For many years I have been meeting with a small group of friends to play cards. We come from a variety of backgrounds, outlooks, and political perspectives. We tease each other a lot, rarely talk politics, but we do discuss Island County issues and concerns that strike us as important. Topics like the homeless, the ferries, crime, traffic, visitors, the Navy, and local businesses. My objective in writing this blog, grew out of these conversations. I seek to get information from reliable sources for residents of Island County.

My first interview was with Rick Felici and Evan Tingstad. Sheriff Felici manages the Island County Sheriff’s office, and his staff responds to the calls that come in to his department via the Island County Emergency Services Communications Center (ICOM911). His office is often the first point of contact for issues related to public safety and they get referrals from community organizations and individuals as well.

My second interview is with Behavioral Health Manager/Clinical Supervisor, Kathryn Clancy. The behavioral health department in which she works is under the umbrella of Island County Human Services. She supervises staff who provide a variety of services for behavioral health issues. Her staff are often the next point of contact for people in need.

Behavioral health is a blanket term that includes mental health. The American Medical Association (AMA) website says that: “Behavioral health generally refers to mental health and substance use disorders, life stressors and crises, and stress-related physical symptoms. Behavioral health care refers to the prevention, diagnosis and treatment of those conditions.”

We met on Friday, Feb. 24^th, 2023 for an interview.  (M. = Mike Diamanti, K = Kathryn Clancy.)

Initial Points of Contact

M. My understanding of things is that deputies and police officers often serve as the first point of contact with people who are having behavioral health issues. When I look at the Island County Behavioral Health-Outreach staff directory, I see people listed who work in Opioid Outreach, as Jail Counselors, Co-Responders and Recovery Navigator Case Managers. Could you elaborate a bit on this?

K. Well, to be frank, there’s an overlap with all our services. But we do have specific jobs that people are responsible for, and I thought what I could do is explain to you a bit about how we like to organize it in our mind and in our work. I think that will speak to what you just talked about in terms of the Sheriff’s office being the first contact for people with behavioral health disorders. In a crisis situation, deputies and officers are often the first responders, and for quite some time we’ve been working with them, even before we had some of our programs with them, in terms of taking referrals from them.

When they would come across someone who was having a mental health crisis or a substance use disorder crisis, and they weren’t in need of being arrested for a crime, we would reach out. We realized quickly that there’s a model out there in the world that works quite well. It’s been called different things, but essentially it’s having a mental health professional along with a law enforcement officer going to the scene.

M. When did Island County start that?

K. We got that going in 2019. Richard West was our first embedded mental health professional, but that program got interrupted by Covid. Once we were able to start up again, he had moved on to another position, but we realized that we really needed someone. He had been so busy with both the Oak Harbor Police Department and the Island County Sheriff’s Office.

M. You wanted to replace him?

K.  Yes, at a minimum. We felt we needed two people. We fund one position ourselves with the one-tenth of one per cent mental health sales tax funding. We asked for some additional funding from the North Sound Behavioral Health Administrative Services Organization. They are in charge of the crisis services for our five county region.

We realized that having two responders worked best in our county due to our geographical challenge, and because we wanted to be able to respond to referrals on our own, and not just with officers. Those were the two challenges. The way the program works now, is that the Co-Responders are housed at the Sheriff’s office and at the Oak Harbor Police Department. They are asked to go out with officers on calls when needed, and respond to additional referrals.

M. Do the responders go out on calls by themselves?

K. Yes, we realized it was difficult to be paired with an officer all day because the officer would have to respond to different calls and they might be needed elsewhere. So we decided that the Co-Responders would each have their own vehicles. They respond in three ways: a planned ride-along with officers/deputies, they go out on calls with officers/deputies when needed, and respond themselves to referrals.

M. And when you say needed, is that when needed by the officers or when needed via the referrals?

K. Both. The Co-Responders work for Human Services. But Amanda Borman-Ballard responds to whatever the Sheriff’s office needs, and Christina LeClaire responds to whatever the Oak Harbor police department needs. So, the way it looks on a daily basis, they may go out on two or three calls with officers, but they also respond to referrals. If an officer on nights or weekends gets a call that the Co-Responders could help with, the Co-Responders get a referral from those officers and they respond to those later – the next day or later in the day.

M. In a medical setting, the triage system is often used. (Triage refers to a preliminary assessment in order to determine the urgency of the person’s need for treatment.) Is that what you are describing?

K. Absolutely. Both of our Co-Responders have mental health and social work backgrounds, and they are both mental health professionals. They bring a lot of knowledge about these areas that currently does not exist in police departments. The Sheriff’s Office and the Oak Harbor police department get a lot of mental health and substance use disorder calls, so the expertise of the Co-Responders is really important.

Outreach vs. Walk-Ins

M. What I often hear from people is: “What are the police doing about the guy who is yelling and wandering around the Dairy Queen in Oak Harbor?”

K. Many of the folks that they are talking about have serious mental illness and substance use disorder. When we’re talking about that sort of complicated combination, it’s difficult unless you’ve built a relationship with that person to be able to help them. And that’s one of the things that I think our programs are uniquely designed to do. A lot of government entities and other counties in particular, are realizing that we need people doing outreach. That’s part of the problem with the current mental health system in our country. It’s built around coming in to the behavioral health office and getting multiple assessments. For people who are having challenges out in the street or with law enforcement, that model doesn’t work for them. There are too many barriers in the world right now for people to get the help they need.

M. We used to have walk-in clinics back in the 1970s and early 1980s. We’re not going back to that model. So how do people get help now?

K. The laws are very strict when it comes to involuntary detainment. And even when someone meets the criteria for that, the stay isn’t very long. It’s just a basic stabilization stay. Unless there’s a plan upon release, which quite often there isn’t, then they are back where they started almost instantly. Our goal is to try to work with people so we can gain some trust in understanding their situation and along with other community providers help them move towards a more permanent outcome.

The Co-Responder program, the Recovery Navigator program, and our other outreach programs help individuals work toward long-term, positive outcomes. We have regular case management outreach, we have counseling outreach, we have early childhood outreach where we go to people’s homes and help them with parenting. I think these services, meeting people where they are, are what helps create more of a long term solution.

Island County Programs

M. I printed out the “Behavioral Health Resource Guide for Island County, WA” and the quantity and variety of resources crammed onto two pages is impressive. https://www.islandcountywa.gov/Humanservices/Behavioral-Health/Documents/2022%20Behavioral%20Health%20Resource%20Brochure.pdf

K. Yes, let’s look at all our law enforcement behavioral health services; the Co-responders are one, the Recovery Navigator program is one -- Bill Larsen is the program manager for the Recovery Navigator program – you’re going to want to talk with him.

 

Jail Programs

K. We also have several jail programs. Essentially it’s three separate programs. We have a jail program where we have a mental health professional who works in the jail seeing individuals Monday through Friday, and that’s Laurel Brown. She does short-term and long-term counseling and daily risk assessments, and she works very closely with the medical staff if there’s any medication needs for people.

And then we have our RSAT Program, which is brand new, and stands for Residential Substance Abuse Treatment. It’s a program that has been around for awhile in prisons, primarily, because it’s up to a 90 day inpatient program. So just like somebody would go to inpatient treatment for 30, 60, 90 days at a substance use inpatient treatment facility, it’s the same in the jail. The people who are accepted into the program live in their own separate “pod”.

They have their own separate expectations, and they attend two substance use disorder treatment groups a day. Plus they get individual substance use disorder treatment and mental health treatment. We have a lot of things in that treatment program that essentially would be just like if somebody was in an inpatient treatment center.

M. It seems that treatment would bring up the issues and the pain that the person is going through, instead of just sitting in their cell.

K. Absolutely, and the third program we have is the jail transition program that we’ve had for many years, and that program has grown. It started out with a half-time position and it’s grown to a full-time position. Leif Haugen is the current jail transition coordinator. He works to assist someone transferring out of incarceration. The service is open to anybody who wants it, even if they are only there for a week. He can follow up for up to six months after they are released. He sets up whatever they might need for success.

A lot of times it’s housing, which you know is a challenge. But it’s also other things like mental health treatment, substance use disorder treatment. He can work with the folks in the jail to get the assessments they need, or other things that might be a barrier when they are released.

M. I see the name Chelcee Lindell mentioned as the Jail SUD Counselor.

K. She is now the Substance Use Disorder professional for the RSAT program. She does most of the groups.

M. She seems like a passionate advocate for helping people with recovery.

K. She is. She started out as a case manager for us and became very interested in working in the jail. She took over the jail transition position and then became a substance use disorder professional in the jail.

M. Can you speak a bit about Jose Briones, who is the Chief Jail Administrator?

K. He’s a great partner. We’ve always worked closely with the jail, and his real insistence is that people are not just warehoused, but that they have opportunities for programs. This has been really helpful and made it easier for us to move forward.

District Court Programs

M. What are some of the other outreach and connections with the public?

K. Jacob Force is one of our outreach case managers. He spends part of his time at District Court helping people get connected to different services if that was their primary reason for being in court. Why is this person appearing at court? Is it a substance use disorder? Is it a mental health thing? Is it because they are homeless? Is it a combination? If it’s any one of those social determinants of health, then Jacob will try to get them hooked up with services on the front end.

M. And District Court consists of both Island County District Court and Oak Harbor Municipal Court?

K. Correct. Both Judge Hawkins and Judge Costek are great advocates and supporters of having behavioral health services available in their courts. Jacob has also opened up the door with probation. He attends probation hearings where somebody has violated probation. Why did they violate their probation? Was it because they couldn’t get somewhere, or they couldn’t afford an interlock device for their car? What is the barrier? Jacob will try to help with those barriers. We’re trying to divert people out at various different points.

M. So Island County Behavioral Health personnel are trying to help people navigate a variety of systems that could help them?

K. Right. And in jail, once they are in the system, we are trying to get them out permanently. After they are out, we want to get them involved in the longer term services we have, like the jail transition, and our Co-Responders work on post-jail situations as do many of our longer term case managers who do a lot, especially with follow up.

The systems themselves, unfortunately, are so complex. I mean, it’s a challenge for our folks to navigate the systems, let alone anybody else who may have other challenges too, like homelessness. It’s very difficult to navigate the systems. And so we do a lot of navigating those systems for people.

Some folks have fallen through the cracks at various points and may end up back in the criminal justice system repeatedly. And that’s what we’re really trying to prevent. Also, people who have a variety of hospitalizations because of mental health issues. Permanent solutions are tough, but they are there. It just takes a lot of work.

Need for Preventive Services

M. Sheriff Rick Felici said that he believes that 75% of the people in the jail are there because of mental health related behaviors or chemical issues. Do you think that’s a fair assessment?

K. It probably is. It might even be higher than 75%. It’s not untrue that our jails in our country have become the quasi mental health centers, mental health hospitals. And instead of just saying, well that’s too bad, we have to work with what we have. We don’t have any mental health hospitals anymore. We really need to figure out what we can do in the future.

There are big ideas that would be helpful, that are very costly. There are also changes in laws that need to happen, as well as other things, to really solve the problem. Preventive services, in my mind, are key to implement. But we are likely to get less funding for preventive services than we do for any other services.

M. In Island County?

K. Just in general. We do have some prevention programs for early childhood and youth and family that we work on, but again, just not as much funding in those areas.

M. I hope to have another conversation with you about other areas, for instance, Veterans Services.

K. Yes, we can talk about those services. And housing. Housing is huge and our folks here know everything about housing in our county. The Housing Support Center is in our office, which is the place that people come to who are homeless or at risk of homelessness to get services.

But one of the things I want to mention is that we use a model to conceptualize our services. It’s called the Sequential Intercept Model (SIM). It really explains  the different intercepts for diversion, as I was mentioning. And many of the service providers around the country use this model. These are folks who work with both criminal justice and behavioral health. Intercepts for people can take place before anyone is ever arrested.

We need somebody with law enforcement, we need somebody at District Court, we need somebody at the jail, we need somebody for jail transition, we need somebody helping people get into treatment.

Hospital/Emergency Room Services

M. One of the things I hear from people is: Why do we have to have so many people in government involved? It used to be that the emergency room of a hospital was the point of entry.

K. That is still the case, but hospitals are different now. Hospitals as well as emergency rooms are complex entities and understaffed. Most services are funded by different and equally complex funding models.

M. And that’s a huge shift that people didn’t notice until it arrived.

K. Right

M. Can you speak to that?

K. We have a strong relationship with Debbie Ries, RN, who is the Emergency Department Manager at Whidbey Health. Our hospital has challenges that other hospitals don’t have. And partly because it’s a rural hospital, and understaffed. Reimbursement rates and preauthorization from insurance companies dictate medical services now, hospitals included. To complicate matters, you may have people coming to the emergency room with complex serious mental illness and/or substance use disorder as their primary problem, and they are in crisis.

It’s difficult with not enough staff and not enough social workers to manage it. Five years ago there were seven or eight social workers on staff at Whidbey Health. Now there’s one and a half. And the social workers they have are dealing with all the social work for patients, including discharge planning. They’re worn very thin.

M. One of the things Sheriff Felici said was that the emergency room often isn’t equipped or able to deal with the situation. I would imagine that the referrals the police officers and deputies and Co-Responders make are very important.

K. They are the staff who work with the hospital the most. Both Amanda and Christina are working with the hospital and hospital social workers constantly.  

Our work with the hospital and other community partners is all about our relationships with them. The relationships that we are building through our different programs are helpful and successful. We are working toward agreements between the hospital, the Designated Crisis Responders (DCR), law enforcement, and other community providers so that we have protocol that can be followed and can offer assistance when needed.

My thanks to Kathryn Clancy for spending time with me explaining some of the services Behavioral Health provides for those in Island County who need assistance.