For this episode of Community Conversations we spoke with Andrea Shea, a Prince William County Community Services Board Emergency Services Therapist.
Q: Tell us a little bit about what you do and what your department does?
A: So I work for what’s called ‘Emergency Services’ for the Community Services Board, and we [do] crisis evaluations. So anybody in the community, if they’re having a crisis – that could be a mental health crisis, could be any sort of personal crisis, and they’re needing a little bit of extra support and assistance. They can come and walk in, they can call us anytime – we’re 24/7. And we’re gonna kinda talk with them, figure out what that crisis is, and then the kind of best way to help them out. I liken us to a mental health emergency room. We’re kind of listening to what’s going on, triage, and then hopefully getting them connected to some other services.
That’s one of our main roles. Another primary role is we work very closely with the hospitals and the police department. So if they have somebody they encounter in their emergency room, or someone they encounter on the streets that’s having a mental health crisis, they can call us and bring them either to us or to the emergency room and we’ll meet them and we’ll do an evaluation for a hospitalization.
Q: And you work very closely with the Emergency Services with police or fire [departments].
A: Not so much fire, not so much fire, but mainly with the police department, both on this side in Woodbridge and then also with the Manassas City Police Department and then the county on both sides of the county. They often call us to consult. They’ll say ‘Hey we’ve got a house, or we’re walking, we’re out at Wegmans or wherever, and this person seems a little odd to us. Do you know them?’ We’ll look them up and so forth, and try to have a conversation with the police department to help that individual who seems to be in a crisis.
Q: What kind of needs do you see that the county is lacking?
A: I would just have to say, in my opinion, psychiatric services. So the doctors, or the nurse practitioners that provide medications for individuals. So even individuals that don’t come and see us, that maybe they have private health insurance, there’s not a lot in our county. People are often going up to Springfield or Fairfax, down to Stafford and it’s not uncommon for someone to have wait maybe three or four months to get a psychiatric, a doctor’s appointment to get started on medications.
Even within our agency it can take anywhere from two to six weeks, depending on the time of year and staffing, for someone to get on medications, which can be a strain to the system in general because if they’re not on their medications, a person who has a severe mental illness, then they’re gonna come across police, they may come across the jail system, they may come across emergency rooms. And it’s just overwhelming – it all puts a strain on the system.
Q: So that’s one way that you may have seen some strains on the system. Does that strain the police at all?
A: Absolutely. They have frequent calls to the same house, so they will have what they call a ‘call for service’ and it’s the run down, it’s just constant – again, again. It’s not uncommon for me to talk to a police officer and they’ll say, ‘We’ve been at this house three times tonight’ or in the last 24 hours. And because that person isn’t necessarily getting the needs and support that they need from the Community Services Board, or within the community, it just puts a strain on the police.
The other strain on the police is that the system in Virginia is very broken, as it’s pretty much been established. And police officers are often having to drive people all the way to Williamsburg, south of Richmond to be in a hospital. And they’re the ones transporting them and that can take an entire shift. So a 10 hour shift is gone, just transporting someone because we don’t have the resources in the Northern Virginia to get a person placed here for a psychiatric need.
Q: So the policies that the police have in place right now, they do their best to find that person a bed, but that actually takes that officer out of the regular patrol and all that.
A: Out of the street, absolutely. So any time we can prevent hospitalization – as part of Emergency Services our goal is to prevent hospitalization. Our goal is to always find what we call a lesser restrictive alternative, which is family, other supports, maybe it’s what we call a ‘crisis house’, which is a voluntary where they can go and sign themselves in, so police are never involved. We don’t wanna call police. We want them to do their job on the streets, so as a last resort we will call police. And vice versa – they’ll call us.
Q: So your job isn’t really just your 9 to 5 job. So why don’t you describe a little as far as how your department is a little different?
A: So we’re a 24/7 program. And one of the strains, if you want to call it, one of the challenges we have is that we have to staff 24/7, which means we have to have clinicians on-call and they’re either at home, they might be somewhere in the community doing an evaluation and they get that call and then they have to go somewhere else. And this county’s big.
You know, we’ve got anywhere from Dumfries to Haymarket, and that’s a long trip. So no, at 3 o’clock in the morning it’s not uncommon. Most of the time we have at least one to three evaluations between midnight and 8 a.m. Whether that’s at the emergency rooms, or with the police. And then we have our office hours staffed from 8 a.m. to 8 p.m., Monday through Thursday.
Q: So who can use your services?
A: Anybody can use our services in crisis. It doesn’t even have to be a Prince William County resident. This is common – somebody could be having a crisis on the road when they’re on their way from New Jersey to Florida – and they happen to enter our county and the Virginia State Police pick them up or our police department picks them up. So if someone’s in crisis, there’s no exclusionary category for them. Now we will like I said do a triage and help them stabilize as best we can, and then if they don’t live in our county, then we work with their adjoining county.
And if people have legitimate health insurance – so BlueCross BlueShield, Cigna, Aetna, Kaiser – then we try to connect them with their insurance companies. But if they don’t have insurance or they have Medicaid or Medicare, they can come and get services with us. Our primary role is to help those individuals in the community that don’t have the resources of health insurance.
Q: You have some other sections of your department. What are some of those?
A: Within Emergency Services, we also work with the police in what’s called the ‘Crisis Intervention Team’. And this is a national/international because we talk about Canada, and we throw I think Australia in there to make it international. But it’s a national program that was founded in Memphis, [Tennessee] in 1988 when there was an unfortunate incident between a seriously mentally ill person and a police officer in which he was killed by the police. And it became this huge awareness of we need to maybe change our thought process with law enforcement and people with mental health [issues]. Because the statistics right now are that 1 in 4 Americans are diagnosed with a mental health disorder.
So it’s advantageous to the police to learn how to work with those individuals and learn verbal de-escalation techniques, a little bit more than what they would get at the academy, recognizing signs and symptoms of mental illness, and being able to just have conversations with people and just not kind of be this gun – you know, the Old West, Wild West everything – and just really understand that they’re all people. That people with mental illness are just people, you know with just some sort of illness. I feel that the Prince William County Police Department with the City [of Manassas] and the [Manassas] Park have done an amazing job. The chief could not be more supportive of this program. He just – the chief is just extremely supportive, as well as all of the other department heads and so forth, to maintain the CIT program.
Q: It seems like mental health issues seem to have a stigma attached to them. And we seem to maybe slowly start to change that. It just seems that it’s going really, really slow.
A: It is, but I think any time – well change is slow. I feel that it’s a lot better than what it was 20 years ago, or 30 years ago. In my opinion, kids these days that go to school, it’s not uncommon for their friend to be on medications. It’s not weird for their friend to say ‘Oh I’ve been diagnosed with bipolar’ whether or not – who knows – saying ‘Oh I have bipolar’ isn’t a big deal anymore. And I think that the kids these days get a little bit older, and they don’t have the stigma that perhaps someone older dealt with it when we were in our early teens or late teens and early twenties. The whole culture in general is changing for the better.
Q: Do you think that if we actually had a mental health facility in the county, do you think that would actually help alleviate issues with the police department? Just the load on your organization? And how do you think that would actually benefit Prince William County, as far as you know, having to drive somewhere?
A: I feel that there’s a lot of ways we could do that. You know, one thing we have right now is we have monies in the West end and it’s still the county, but they have a CIT officer that went through the training, the specialized training, and they have what we call an assessment center. And that person is brought in by police and he does what’s called a transfer of custody. So let’s say I’m the police officer – I have the individual – I’m transferring the custody to you. And this is your detail, you’re not on the street, this is your – you’re kind of just on your own, although you’re clothed and you have your gun and everything like that. And that allows me the…officer initially, to get back out on the street.
At this assessment center, it’s very comfortable. We have what we call a ‘peer’ who has a mental health diagnosis work and talk with that consumer that’s been brought in by police to help kind of ease the anxiety and the tension of all of this going on with the police department. So that has, in my opinion, two benefits. One is that it gets that officer back out on the street. The other one is for that consumer that client, or the person in crisis. Is that they’re not handcuffed necessarily, they’re not handcuffed to a bench. They’re not handcuffed to a bed. All of those indignities that come with being handcuffed. They don’t have to be escorted to go to the bathroom. And it’s just a nicer way of treating a human being. So that’s one thing we already have going on – that the police department and the CSB do together.
Another thing that we’re trying to start slowly is to try to do these evaluations out in the field. Meaning we need the police officer out in the field. As clinicians – that’s their job, safety, let them do their thing – we’ll wait until the scene is clear and safe. And then we’ll go meet that individual in their home. That individual may not need to come in and be handcuffed you know, and sit in a police cruiser. They may just be having a bad day and they made a statement that they don’t really mean. And to save that person time, money, a lot of times police don’t know where to take them so they just take them to the emergency room, which is very full. So it saves the emergency room all that. It saves that person a huge bill as well – they don’t have the emergency room. Everything can get kind of sorted out in the home, which is a much more, in my opinion, dignified place. That’s not to say if the person is really in need of psychiatric assistance, we’ll do our procedure. You know, but this way we’re kind of hoping to make things a little more human, as well as save the time. We’ve done a couple of trials and the police officers said each time it’s probably saved them anywhere between 2 and 4 hours.
