Carson City’s MOST program helps those dealing with some form of mental illness
The program started in June 2014 after Carson City Sheriff Ken Furlong noticed there was a substantial amount of people being treated within the jail. After implementing the Forensic Assessment Service Triage Team within the jail, which brought a license psychologist in to assist inmates with their mental health problems, Furlong said they saw a 25 percent decrease in the number of inmates in the jail. He said that sparked the idea to try to work with the mentally ill in the community, before things escalated to a criminal level.
The Sheriff’s Office created the Crisis Intervention Team program for deputies and the FAST program was started within the jail to treat those who had already been arrested and two years later, they decided to expand that to the MOST to try to more preventative to help them before they got to jail rather than reactive measures once they were there.
The 2011 IHOP shooting was a big wake up call for both Furlong and the community, and showed that mental health is a topic that needs to be addressed before it escalates.
“IHOP brought to light a lot of folks in this town who aren’t aware there are services out there,” Furlong said. “IHOP was one with, my CIT training, that we learned jail is a bad place to put people who are in crisis.”
The program also started because of three additional reasons: Mentally ill residents were calling 911 for non-emergency incidents and increasing the calls for service; mentally ill individuals were being arrested and unable to receive adequate mental health treatment within the jail, and surrounding departments already had established and successful programs that were benefiting their communities.
It started with Bekah Bock, a trained social worker with the Carson Counseling and Supportive Services, riding with Deputy Dean Williams once a week to try and work with mentally ill individuals. The Sheriff’s Office, Carson Counseling and Support Services, mental health court and aging and disability services referred these people to MOST for problems from suicide threats to delusional episodes.
The purpose of the program to complete and maintain regular welfare checks on problematic or frequent users of mental health services to promote medication compliance and wellness and provide assessments to encourage voluntary use of community resources to prevent future crises and help treat the illness, Bock said.
The Nevada Legislature voted in 2010 to provide funding for the program, where it started in Reno. Today, Carson City receives funding from the federal and state government through various grants.
“CIT was used to send an officer out to a situation if something can be identified soon enough (as a mental health issue) and we go there to take the time to talk with them instead of just going to arrest. They want us to take the time to talk with people and a graduation of that is MOST.”
Bock now works full time with the Sheriff’s Office, riding three days a week with deputies and creating programming the remaining two days of the week.
Jane seems like a normal elderly woman living in Carson City; she has a loving family with children and siblings in the area, she pays rent, she shops at the grocery store. However, after talking with her for a just few minutes you find out she believes a group of wiccans comes into her room every night and violates her in her sleep.
She constantly changes rooms in the motel where she lives because she says these wiccans are getting into every room she’s in. Jane also was well known at the Carson City Sheriff’s Office because she would call 911 several times a week to make reports about the people she saw.
Mentally ill individuals can be a difficult group of people to handle because of their detachment from reality and their outbursts can turn violent, and sometimes even deadly, if they don’t receive necessary treatment for their illness.
To help Jane and others, the Carson City Sheriff’s Office has created a program to help reduce the amount of mentally ill individuals being arrested and jailed in the community. The program provides preventative assistance through law enforcement contact.
In conjunction with the Carson City Division of Public and Behavioral Health, the Sheriff’s Office has created the Mobile Outreach and Safety Team, or MOST, that pairs a social worker with deputies on patrol to help individuals who have mental health issues in the community. The purpose of the program is to work with these individuals to work through their illness to provide helpful resources for treating it.
To build MOST, the Sheriff’s Office relies on Bekah Bock, a trained social worker with the Carson Counseling and Supportive Services who works full-time with the department and rides three shifts a week with deputies to go to calls and conduct follow up conversations with individuals who may be mentally ill.
“So instead of just having a cop with good intentions who has had 40 hours of training, let’s put the cop with someone who really knows what’s going on, a licensed clinical social worker and that is what Bock is,” said Deputy Dean Williams.
Bock has a cell phone strictly for her clients to be able to reach her 24/7 in case they are having difficulties. Bock speaks with Jane often, usually once or twice a week. It was apparent in just 10 minutes on the phone, Jane’s mental health improved thanks to Bock.
“A lot of people just want to have someone to talk to because a lot of them don’t have someone to care about how they are doing or what they are doing,” said Deputy Nick Pinochi, one of the MOST officers. “So when one of us is checking up on them and saying ‘hey how is this going, where are you at with this stage of your mental health process?’ and you can see they just want to talk to someone and get the help they need.”
Jane is an example of how the program can be successful too. With Bock’s help and guidance, Jane’s family set up an intervention and convinced Jane to get treatment. Even though it took everyone involved some time to convince Jane, the end result was eventually she agreed to get the help she needed.
“We can only offer services, a lot of people will deny services but a lot of the doors will open, it is amazing how many people allow us into their home,” Bock said.
Time after time, often all it took was just someone checking in and talking with these individuals for a short period of time to get them in a better place. Most of the time the team isn’t transporting people to hospitals or counseling, but providing temporary help of calming individuals down before a situation potentially escalates. Sometimes, that was all the help the clients needed at the time before they committed to long term help and resources.
One of the main reasons the program was built was for diversion. Though not everyone accepts the resources offered to them, it works with jail diversion so the mentally ill aren’t arrested.
“The jails are not designed to handle these kinds of people, so it’s nice to be able to help them so they don’t go to jail,” said Deputy Israel Loyola. “It helps out the jail too, because a lot of times they wouldn’t know what to do with (the mentally ill). They would put them in a cell and say ‘well what do we do with them now?’ It’s great now that we can offer them all these other resources instead of just ending up in jail.”
This program is important because if untreated, mentally ill individuals can potentially be dangerous to the community. If they are having a bad episode, the end result can be anything from property damage to suicide, said Carson City Sheriff Ken Furlong.
“When they are in crisis, they are unpredictable with what they may do,” Furlong said. “So MOST identifies these people, and we hope to intervene before it gets to that possible violent outcome. Why wait until someone is in such a crisis that they end up in jail? Why not get them help before they get to the level of crime?”
Furlong said the difficulty with getting help to mentally ill individuals is many organizations who can offer resources are afraid to go into people’s homes unprotected and alone.
“I am sympathetic of that,” Furlong said. “Which is why we provide Bock with an officer to assist her. And the added benefit to us is that we get the training on handling the mentally ill.”
Bock said the success of the program is because of early intervention into the mental health cycle.
Though not all mentally ill individuals are violent, as Pinochi described it, there are a million in betweens that fall on the mental health spectrum. It takes someone as skilled as Bock to be able to identify and help these people, so they aren’t getting themselves into trouble with law enforcement and the community.
“We want to provide more preventative measures by interfacing with the people prior to arrest, such as getting them patched up with community resources so they aren’t having to be arrested,” Bock said.
The workload keeps Bock and the deputies busy. Aside from normal calls for service, they try to interact with people on their referral list and normal client list as much as possible.
“I would say if you did the math on it, in my opinion, close to half of (our calls) have some sort of mental illness,” Pinochi said. “But it’s more than you think because not everyone is perfect and not everyone’s mental health is perfect. So once you realize that and you see it, it’s kind of like starting to comprehend why that’s happening, and then these are the steps to help them fix it.”
Currently there are only three deputies who work with Bock and MOST: Pinochi, Loyola and Deputy Jimmy Surratt. But deputies from all shifts will flag individuals who they may interact with to have MOST follow up with them on a later date to see what resources they can offer for the individual.
The resources available are wide reaching. It’s about crisis intervention, so it can include things like substance abuse counseling and inpatient treatment or can even be helping to stabilize finances.
“We don’t deal with just the mentally ill,” Loyola said. “Sgt. Craig Lowe came across a family sleeping in a car in the park and he was able to get them a hotel, groceries, gas money and help point them in the direction of some more resources. So, we don’t do just the mentally ill because crisis for someone can be that person not having a place to stay today.”
“It’s about getting people on their feet to get them in the right direction for almost anything,” added Pinochi.
The MOST members agree this program, also has helped deputies become more aware of mentally ill individuals they may encounter.
“A lot of times, we would just go out and arrest them and take them to jail, but now it is kind of eye opening to see how to handle these kind of situations instead,” Loyola said. “Now we can give them some resources or help instead of just jail. Back in the day, we were clueless as to what these people were.”
It isn’t surprising the deputies would miss some mental health cases, because at times, it’s hard to spot for someone without that special kind of training.
The School Resource Officers had referred Susie to the MOST team because she had been making reports teachers, her ex-husband and other school officials were making up stories she was using drugs and harming her child. It seemed as if she was a normal person, however, after talking with her, Bock said Susie showed signs of untreated paranoia and schizophrenia. Though Bock advised Susie to set up an appointment with a counselor, Susie refused.
She exemplified a common challenge the MOST team faces: Getting clients to accept help.
Many people don’t believe they have a problem or don’t think treatment will do any good. Even if they do get help, it can be a struggle of ups and downs for these clients and MOST sees individuals who are healthy for a period of time before relapsing again.
“Some of the problems I have noticed is, when they are on their prescription medication, they are doing well and feeling good. They feel like a normal person and some feel like they don’t need to be taking that medication anymore,” Loyola said. “So they stop taking their medication and they fall back again and then that’s when they start using meth, marijuana and all these other things to self medicate.”
When individuals stop taking medications, it isn’t just difficult on the team, it’s hard on the individual’s loved ones as well. Team members encountered Margret during one of their checks, who had called 911 twice in one week, claiming she was swallowing pills to kill herself. Her husband had informed paramedics she hadn’t taken anything because she had stopped ordering her medications. Her mental health deteriorated off the medications, resulting in extreme depression and possible suicidal tendencies.
“When she is running on all eight cylinders, life is great,” he told Bock.
The team often sees this problem. Margret started to feel good on the medication, so she figured she didn’t need it anymore to feel good. However, taking herself off of her medications had caused her mental issues to resurface.
“(It’s challenging because) unless they want help, we can’t force it upon them,” Loyola added. “It is challenging because a lot of the people we deal with, in their mind they are all right; it is us and everyone else that has the problem and that is the hard part to try and get them to get that help too.”
Often, the individuals MOST deals with are similar to Susie and Margret: people who aren’t necessarily being criminal, but who are creating disturbances and taking deputies’ time away from critical calls to respond to the disturbances. So this program is just as important for the community as it is for the clients because deputies are more available for real calls for service instead of spending their time at calls that aren’t law enforcement related.
One way the program reduces that problem is with the MOST phone Bock keeps on her. This way, Bock can spend the time to talk with clients about whatever issue they may have and try to work it out with her instead of calling 911 constantly.
“A lot of these people all they want is that if you can check with them or talk to them once a week they will stay off the 911 and taking up the line for non-emergency stuff,” Loyola said. “It’s nice when we go and check on them and you get the feedback from dispatch saying you guys are doing a good job they haven’t called so much so it’s a good thing.”
Though it’s a difficult job, the MOST members are passionate about helping those in the community who truly need it.
“I love working with the MOST team as you see real life changes with the persons we interact with versus in a therapeutic setting,” Bock said. “Change is a long process and not as readily visible.”
Being involved in this program has not only helped the mentally ill individuals, but it also has helped improve the department. Bock said she has seen such a change in the last two years in how officers see the mentally ill and handle those types of calls to provide treatment and resources instead of just jail time.
“Through MOST and CIT training, I have learned that there are so many different channels to try to provide resources to get individuals with mental health issues healthy and stable, and then see them become productive members of society again.” Pinochi said. “Seeing them go through all the steps and return to normal is priceless because that is what you do the job for, you do it to see people get better and have a good life with a job and all the stuff they need to be happy and functional citizens.”
“It is just such a broad range of ways to help people and it’s amazing to see success stories,” Pinochi added. “You are proud of them and it’s cool to be a part of.”