San Juan County may get a crisis triage center. Here's what to know about the proposal.

San Juan County residents heard their first description of how a proposed crisis triage center would operate and the kind of services it would offer during a public meeting earlier this week at the Farmington Civic Center.

The meeting, which was presented by San Juan County officials, was held to introduce local residents to crisis triage centers, which are 24-hour behavioral health facilities designed to stabilize people experiencing mental health crises. Earlier this year, the San Juan County Commission contracted with RI International — a Phoenix-based firm that operates crisis triage centers across the United States and in New Zealand — to put together a study examining the feasibility of establishing such a facility here.

While the idea of opening a crisis triage center in San Juan County remains in the exploratory stage, the San Juan County Commission is expected to decide soon whether to contract with RI International to put together a business plan for operating such a facility. Monday’s meeting drew dozens of local residents eager to hear more on the subject, including elected officials, law enforcement representatives, behavioral health professionals and even some folks who indicated they likely would be recipients of the kind of services such a center would provide.

County Commissioner Terri Fortner, who is a nurse, opened the meeting by explaining to the audience that a measure to establish crisis triage centers throughout the state was considered, but did not pass, the most recent session of the New Mexico Legislature.

She then introduced the meeting’s main speaker, RI International Vice President of Consulting and Business Development Wayne Lindstrom, a 52-year veteran of the behavioral health field. Lindstrom delivered a lengthy presentation on what a crisis triage center in San Juan County could look like and the impact it might have on local efforts to provide meaningful care for those experiencing mental health crises.

Lindstrom opened his presentation by pointing out that San Juan County already takes a relatively progressive approach to dealing with residents who are in the midst of a mental health crisis. But he said the Crisis Now model that RI International has developed is meant to radically transform how communities respond to those folks, providing them with meaningful short-term and long-term care instead of simply leaving it up to law enforcement officials to take them into custody or relying on hospital emergency room personnel to deal with them.

The kind of crisis triage center that Lindstrom described would offer three core services — a crisis call center hub, crisis mobile teams and a crisis recovery center. Lindstrom said it is very important that the first element, the crisis call center hub, include text and online chat elements, given the fact that many of today’s young people prefer those forms of communication to traditional over-the-phone conversations.

“Young people don’t communicate verbally,” he said.

Such a call center also would need to be GPS enabled, he said, so that the location of a caller could be ascertained.

The crisis mobile teams would be small squads of behavioral health professionals who are designed to take a “serve anyone anywhere anytime” approach to their work, he said.

The final element, the crisis recovery centers, would be designed to replace detention centers and emergency rooms as the destinations or drop-off points for walk-in clients or people who are brought in by law enforcement officials. Lindstrom said most of the folks who find themselves experiencing a mental health crisis have experienced some kind of traumatic event with which they are unable to cope, and such centers are designed to help them return to a stable frame of mind before their long-term needs are addressed.

“The goal in these crisis centers is to be able to say yes 100% of the time to anybody who presents,” Lindstrom said, indicating no one is turned away because of an inability to pay or because of overcrowding.

The centers also are designed to remove a significant burden from law enforcement officials who sometimes find themselves tied up for hours filling out paperwork associated with people experiencing a mental health crisis at detention centers for emergency rooms.

“We guarantee law enforcement they’ll be off the premises in three to five minutes,” Lindstrom said.

Those crisis centers can operate in three ways, he said – as short-term centers that feature recliners instead of beds, where people in crisis can go voluntarily or be taken involuntarily for up to 24 hours; as longer-term centers with beds where clients can stay up to two weeks, and as centers that offer both recliners and beds. New Mexico is one of only a few states that permits centers to operate by that hybrid third model, Lindstrom said.

Centers that offer recliners provide a distinct advantage over those with just beds in that they do not face capacity limits, he said, allowing them to not have to turn guests away if they are full.

Lindstrom said RI International operates its crisis triage centers in a calm, low-key fashion designed to minimize stimuli and perceived threats, leading to a natural de-escalation of aggressive or antisocial behavior. The centers feature a living room-type atmosphere instead of looking like an institution, and they operate with an open floor plan in which the staff mingles with the guests. There are no security guards, and only rarely — in 4% of cases, he said — is it necessary for a guests to be placed in restraints or put in seclusion.

“We regard seclusion and restraint as a treatment failure,” he said.

The facilities are staffed by multidisciplinary teams that include doctors, psychiatric nurse practitioners and peer support workers who have lived experience with behavioral health issues, Lindstrom said.

“That’s our secret sauce,” he said, explaining that those peer support workers — who make up 50% of the staff at RI International’s crisis centers — are highly skilled at engaging guests and determining how they function in the world.

Lindstrom said if county officials decide to have RI International compile a business plan for a crisis triage center, his firm’s responsibility would be to “give the county a clear road map of how to implement” such a facility — one that would be financially sustainable while providing significant benefits to many local residents.

Lindstrom maintained the cost of operating such a center would be more than offset by cost savings to law enforcement agencies and health-care facilities that currently bear the responsibility of dealing with folks experiencing a mental health crisis.

“There will be a net cost savings to the county,” he said.

He acknowledged that the establishment of a crisis triage center would not serve as a silver bullet by eliminating all of the county’s behavioral health issues. But he said it would provide a number of services and benefits that are beyond the county’s reach now.

The discussion about opening a crisis triage center in San Juan County was welcomed by one of the law enforcement officials in attendance Monday night, Bloomfield Police Department Chief Phillip Francisco.

“This kind of project is really where my heart is,” he said, explaining that his focus during his law enforcement career has been on eliminating the revolving door of arrests, emergency room visits and jail stays for many of people experiencing a mental health crisis.

Francisco said that during his time as chief of the Navajo Nation Police Department, he initiated a pilot project in which officials compiled a list of who the 20 most-frequent offenders were across the department’s seven districts. That study showed that a single individual with mental-health issues was arrested by officers 111 times in a single year. The cost to his department for those encounters, Francisco said, was $250,000.

Another supporter of the idea of the establishing a crisis triage center is Farmington police Chief Steve Hebbe, who long has expressed concern about the relative lack of mental health treatment options across San Juan County. Hebbe was not present for Monday’s meeting, but he issued a statement on Tuesday endorsing the concept.

“We have been part of the conversation as this idea has been kicked around, and I strongly am in support of the conversation,” he said in a statement emailed to The Daily Times. “I am excited about the prospects of it but there is a lot of hard work to get there.”

Mike Easterling can be reached at 505-564-4610 or measterling@daily-times.com.Support local journalism with a digital subscription: http://bit.ly/2I6TU0e.

This article originally appeared on Farmington Daily Times: County Commission could seek creation of crisis center business plan