Tag Archives: mobile crisis

What’s in your wallet?

February 21st, 2013

6417415359_c09182877eNot too long ago my youngest son and I went off to Walmart to get some much needed supplies.  We each grabbed a cart and our plan was to meet at the checkout aisle in 30 minutes.  Little did we know that three hours later I would be supporting a mom whose daughter was having a mental health crisis and having trouble accessing mobile crisis services.

The store was filled with shoppers and lots of noise on this busy Saturday.  Every aisle I visited had at least two people, sometimes many, in conversations.  There was one constant sound in the store, though, and it was a young girl screaming about a doll. At first I ignored it, thinking it would stop when she got tired or her parents left the store.  I remembered at times my boys would cry because I would not buy them another toy while we were out shopping.  So I had learned to tune those sounds out.  But I couldn’t tune this out ….it was different.

The yelling was getting louder and closer with the little girl now screaming “I want that doll.” Then the chase began.  The little girl ran right by me screaming, chased by her crying mom who was walking fast to catch up with her.   This went on for a long time and I kept thinking that the manager or an employee would offer the mom some help or even call the police to help calm the situation down.  But no one did anything.  When my son and I got to the cashier, we started unloading our carts.  I could still hear the mom crying so I looked for her.  When I saw her trying to restrain her daughter and being bitten, I knew I had to try to help.

I bent down and said to her “I don’t know how I can help you right now but I would like to try. Please let me know what I can do”.  By now there were at least 20 people watching us and not one said “I’ll help too.”  She said that she could not pick her child up because she was biting and kicking her and she needed someone strong to help.  As I stood up to see who I could ask, a man entered the store and came right over to us asking how he could help. The two of them carried her out as she was trying to hit and bite them.

The mom asked the man to put the girl in her car seat so she could not hit or bite anymore. The girl was stiff and rigid and it was impossible to get her in her seat.  The man restrained the girl and the mom and I began to brainstorm ideas.  She told me her five year old daughter had ADHD and saw a clinician. When I asked, it turned out she had the clinician’s crisis number.  She called and explained that she could not get her daughter into her car seat and need them to come to Walmart and help her.  She was told she had to bring her daughter to their office.  They offered nothing else and that was the end of the call.

I then asked her if she knew about mobile crisis services and she did not. I explained, then asked if she wanted me to call for her.  She said yes but please, don’t call the police.  I said I would not.  So while the man was still restraining the girl, I ran into Walmart to use the phone and call for help.

First, I called directory assistance.  I had the address and knew the kind of service but they replied they had no such listing and even though we tried to brainstorm, it got me nowhere.  I then called the local hospital’s emergency room for the number.  No luck. Next, I ran and got my purse out of the cart because I thought I had the mobile crisis business card in my wallet.  I didn’t. I ran to my car to see if I had it in my briefcase but again, I didn’t.

Finally, I ran back to the mom’s car to find the little girl was still so out of control that the man was not able to let her go.  I felt like a failure and said to the mom, “I can’t find the number.  Do you want me to call a relative or someone?”  She told me her husband had just picked up her message and was trying to find a ride.   I told her I thought she was doing a great job of staying in control and handling the situation. I gave her my card, told her about PPAL and said to please call.   At this point, the young girl’s father arrived.  The girl was still crying, but exhausted now and it was easier to get her in her car seat.  They thanked us and off they went. It had been almost two hours since the crisis began.

I went back into Walmart and talked to the manager.  She said they usually call the police when there is an incident, but didn’t feel it was the right thing to do with a young child.  I explained that the police shouldn’t be your only option.  Later that day, I returned with a stack of business cards that I asked her to pass to her employees and leave at the service phone.   I put a few cards in my glove compartment and several in my wallet.  Now when I am in a store I give the manager one and ask her to post it by the main phone and let their employees know what it is.  I would never want another family to have problems accessing a service that is intended for this purpose.   So, will you be ready to help someone in crisis in your community?  What’s in your wallet?

Beth is the mother of three young men with mental health and medical challenges.  She is a strong advocate and involved with several groups and initiatives around genetics, medical and mental health.  Beth is the Training Coordinator for PPAL.


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The Night Before School Ends

December 21st, 2011

Twas the night before school break and all through the house,

My awake dogs are wondering if it’s a child or a mouse.

The children are ready for the transition to begin

In hopes of finished schedules and mommy to chime in.

The schools will soon close for a break and a rest

And I will hope for transitions to work out for the best.

It will balance fun, with appointments to drive to

In hopes that I’ll get there without wounds to attend to.

My week will have bumps and meltdowns will arrive

But my phone will be ready to call MCI.

If my supports are all ready with tricks and ideas

I will be safe to survive the teenage years.

I’ll dance and I’ll sing with humor around

In hopes that my daughter is homeward bound.

To make her brothers laugh and bounce back to fun

Cause she’ll show them her funny face then she’ll run.

It will all work out as it does every year

But this one is tricky because of the teenage gear.

As the break happens,  you wonder how to survive

Remember there’s one thing  you can continue to drive —

The supports that you need and friends close and dear

So that you will be able to move through the year.

Merry Christmas to all and to all a good night.

Holidays will happen if you want them alright.

Keep your smile intact so you continue to glow

My children, like yours, will teach us to grow.

Happy Holidays to you and to you a goodnight…

Meri Viano is our guest blogger.  She is the parent of two sons and a daughter who will be home during school break.

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Thumbs up, Governor

October 21st, 2011

Dear Governor Patrick,

Let me say right up front that this is a letter of thanks.  Something remarkable is going on in children’s mental health here in Massachusetts.  We’ve been pretty quiet about it and I’m not sure why.  I think we should be shouting it from the rooftops every chance we get, don’t you? 

As you know, a girl named Rosie D and her family got together with others like them and sued the Commonwealth of Massachusetts a few years ago.  Her family believed that children should receive mental health treatment in their communities whenever possible instead of going to residential programs or hospitals.  The state had a few small programs to fit the bill, but not enough to even start to go around. 

The federal judge wrote in his decision that Massachusetts needed to change how it delivered mental health services to children and youth receiving Masshealth a year before you became governor.  But when those families went to court, they wanted a remedy, not money or damages.  What landed in your lap was the task of creating that remedy and having it meet the needs of all those children, youth and families that were counting on it. 

There are lots of children and youth here that need these services in order to have the kind of life their parents want for them and that they deserve. Epidemiologists tell us that 1 in 5 children experiences a mental health disorder during the course of a year. That comes out to 286,600 children in the Commonwealth.  For most of them, there is a delay before they receive treatment, often a delay of years. 

Since that judge issued his order, the people on your staff have created something amazing and unprecedented.  They designed the Children’s Behavioral Health Initiative and they said they were going to change how things work for children and teens like Rosie D. They made sure the services were in the community.  They created a model where families were part of the team figuring out what care was needed.  They designed a new way to respond to mental health crises (and we all know that children have their crises at inconvenient times) so that the team came to the family instead of the parent and child trekking to the emergency room.  And it’s up and running all across the state.

As with all new initiatives with this kind of scope, there are still things to work out.  Sometimes the services don’t work the way they should.  Sometimes children don’t get what they need right away.  Sometimes we just need to tweak things and sometimes significant advocacy is called for.

My father, a New Englander to the core, used to say that you can’t learn to ice skate without falling down.  While no one wants to see mistakes, we can learn from them.  Parents want their experiences, good or bad, to make it better for the next family behind them.  Parents want to and will be the Amazon.com reviewers and consumer reporters of the services that their children receive.  I wish there were a way to make sure their experiences were collected and used to improve the design, the practice and the kinds of outcomes we focus on.  Their input is incredibly valuable.  Can we think about that?

You probably know all this, but what you don’t know is how the rest of the country — or at least those who pay attention to the children’s mental health world — finds this both jaw dropping and exciting.  It’s not just what’s been done here, its the scope of it. When I go to an event with people from other states, they come over and want to hear the details.  They want to know how families see things, how this new initiative has changed our system of care for children in Massachusetts and they are hungry for both data and advice.

People in other state governments want to hear about our successes, our roadblocks and how we continue to improve things.  Researchers want to hear about our data and outcomes.  Policy makers are interested in how this has impacted other children’s services, funded both by the state and by private insurers.  Families want to know how they can help build something similar in their own states. 

We all need good news in these tough economic times.  You’ve done something remarkable here despite those tough times.  Let’s get the word out.  In the meantime, thumbs up.

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Dear Santa

December 19th, 2010

Meri Viano is a guest blogger for Hold On, It’s Not Over and the mother of three children. This is her letter to Santa.

Dear Santa,

I have been exceptionally good this year. Well, at least I’ve tried really hard to be good. But there are all sorts of things that can get in the way.

I’ve been doing extra chores this year. It’s hard to pick up after children that hide things, especially cookie dough behind the cabinets, snacks in drawers, and even the papers that get ripped up into a million little pieces because it is an “activity” that keeps one of my kids busy. It can take a huge amount of planning to get the chores done and also manage to pick up and move pictures to the holes in the walls so that the visitors do not feel they have entered a “unsafe ” place.

I am not even talking about the singing that I have to do to get my daughter to eat, or the dancing I must do to get her to drink. It is difficult being the mom and the entertainer. Combining discipline and building positive self esteem is hard. NOT like the Italian home I grew up in.. you knew if the wooden spoon was raised you ran!

I have also tried to go grocery shopping at 11pm so that my children are sleeping all nestled in their beds and limit the number of customers who point at me and say “That”s the mom with the unruly child.” It also helps with the child who feels he needs to eat certain things to keep the voices in his head away.. if you drink lots of water you will not hear the scratching on the window that is not there.

I am trying to be nice to everyone but Santa, have you ever called Mobile Crisis? They want you to schedule a time for the crisis! When you call, they seem to always say it is shift change and they won’t have a clinician in for four hours. How do you pause a crisis? I call, at first to explain, then I’m more demanding but still patient, and then okay, I talk about the laws and then I’m called the parent OUT OF CONTROL.

Santa, I’ve spent a lot of time teaching too. Everywhere I go it seems I have teaching to do — grocery stores, banks, even people in cars looking as you are waiting for the stop light. Seems like everyone has to LOOK at our kids and judge us. So I am trying Santa.. but it gets hard. The new item in the state is Wraparound. What they don’t tell you is…well, can you imagine not believing in strength based families? Why is it such a hard concept? And you know my tough child–the one that hears voices–who doesn’t know what to do and sometimes wonders why he should continue to try? This Wraparound thing would never work for him because he is too unique–the system calls him too complicated.

Finally.. I really want to go back to DMH and get a caseworker that believes in families, believes in clinical help. They call back, they support, and guess what .. they do not want to file 51As. I am trying to believe that the professionals in Wraparound will get it.. but how many times do you need to change teams in order to succeed?

So I hope all this counts. My list this year is a list of the things I think would help me with the system. It’s a little like a top 10 countdown (I would love to be Jay Leno, or Letterman). Will people get my sense of humor? It is different then most… I guess not really if you have a child like mine.

The items on my list are in the order of importance, so if there are too many things for you to carry, please delete as few of the items as possible, starting from the bottom of my list.

Santa, I will leave you organic oatmeal cookies and soy milk (in case you are lactose intolerant) and carrots for your reindeer (organically grown of course).

Thank you in advance. I know you receive a lot of letters so you don’t need to reply unless there is a problem with my list or you need services for another child. I have taught myself to be resourceful so please let me know if I can help someone else get it right!

10. Mobile crisis to move in my home

9. Clinicians who will talk to all parts of the team

8. Schools that do not depend on the parent to play expert, and then blame them if it doesn’t work

7. A secretary

6. A full time nurse – those somatic symptoms creep up on us

5. News station to teach the public about children’s mental health

4. Safety protection.. not what you are thinking… i want bubble wrap so when the heat is hot.. i am protected!!!

3. Another set of eyes.. reality tv please. The money would pay for the lawyers.

2. I always wanted more children, so for this one could each kid in DCF or any other system get a someone to call mom, dad, grandma or grandpa?

1. Ok.. I have decided.. nothing can be cut off my list…I need it all to make things work

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Calling for mobile crisis

February 28th, 2010

One of the new services for families in Massachusetts is the mobile crisis initiative or MCI.  Mobile crisis — sounds like something that will come to you when you have a crisis and stay there till the worst has passed, doesn’t it?  Except it doesn’t always work like that.

This service has incredible potential.  And in some parts of the state, it helps families whose children have a behavioral health crisis enormously. The intake worker “gets it” and sends out the team, the team goes where the child or youth is and figures out what to do, and the family has follow-up for 72 hours if that’s what they need.  The team includes a family partner whose role is to ensure that a family’s perspective and choices are heard loudly and clearly and included in the solution.  Until these new services began, the only “mobility” anyone ever saw was the crisis team going from their office to the hospital emergency department and then traveling back to their office.

The tricky thing about mental health care is that how well it works relies heavily on relationships, even very short term ones.  Clinical skills count as does experience and expertise.  But the expectation that each person has a job to do and is doing it as best they can is what builds the bond that can make things work.

Most crises, as any parent can tell you, happen at home and after business hours.  Sure, there are times when a child or youth becomes suicidal or out of control at school or somewhere else.  But a huge percentage of mental health crises occur at home. The parent sees what sets things off, usually knows what isn’t going to work ahead of time and can judge what’s outside of their own ability to handle things.  So, they call in reinforcements.

Sometimes problems start with the phone call.  The intake worker decides that the parent should be able to “manage” things at home.  Or advises the parent that the MCI team can’t come out and they should try the emergency department instead.  Sometimes new problems come with the team themselves.  In one instance, the mobile crisis worker remarked, “This child is running the house.  What are you going to do about that, Mom?”  In these cases, the service may have changed but the attitude hasn’t.

Massachusetts Behavioral Health Partnership, who oversees the new mobile crisis services, has been working hard to improve them by offering training, consulting and other assistance. For some provider agencies with MCI teams, this is just what they need.  Others, however, don’t seem to have the committment to adopt this new model and, instead, continue to do business as usual.

One father wrote in an email recently of his experience with the MCI team in his area.  He called and outlined the escalation in his son’s delusions and behaviors and asked for the team to come out.  Instead he was told to go the emergency department.  After several hours, poor service and little help, a supervisor apologized for making his son and he go through it all.  “I told them that the ER visit wasn’t needed, and now all we got was an apology for having to go through it, he wrote.   “Parents need to be listened to from the beginning, not apologized to at the end. “

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