Linn County will launch mobile mental health services

Linn County will soon dispatch a mobile mental health care clinic for residents. The Mobile Crisis Intervention Team will be able to work with residents throughout the county and assist in a crisis situation.

Workers have traditionally met with residents in emergency rooms but the mobile clinic, a modified van with a workspace and onboard generator, will provide more flexibility.

We hear more from Todd Noble, the county’s health administrator, about the need for more accessible care and how a statewide mental health crisis is affecting the region.

Note: The following transcript was created by a computer and edited by a volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Linn County is about to launch a mobile mental health care clinic. The Mobile Crisis Intervention Team will be able to travel in a van throughout the county to assist people who otherwise might not be able to get help. Todd Noble is the county’s health administrator. He joins us now to talk about this new service and the challenges in public health right now, more broadly. Todd Noble, welcome.

Todd Noble: Welcome. Happy to be here.

Miller: How did this new van come to be in Linn County?

Noble: Well, I think it first started off with the National Suicide Hotline Act of 2020 which went into law. And in Oregon, 988 was implemented and as part of that is House Bill 2757 which was sponsored by Representative Sanchez and Representative Nosse, put this out there that they really wanted to be mobile in the community, meeting people where they’re at. And so that sort of started the whole process and here we are today, and we finally are out there and we are mobile.

Miller: Oh, so it is already going around. My understanding is the last couple of weeks or months you’ve been getting it ready, but is it on the streets as of today?

Noble: So we’ve been actually mobile, just in cars, for a number of months. But yeah, our van was just, we got it a couple of weeks ago and I believe the actual van hits the roads next week. But as far as the mobile response we have been doing that for a number of months, in compliance with the new rules.

Miller: In the past, before these new rules and before you had people in cars, for the last few months or soon [in] this sort of tricked out van, what were you able to do in terms of responding to people in mental health crises in particular?

Noble: So, traditionally, community mental health programs have always been responsible for crisis services, for people that are having any kind of a mental health crisis. And that’s been that way for decades. But traditionally, what we have done is we’ve primarily gone to emergency rooms and hospitals, sometimes jails, but primarily hospitals overnight. In the daytime, all community mental health programs have had walk-in clinics, but that’s what’s normally happened over the years. And this is different because it is really trying to meet people where they’re at.

We will clearly be still covering our emergency rooms. But as we all know, emergency rooms are very busy and very overloaded. And so this will be a way to hopefully ease some of the challenges that emergency rooms face and again, trying to get out there in the community and meet people where they’re at. So that is the plan. And so we have this new tool to be able to do that for our community.

Miller: Can you give us a sense for the kinds of situations that folks in the van will be responding to? I mean, what’s an example of the kind of crisis that might necessitate a call?

Noble: Yeah. So it could be something like somebody is having issues of suicide, they maybe have some suicidal ideation or thinking, family members may call up and they’re concerned about their loved ones. So we could go out and see those folks. Somebody that may be experiencing some kind of symptoms. For example, aside from being despondent or depressed, somebody who may have some psychotic symptoms and rather than going to the emergency room, we could go and intervene.

We are pretty skilled at deescalation and getting people settled down and so that they can be receptive to services. So things along that line. Pretty much anybody that does call that identifies as having some kind of a crisis, as long as the scene will be safe, we will go out there and meet them where they’re at.

Miller: And when you say does call, meaning calls 988, as opposed to 911. How will dispatch work?

Noble: 988 has been in effect since 2022. Right now, if somebody gets out there and calls 911 and they’re having some kind of a crisis or a family member or something like that, it gets channeled to the 988, which is pretty much the National Suicide Hotline. And we’re trying to get it out there in the community that we do have 988 now. So I think over time, people will know that, just like 911. But I think at the moment if somebody doesn’t know that and of course not everybody does, they call 911, it’ll be dispatched right to 988. And then we are involved.

Miller: There are different staffing models that we’ve heard about in the last couple of years, for how different local versions or regional versions of crisis response teams [are] staffed. How did you go about thinking about who should actually be in the van?

Noble: Well, I think it was a bit of a compromise. A lot of this comes from the CAHOOTS [Crisis Assistance Helping Out On The Streets] model from Lane County. Mobile response is national now and that’s what the move is across the country. But with Oregon, the way we looked at it, it’s pretty much we have a therapist, so a person that’s trained in crisis, that would be a therapist [and] goes out with a van. And we also have folks that are not master’s level but bachelor’s level folks, that work with our clients on a daily basis. And that are very good at engaging folks. So that’s what our model is, where we have a therapist, a crisis therapist and then another, a paraprofessional, who is very well versed that has been certified, that has gone through trainings and that’s what we’re doing.

I think CAHOOTS was originally, they had an EMS person with them. But that was probably a tall order for EMS. And so it’ll be two folks that are experts in dealing with people and de-escalating situations.

Miller: Linn County is about 2,300 square miles, one of the larger counties in Northwestern Oregon. Do you have enough vehicles and trained responders to actually be able to get to people where they are?

Noble: Well, this is our first step. We have the one van now and we have cars. So the team will be small to begin with. We typically have gone to the emergency room about 60 times a week. So yes, Linn County is a very big county. So to go and cover the whole county will be a challenge. Luckily, we probably won’t be getting multiple calls at once.

This is sort of the start to this process. I think Oregon is very invested and legislators have been very invested as well as the governor to deal with the behavioral health challenges that Oregon has faced. And this is one of the tools to do that. So we’ll start off with this one van and see how it goes and at the same time covering the hospitals. But I think part of it is, we’ll see as we go what the need is, what the demand is. And from there, we will adjust to try to meet the community needs the best we can.

Miller: What happens after people show up? I mean, if somebody, say, needs inpatient care, are there available beds in general that they could be taken to?

Noble: Well, that’s actually a really good question and I speak about this a lot because I mean, to be quite honest, I think that right now, 2024 is the most challenged that the state of Oregon has ever experienced when it comes to crisis and access of care. And I believe this is why the sponsors of [HB]2757 wanted to get this tool out there. But it is a big problem. I mean, right now, one of the aftermaths of the pandemic is that we have not had access to a state hospital bed in over two-and-a-half years. The state hospital we used to be able to put folks in, civil folks, they would go to a local psychiatric hospital and if the person didn’t recover quickly - because we want to get people back into the community - they would go on and be referred to the state hospital. But that option is completely gone right now.

We, in Linn County, like everywhere else including the state hospital and hospitals, health care providers, are really in a crunch for staff. And the state hospital is experiencing that. And currently most of the state hospitals are forensic cases, so when you don’t have access…

Miller: Just to remind folks that what these specialized terms mean - those are in the criminal justice system and then, say, they’re at the state hospital until they can actually be mentally competent enough to defend themselves in criminal proceedings or different versions of involvement in the criminal justice system, as opposed to people who would be civilly committed.

Noble: Yes, that is correct. Yeah, I should have been clear on that. The state hospitals had two tracks. They’ve had the track that you just outlined, folks that are forensic cases and that need to be able to aid in their own defense. And the other track is the civil cases and that is just a person in the community that is struggling and really needs a head on the bed service because they’re an imminent risk to themselves or others. The state hospital has always had that, so we could get civil beds in there. Unfortunately, because those civil units are completely shut down, we have very little access to move people through the system.

For example, in our community, and again, because of staffing challenges, we have had 24 beds in our area since 1995. Right now, we have between 10 and six beds, and it’s typically more like six beds because of the acuity. And the difference though is in the past, a person would be in the hospital. We have a great hospital locally and they would be in for an average length of stay of six days. Now, because the state hospital is shut to the community, those folks are there for weeks to months. So that is a huge problem because if we don’t have access to beds and being able to do civil commitments, it is a huge challenge for our community. So this van is great because we can be out there serving the community. But if somebody needs to go into a hospital because of the acuity and they’re a danger to themselves or others, we have very little options.

Miller: So what might you do? I mean, if there is no bed available locally or in Salem and somebody is in a crisis, the people in the van soon or in the cars now, they can’t put somebody in a bed that doesn’t exist. What do they do?

Noble: Well, that is our challenge. I personally ran a crisis for well over a decade and it is stressful right now because that very important tool is very limited. So we’re resourceful. We’ve been working at it now. We try to get people into our programs. We have assertive community treatment programs, which basically it’s like almost what a hospital would be as an outpatient, but it can’t be as comprehensive as a hospital. We try to engage people the best we can. We try to have quick access. And we do work with our hospitals. They will hold people for a time being as we scramble to find a bed. But it has been a huge challenge. And it keeps me up at night. I have a lot of community folks.

Recently I had one of our community members who has a sibling that has really been struggling and we have desperately been trying to find a bed. And it is a real challenge when there’s none to be found. There’s not like there’s not any, but they’re just so reduced. So it is a challenge, which is why my staff need to be very skilled at engaging people, calming people down and then giving them quite quick access to outpatient treatment. But we are missing a huge tool. And once we can get that workforce back…I don’t know where they’ve gone. That is a challenge that all of Oregon faces, and I think legislators are very aware of it. The Oregon Health Authority is aware of it. I met earlier in the week with the new director of OHA and basically spoke my mind, and she’s aware of it. And I think that all of us collectively are trying to get hospital beds back online, but it’s not going to happen any time soon. And so this tool, meeting people where they’re at, trying to de-escalate, is something that can be helpful. But ultimately, the system right now is having some challenges.

Miller: Todd Noble, thanks for starting us off today. I appreciate your time.

Noble: Thank you.

Miller: Todd Noble is the health administrator for Linn County.

Contact “Think Out Loud®”

If you’d like to comment on any of the topics in this show or suggest a topic of your own, please get in touch with us on Facebook, send an email to thinkoutloud@opb.org, or you can leave a voicemail for us at 503-293-1983. The call-in phone number during the noon hour is 888-665-5865.