our emergency room and how they navigate that when they go on their own. And we talked about the shortfall of what we can do when there are a shortage of inpatient beds, and people are forced to outpatient services. And there are gaps in how we're able to follow up on those cases, right, complicated by people who perhaps don't even realize that they need continued care. And they fall through the cracks in the system. So I think those are some gaps and weaknesses that we can work on.
Min Xian: In the final report that came out in November. The taskforce formulated 11 system wide recommendations for change, eight separate recommendations for specific agencies and two recommendations for implementation of the report. And the report made a point that there's no hierarchy among them, they are all interconnected, because so many different partners are involved. Leslie, can you talk about this idea of reforming the entire ecosystem holistically and, and maybe share an example of how the recommendation may achieve that in a way that is lifting all boats?
Leslie Laing: Well, lifting all boats is indeed our desire. When we think that there are six different municipality police departments, there's a sheriff's department, there's the state police, there's the correctional facility, there are hospitals, there are independent services, it seems almost insurmountable when we think that we could only come up with 21 recommendations. No, it was really just 21 recommendations that we could agree upon. So floating the boat holistically is really going to take us quite an effort, right?
We want to see a co-responder model. And we are quite distraught and frustrated that we don't have one yet. Because there has been a model here using sexual assault and victims’ rights for years. And when we knew that we needed specialists to go out on those calls, we got it. So even internally, having people recognize what's already in existence that we might model as a best practice, would move us in a holistic lifting of that boat, if we could just get on board.
We need to change those things, even in the way we communicate with one another in the crisis coordination for our services, in the standardized protocols that we have even the existing Mental Health Procedures Act, we need to think about how that affects people with mental illness and disabilities and learning disabilities and all kinds of things.
And until we can start looking at that holistically, I feel like I don't have a solution to say what that answer looks like. I do know that we started valiantly with 21 recommendations. And Patricia and I stayed up very late, many nights deciding how could we get them to agree that implementation was mandatory, it's not optional. And that's really hard when it's out of our hands, right? We're looking at a borrower, we're looking at a county, and then we're looking at agencies within there. But like Patricia said, we had many people on board, who were in agreement that these efforts need to be made. And so I think they are going to move forward, as evidenced by the most recent February meeting, that we have advocacy and partners and groups that are coming up to help us do this work.
Patricia Best: Our whole focus in this taskforce from the very beginning was an actionable report - actionable. And so we didn't include any recommendation that we did not believe was possible. So this really was a report meant to put it into the hands of people who could make the decisions, secure the resources, had held the responsibility for putting these things in place, but would not be out of their reach in order of these different responsibilities of these different areas of government. So yeah, we not only hope, we do expect, because we wanted to give them something that could definitely be acted upon, and was within the realm of possibility. So, always the optimist right, Leslie?
Leslie Laing: Always. We really did try when we think about those recommendations. We were calling for family involvement. I mean, how about that as one of our recommendations, right? I think that's like number two, we want mental health planning more holistically and to take into more consideration. When we talk about, I think you said cross agency training, right? We discovered that we need cross cultural training for our police officers, we need more de escalation training for our officers. We made those recommendations and there in that report.
Patricia Best: There really were six themes. And that is what tied all of this together, and the care and cultural responsiveness were at the base of what we did. So what you will find embedded in every one of those recommendations goes back to those two things, in terms of all care to all people who need it when they're in a mental health crisis. And it doesn't mean that it's that you do the same to everybody. It's that you do what that person needs for their particular situation and circumstances and for their own cultural sensitivity and backgrounds.
So the coordination, we talked about enhanced coordination of services, we wanted to help increase the efficiency and effectiveness of delivery. Here's a specific example. I think that almost everyone who's ever worked with any kind of a health crisis or a mental health crisis - a basic common form for the family or the initiator to provide information that follows them through the process, from one provider to the next provider to the next provider, so that they aren't constantly repeating and also that there's a consistency then, for the providers in the reports that they have one person is not acting on something that the next person doesn't have information about in that situation.
So something as simple and basic, what seems as simple and basic as that, is embedded in some of these recommendations. So that's why when we emphasize how actionable these are, they really are some things that go from very basic in terms of process and procedures, to things that are much more complex like co-responder models across the whole county system. That gives you a picture of the gamut that we ran in these recommendations from some things that really are very specific to some things that really are going to be as Leslie was describing, lift the whole boat kinds of things if we're able to do them.
Min Xian: This is Take Note on WPSU. If you're just joining us, we're talking with Patricia Best and Leslie Laing, members of the State College/Center County Task Force on mental health crisis services. The task force published its final report in November and gave recommendations on better serving those in need.
There is a lot of tension when it comes to the discussion of serving an involuntary mental health assessment, also known as a 302 warrant, as we have discussed. It is a tool meant for families and friends of those in mental health crises to seek help on their behalf. And it involves getting the police to respond to crisis situations, which is currently mandated by law. Patricia, can you talk about how the process is meant to work? And what are the challenges in the current system?
Patricia Best: The 302 process is part of the Mental Health Procedures Act in Pennsylvania. And it describes the process for gaining treatment for somebody who is resisting treatment. And as you said, an involuntary process. It involves a petitioning process, which is part of what the delegate services for, there's a second process then about delivering a warrant for the person because you are taking them then into a treatment situation. And in this case, most often it would be to Mount Nittany, to the emergency department. The other part of the 302, then is for a physician to examine the person requiring treatment and indicate whether or not they meet the criteria for involuntary commitment to receive treatment.
It's a very serious thing to go through an involuntary commitment for someone. And so there are specific criteria. The most basic criteria is a danger to themselves or to others. There are other parts of the criteria that talk about inability to function to self care, to manage life processes and in care for yourself.
There's disagreement around how different practitioners apply the laws to different people, some person might qualify when one practitioner examines them; another person, not, under the same criteria. And in the current language, it's very specific about there are 30 day timelines that must have been demonstrated this threat or the realistic of threat within a 30 day timeline, there must have been an evidence of accessibility to a weapon in a way to further the danger.
And so we're saying these are areas to examine, and to take a look and see if there's not a better way in view of modern methods of treatment, and much more sense about how to provide service to people in mental health crises. So that was a rather long answer. But it's a complicated situation. So three parts to the 302s, based upon the involuntary commitment process, engagement of a delegate through mental health services, generally, could be law enforcement, if a 911 call’s involved and often will go through law enforcement but still has to go through the mental health petitioning process before that, and then eventually to an emergency room and a physician certification.
Min Xian: And how does the co-responder model factor in this complicated process?
Patricia Best: We are very enthused about the co-responder model. And we've looked at a number of best practices around the country and thought, yes, absolutely, this is something we should look at. As Leslie mentioned earlier, it's not that we haven't had had models of treatment and response that are co-responders. Anytime you put two providers together with different backgrounds and strengths and skills, you have a co responder model.
What we're looking at now where things have progressed because of the emergence of the responsibilities being shifted to law enforcement in so many communities to respond to mental health crises, resulting in sometimes tragedy and tragic outcomes. For that, we are beginning to look at other ways of co-responder models. So what we've included in our recommendation had two options basically to take a look at some co-responder models set up a mental health response team or behavioral health response team that consists of a law enforcement person, and then also a mental health person. That's one kind of model and a number of communities have that. Another kind of model is where the CO responders might be a mental health professional, and also a clinical professional. And it may or may not be at the level of a psychologist, it may be a sociologist, a social worker, or somebody at that level, that can then make an initial assessment to try to get the person help.
So we are suggesting examining and for Centre County, for our region, what can be done to use a co-responder model that would add to enhance what we already have. And then we'll provide an extra resource for law enforcement and for mental health as well.
Min Xian: And the task force, the report calls for a standardization of the 302 process, which I think mostly involves a lot of the elements that you were talking about, Patricia, while we know there are some advocates who say that police should not be serving these warrants, period. Leslie, I want to hear your thoughts about those arguments. Of course, knowing that we in Pennsylvania right now is very much mandated by law to do these activities with police presence. But I guess, in general, what do you make of those arguments?
Leslie Laing: Min. That's a loaded question. We had eight organizations and several community members that formed the 3/20 coalition. And we are very much in favor of creating a countywide co-responder model that we spoke about passionately. And we like the idea of having civilian mental health response teams too. We like the idea of having mental health professionals do trauma care, before there's crisis, and offer the services.
We are most passionate about calling for the removal of guns from the service of the warrants. Officers still have a variety of tools on their belt. And they can have options. And even if they're legally bound to respond to these calls, they don't have to serve the call with their guns strapped on. And I'd like them to consider that. I'd like them to talk about what's difficult about that for them. I think the community is waiting to hear why they think they can't do it when there are models across the country that do it and serve those warrants without guns. We know the system is overburdened and we appreciate the roles that they do provide. But let mental health specialists do the work that they're supposed to do, allow them to be crisis workers to be called for them to respond. Hire them if they don't exist, we have several. We know we're strapped but there are several crisis workers and mental health specialists who are interested in this work in forming the co-responding model. And yet, our borough and counties have not outreached to find out who they would be and be willing to serve in that capacity and so I’m frustrated by that. I'm sure there are others that would agree.
I think the transportation plan we mentioned before many people who are being transported don't want to go in handcuffs in a police car to the hospital and then have an officer sit in a waiting room publicly with them while they're in distress. These are compassionate things that can be done now, they don't require a lot to change them. And we need people to step up and to be willing to sit at the table and think about those solutions that we can implement until we can change the laws.
We're excited, Patricia and I to hear that they want to implement an ad hoc committee, and that both the borough and the community and the county are willing to have mental health task force members reconvene in order to hold them accountable, and to keep the community abreast of the progress that's being made. And so we look forward to the assigned agencies that Patricia and I can both meet with in the future, in order to have these discussions and progress, make some progress in our community.
Min Xian: Many of the gaps and challenges documented by the task force were not necessarily unique to this community. lack of funding we've discussed resources and personnel is a statewide, even nationwide problem. Having been part of the task force, what kind of wider scope of work do you believe should be done to improve services for mental health crisis overall? Patricia?
Patricia Best: I think probably if we look at the very broadest part of this in terms of the nation, we are, we have been struggling with health care in general, for - we're going on decades now. And we haven't solved this problem. And I think when we look at the support for mental health and mental health crises within the healthcare system, it's especially something that is way underserved, and has just got to be remedied. And so that is something that I hope that we can have more of a groundswell and more recognition that there needs to be support. Everyone needs to have access to this.
One of the documents that we referenced with our task force was a best practices toolkit. And I mentioned this in this conversation, because it was produced by one of the administrative services in one of the federal departments. And what they say in the very first paragraph is, mental health services are for anyone who needs it anytime they need it anywhere they need it. Well, that - Yeah, we aspire to that. But that's not what's happening nationwide. And that's what we're working on locally. You know, it's like think globally, act locally. It's a little bit where we are right now. But yes, so I think the health care and the mental health care is certainly something that we need to look at.
The other issue about diversity and equity and inclusion. You know, as Leslie said, in terms of the nation, yes, we have come far. But we have so much further to go. And the same thing locally we have, we have people who have been working on this for decades in the community. And we have those who are ready to take it further and want to see this happen as well. So those are just two examples. I think in terms of your question about the broader national impact of this that we also see the ramifications of locally.
Leslie Laing: I think Patricia summed it up nicely. I think there's a quote because she's always giving us those, you know, as the best practice, our superintendent and our wonderful educator. Margaret Wheatley says, ask what's possible, not what's wrong. And I think that's really the answer, right, to thinking globally and acting locally. What we do every day has an impact. How we show up every day makes an impact what we're able to accomplish, we'll make the impact. And we have to stay the course, stop asking what's wrong, ask what's possible, and do that.
Patricia Best: That's so good. Leslie, the last part of that was, keep asking. That's a good one.
Leslie Laing: You know, that's my philosophy. I keep asking.
Patricia Best: Absolutely.
Leslie Laing: And it keeps showing up.
Min Xian: Patricia Best and Leslie Laing, thank you so much for joining us on Take Note.
Patricia Best: Our pleasure.
Leslie Laing: Thank you, Min.
Min Xian: Patricia Best and Leslie Laing are members of the State College/Centre County Task Force on Mental Health Crisis Services. The Task Force published its final report in November and gave recommendations on better serving those in need.
You can listen to more Take Note interviews on wpsu.org/takenote. I’m Min Xian, WPSU.