Rebecca Phelps-Smith and M. Christine Macbeth: Your courage, our care

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PITTSFIELD — In May, the Brien Center's Crisis Team helped 489 adults and children in Berkshire County resolve a behavioral health emergency. In the last 11 years, this is the highest number of cases that we've seen. In fact, the number has risen every month but one in 2018 — testament to an increasingly complex world these days with more drugs, more violence, and less hope.

The increase in cases takes on even more significance when the size of our Crisis Team is added to the equation. We have eight full-time trained mental health professionals with expertise in crisis intervention; five part-time members and a handful of per diem members. Each one brings a level of compassion, dedication and skill that have combined to save lives and get families back on track. There just aren't enough of us.

In light of the growing need, we think it would be helpful for our community to better understand our work. In essence, we are the emergency department for behavioral health issues and our phone rings around-the-clock, every day of the year. The calls come from frightened parents with depressed teens, from frantic husbands or wives worried about a suicidal spouse, from school officials who need assistance with an out-of-control student, and from individuals who believe they need help — right away.

In a perfect world, a member of the Brien Center Crisis Team would be dispatched immediately to each situation. But given our numbers, our reality is far different. Thus, we triage emergency calls, balancing the out-of-control student at school with the caller who says he wants to end his life. We understand how difficult it can be for people in crisis and their families to cope with the wait.

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Ultimately, a member of our Crisis Team will answer every call, beginning a comprehensive response that includes an evaluation of the person's mental status, what symptoms they're experiencing, and an assessment of their risk. We try hard to speak with loved ones to get a complete picture of what's happening at the moment and what may have led up to the crisis. The Brien Center Crisis Team cannot prescribe medication.

If the person in crisis is already connected to an outpatient provider, he or she is contacted. Once the crisis has been resolved, and with the individual's network of loved ones on board, the crisis team member may leave the patient with a follow-up appointment and other resources for help. Most people in crisis do not need a higher level of care beyond the intervention provided by the crisis team member. If further evaluation is necessary, the patient is sometimes sent to the hospital emergency department.

At the hospital, the Brien clinician, in consultation with the emergency room physician/physician's assistant/nurse practitioner, psychiatric resident and attending psychiatrist, determine the next steps. All have to agree with the disposition of each patient. Few are hospitalized. The vast majority are sent home with a plan that includes check-in calls to the Brien Center, an appointment to see a psychiatrist or counselor, and a lot of safety planning to identify their support network at home.

This is very hard work — for both the crisis team members and the people and families we serve. They are facing the toughest days of their lives and need all of the resources we can provide. In some cases, we are able to refer a family to family partner which has lived through a similar situation with a loved one. We also have peer counselors — individuals who have come out on the other side of a behavioral health crisis and can offer the kind of personal support and hope that can only come from someone who was once in their shoes.

All of this reminds us again why the slogan of the Brien Center is so appropriate— Your courage, our care.

Rebecca Phelps-Smith, LICSW, is division director of Acute Care Services and M. Christine Macbeth, ACSW, LICSW is president and CEO at the Brien Center.


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