What to do in a Psychiatric Crisis in Carroll County, Indiana

Transcription

1 What to do in a Psychiatric Crisis in Carroll County, Indiana A psychiatric crisis includes but is not limited to: a person who is suicidal or is having suicidal/homicidal thinking and/or behavior, acute psychotic symptoms, sudden change in mental status, violence, or who is gravely disabled and unable to manage his or her daily living. Below is information for persons in Carroll County, Indiana that should help in dealing effectively with such a crisis. 1. Name, location, phone number of your Community Mental Health Center: Wabash Valley Hospital 2900 North River Road West Lafayette, IN , Serving the following 9 Counties: Tippecanoe County Outpatient Branch 610 Main Street Lafayette, IN Tippecanoe, Benton, White, Carroll, Montgomery, Warren, Fountain, Jasper, Newton 3. The following answers are for Carroll County 4. Respondent s name/title, phone number/ Rosemary Rives Administrative Secretary ext, 221 rryves@wvhmhc.org 5. Who is the first person a family/caregiver should call in a crisis in this county? If it is a life-threatening emergency, call 911 first. If there is a medical emergency, such as the person has taken an overdose, take them to the nearest emergency room. If the person is already in treatment with a mental health provider or primary care physician for mental health, call that provider first for direction about what to do. The primary provider knows the case best and knows the resources. If hospitalization is needed, they will be able to provide us with the critical information that we need in the most efficient manner. Even if the provider is not a Wabash Valley Hospital clinician, they should be the person you call for guidance about what to do next. If the person is not in treatment with anyone and is medically safe, follow these guidelines: During regular office hours (generally Monday through Friday, 8:00 a.m. 5:00 p.m.), call the outpatient office closest to where the patient is and inform the receptionist that it is an emergency. You will probably be directed to bring the patient to the office at a specific time. If the person will not go with you, the family/caregiver should let the receptionist know that, but still plan to come to the appointment time to talk with an emergency clinician for an assessment of what to do next. The Wabash Valley offices which do emergency evaluations for people who are not currently clients are:

2 Tippecanoe/BentonCounties 610 Main Street Lafayette, IN Benton County 106 South Main Street Otterbein, IN Jasper/Newton Counties 131 W. Drexel Parkway Rensselaer, IN , Fax: Fountain/Warren Counties 41 North Long Ave. P.O.Box 415 Attica, IN , Fax: Montgomery County 1480 Darlington Avenue, Crawfordsville, IN , Fax: White County 920 W. Executive Court Monticello, IN , Fax: Carroll County 1265 North Bradford Drive Delphi, IN , Fax: After the outpatient offices close, emergency services are handled by calling the main center at or An answering service will ask for some basic identifying information including a phone number to return your call. They will then contact a therapist on call to speak with you to decide how to proceed. 6. What does this county advise the involved relatives/friends/neighbors of those in crisis to do for those who ARE COOPERATIVE? Assess whether the situation is a true emergency i.e. cannot wait for a traditional appointment time because there is a significant concern about the safety of the person. Most of the outpatient branches can get someone in for a first appointment within a week. If the emergency cannot wait, then alert the staff and they will make arrangements. Keep a record of what symptoms the person is having, how often s/he is having them, and what you have tried to resolve them. If you have private insurance (anything other than Medicare and Medicaid), check with your insurance company provider to see if they require that you go to a particular provider for services. Lafayette Home Hospital has a psychiatric unit that offers similar treatment on a voluntary basis. They can be reached at

3 Regarding consumers who have diagnoses of mental retardation or developmental disabilities: The State of Indiana has contracted with several companies to provide some crisis intervention for consumers with mental retardation and developmental disabilities. In the Lafayette area, Anthony Wayne Services provides that intervention. The call to them needs to be at a point where there is some time for them to assess the situation and make some interventions. Their contract specifies that they need to respond within 48 hours so this is not an emergency line but in some cases it may be the best place to call to find help for a consumer who is also MR/DD and needs help in a hurry. They can be reached at What does this county advise involved relatives/friends/neighbors of those in crisis to do for those who ARE NOT COOPERATIVE? First, make sure the person and others are immediately safe. This may require calling the police or taking them to the emergency room if they have a medical need. The hospital does not come to the home or pick up patients. Generally it takes a little time to evaluate the situation and make arrangements for appropriate care. If there is a weapon involved or the person is needing immediate restraint for safety purposes, please call 911 before attempting to call the mental health provider. Keep a record of what symptoms the client is having, how often s/he is having them, and what you have tried to resolve them. Be aware of the state statutes on involuntary treatment. Having symptoms of a mental illness is not enough to force someone to be detained in the hospital. They must meet the criteria of dangerous or gravely disabled and a physician at Wabash Valley Hospital must agree to admit the person. Dangerous: a condition in which an individual as a result of mental illness presents a substantial risk that the individual will harm the individual or others (IC ) Gravely disabled: a condition in which an individual, as a result of mental illness, is in danger of coming to harm because the individual: 1) is unable to provide for that individual s food, clothing, shelter, or other essential human needs; or 2) has a substantial impairment or an obvious deterioration of that individual s judgement, reasoning, or behavior that results in the individual s inability to function independently (IC ). Indiana law (IC ) allows a facility to detain an individual for up to 72 hours for examination and emergency treatment if an application has been filed which states that the person is believed to be mentally ill, dangerous or gravely disabled, and in need of immediate restraint; has a statement by a physician that the person may be mentally ill and dangerous or gravely disabled; and is endorsed by a judge authorized to issue warrants for arrest in the county where the person is present. The detention authorizes a police officer to take the person into custody and transport them to a facility. The statute does NOT obligate the hospital to admit the person ordered. Judges do not have hospital admission privileges. So before a patient can be admitted, a physician with admission privileges at Wabash Valley Hospital must agree that the patient is appropriate for admission and give an admission order. 8. What does this county recommend relatives/friends/neighbors of those in crisis to do if the person does not have a mental health care provider? Follow the same guidelines as listed in Number What hospital Emergency Room serves this county? Tippecanoe and surrounding counties:

4 Lafayette Home Hospital 2400 South Street Lafayette, IN St. Elizabeth Hospital Lafayette 1501 Hartford Street Lafayette, IN Jasper/Newton counties: Jasper County Hospital 1104 E. Grace Street Rensselaer, IN Fountain/Warren Counties: St. Vincent s-williamsport 412-North Monroe St. Williamsport, IN Montgomery and surrounding counties: St. Clare Hospital 1720 Lafayette Road Crawfordsville, IN White County: White County Memorial 4101 O Connor Blvd. Monticello, IN How does this county handle a person in a psychiatric crisis who refuses voluntary placement, and his health care provider recommends hospitalization? Describe the process by which petitions for emergency evaluation and/or involuntary hospitalization may occur without a judge? Unless a police officer is involved who is willing to do a 24-hour immediate detention, we would require a 72-hour emergency detention order signed by a judge. 11. Describe the process by which petitions for emergency evaluation and/or involuntary hospitalization may occur with a judge Prior to contacting a judge for an emergency detention order, the concerned party should call Wabash Valley Hospital for evaluation of the situation, following the procedures provided above. If the caller is an MD or psychiatric provider, their information will be routed to a psychiatrist here to determine appropriateness for this facility. The healthcare provider should follow the same guidance about which office to call. During regular business hours, contact the office closest to where the patient lives. Providers can also call our inpatient services secretary at ext. 277 for guidance about getting connected to the appropriate psychiatrist. After the determination is

5 made by a Wabash Valley Hospital psychiatrist that hospitalization is appropriate here and that there is an available bed, the 72-hour Emergency Detention Order paperwork needs to be completed. The concerned party can obtain the application from any of the Wabash Valley Hospital offices and complete the first page, have an MD complete the Physician s Emergency Statement, then take the form to the circuit court of the county where the patient is presently at (or any other county judge if the Circuit Court judge is unavailable) for endorsement. The judge will not sign the form unless a Wabash Valley Hospital psychiatrist has agreed to accept the patient. After the form is signed, the petitioner will take it to the county sheriff s Department and provide information to them about the whereabouts of the person. The sheriff s department is responsible for apprehending the person and transporting them to Wabash Valley Hospital. 12. How does one file a petition in this county during non-court hours? After 5 p.m. on weekdays and on weekends and holidays, the easiest way to obtain a 72-hour Emergency Detention Order is through the emergency room. They have both a physician available to sign the application, if appropriate, and the phone numbers to contact the judge for an order. The emergency room would contact the local sheriff s department to take the petition to the judge s home and obtain his signature. The alternative to this would be if a physician is involved and willing to contact the judge to obtain an order, then to contact the sheriff s department to take the paperwork to the judge. The local sheriff s department usually knows how to get in touch with a county judge after hours and can assist with this process. The other option is to have the police do a 24-hour immediate detention order if the officer has grounds and is willing to complete the appropriate form for detention. 13. Do you have a Crisis Intervention Team (C.I.T.) in your area? These are emergency responders who are specially trained to handle mental health cases and to evaluate people in crisis. No. There is a C.I.T. program for Tippecanoe County and through this program we provide training for officers in surrounding counties on mental illness. Contact William Lefurgy, Executive Director of NAMI West Central Indiana for information. 14. Who handles the qualified pick-ups for involuntary holds? Each law enforcement agency has its own routines as designated by the county sheriff. In general, each officer is responsible for evaluating the situation, contacting Wabash Valley or taking the client to the emergency room, and completing the 24-hour immediate detention paperwork if needed. All law enforcement officers are trained to detain and seek emergency evaluation or treatment as they feel necessary under the immediate detention guidelines. The police routinely take involuntary persons to Wabash Valley Hospital s outpatient office or to the local emergency rooms for mental health evaluation. Calling 911 is the best choice for accessing a law enforcement officer in an emergency. Where the person is currently located will determine whether the police or sheriff will respond. In any location, the caller should identify early in the conversation that they are calling about a mental health crisis, the name and location of the person you are concerned about, and the most vital information about the dangerousness of the situation. Avoid giving excessive information in the phone call. An officer will be dispatched and you can give him/her the full story at that time. The

6 dispatcher needs to know what the immediate emergency is, if there are weapons involved, if the person is in immediate danger, and if they have a history of being violent with first responders. 15. Do you do face to face assessments after hours? Generally, No, but the therapist or psychiatrist evaluating the situation has the option to set up a face to face evaluation if they feel it is necessary. They may also ask that the person be taken to the local emergency room. 16. How does one get an emergency evaluation form/petition in this county? At any Wabash Valley Hospital location, at the local emergency room, at the local sheriff s office, and the NAMI West Central Indiana office. 17. Where does one file a completed emergency evaluation form/petition in this county? The concerned party can obtain the application from any of the Wabash Valley Hospital offices and complete the first page, have an MD complete the Physician s Emergency Statement, then take the form to the circuit court of the county where the patient is presently at (or any other county judge if the Circuit Court judge is unavailable) for endorsement. The judge will not sign the form unless a Wabash Valley Hospital psychiatrist has agreed to accept the patient. After the form is signed, the petitioner will take it to the county sheriff s department and provide information to them about the whereabouts of the person. The sheriff s department is responsible for apprehending the person and transporting them to Wabash Valley Hospital. 18. Do you ask the caregiver bringing a patient to your care for any and all mental health history and/or recently observed behavior? Yes, we prefer to get collateral or confirming information from the caregivers. Sometimes it is not possible to meet with that person at the same time as the admission is being done, but we do want to get their information. Caregivers could provide information in a typewritten format detailing recent behaviors, what normal function is for this person, how long things have changed, and possible causes of the change, and things that have been tried to help the situation. Noting the person s sleep, activity level, substance abuse, and changes in ability to do things that they normally do is very important. If your loved one is hospitalized at Wabash Valley Hospital, the contact person to give information to is the social worker. You can call any time and leave the social worker a message and they will call you back. Wabash Valley Hospital has a Family Support Group that meets every Wednesday night at 6:00 p.m. and is open to any family member of a Wabash Valley Hospital client inpatient or outpatient. Caregivers often find that this group is helpful in identifying what can be done in a difficult situation by asking other family members. 19. Is there a Mental Health America in your area? Do they assist with people in crisis? Yes, in Lafayette Their offices are open 8:00 a.m. 5:00 p.m. They have a shelter for the homeless that is open later, but the office itself is not open 24/7. They do assist people in getting evaluated and treated through our system, but do not provide that service themselves. The local chapter of the National Alliance on Mental Illness, NAMI West Central Indiana, also makes referrals for assistance in the community. They can be reached at The NAMI WCI office (Wabash County Indiana) is open during regular business hours also but they have an answering machine and will return calls the next business day.

7 Consumers, family members, providers, and other concerned people need to be aware of the significant sources of treatment available as well as the limitations in some areas of requested treatment. For example: In a crisis, most people assume that the case must be handled only in the hospital. The truth is that most crises are handled in an outpatient setting. Hospitalization is only recommended for a select few cases where no other plan can be made to keep the consumer safe and where hospitalization is reasonably expected to improve the situation. Hospitalization is short-term option meant to stabilize crises. It is not used to speed up the therapy process or provide an alternative to seeking appropriate outpatient treatment. Many people come to treatment requesting long term treatment. Most long-term treatment options are strictly outpatient. There are very few options for long term inpatient care. The state hospital system is the only significant long-term treatment facility that most consumers can afford. There is a strict limit to the number of beds available in the state hospital system and therefore only a very small percentage of clients ever go there. The state hospital system in Indiana does not lock up consumers for lengthy periods of time. The state hospitals are just a slightly longer treatment option for people who have worked with the various outpatient programs available but have still not been able to maintain safety in the community. Long-term treatment for addictions is very rare in Indiana. While there are a few private facilities for those who can afford to pay for them, almost all treatment for addictions is done in an outpatient setting. One alternative to long-term hospitalization is involvement in our community support team. The social services staff at the hospital or outpatient office can offer you some suggestions about available community resources. There is no guarantee regarding length of stay in the hospital. Most clients are treated and released within a few days. They are expected to follow up with outpatient treatment at that time. Regardless of whether they come voluntarily or on a 24-hour emergency detention order, the psychiatrist has the legal right and responsibility to discharge the patient when he/she feels that the patient no longer meets the criteria of being dangerous or gravely disabled due to a mental illness. This can and often does happen in less than 72 hours. Sometimes, being hospitalized creates other stresses for a consumer like missing work, appointments, or obligations, being away from family and friends, and adding to medical bills. Hospitalization is not free. If a consumer does not have insurance, they will incur a bill even from the community mental health center. It is more than likely that, if you haven't had the benefits of the support and education about mental illness that the National Alliance on Mental Illness (NAMI) can provide (without cost to you), getting in touch with us would be of immense value to you. If you don't know whether there is a NAMI local affiliate in your area, you can find this out either by contacting NAMI Indiana at , or by visiting the NAMI web site ( and click on State & Local NAMIs. If there is no local affiliate close by, NAMI Indiana is eager to talk to you about helping you to form one. Contact Pam McConey at or at pmcconey@nami.org for more information about this possibility. To find out more about the various activities of NAMI Indiana, log on to