A Better Way: Insights From Mental Health Program Director

Rachel Christensen always knew she wanted to be in a helping profession and discovered she loved her psychology courses at Olivet Nazarene University. While in college, she managed a local movie theater, where staff brought clients from a nearby state institution.

“Even just buying a ticket and popcorn for their patients – I call them clients – I could see how unkindly the staff treated them.”

She got a look inside the institution, cold and unhomelike, when she interned there. We can do better, she thought. Soon after college, she moved to Frederick, Md., and began an almost two-decade career serving people with mental illness, substance use disorders, legal issues and cognitive disabilities. She began in direct services in a small three-county, multi-tiered program. She’s now a program director in a statewide mental health system that serves 6,000 people at any given time. Her program, the Residential Crisis Stabilization Unit, serves people being released from the state psychiatric hospital, meaning they have the most treatment-resistant diagnoses and have had legal issues in which the state treated her clients rather than incarcerating them. She helps those clients avoid institutionalization.

Christensen’s program is part of a larger system run by her organization, and others in the state. Her company – she is speaking solely as a professional, not as a representative of her organization, so she asked it not be named – treats children, adolescents, people with cognitive disabilities, homelessness, substance use disorders, mental illness, as well as veterans and senior citizens.

“If their condition is in the DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders 5th ed.), we treat them,” said Christensen.

Presently in the U.S., mental illness and substance abuse disorders are involved in one of every eight emergency department visits, according to the National Association of Mental Illness (NAMI). Mood disorders are the most common cause of hospitalization for all people under 45. Thirty-seven percent of incarcerated adults have a diagnosed mental illness; almost 21 percent of people experiencing homelessness have a serious MH condition; 15 percent of U.S. vets experienced a mental illness in 2019 alone; and, 70 percent of youth in the juvenile justice system have a diagnosable condition. Serious mental illness causes an estimated loss of $193 billion in lost earnings.

Those problems are not equally distributed across states and communities. States that have prioritized spending dollars to improve community mental health have much lower rates of homelessness, incarceration, hospitalization, crime and suicide. Maryland is in the top 10 for treating and reducing mental illness. Indiana is close to the bottom – 43rd out of 50 states. Indiana has more adults with mental illness, substance abuse disorders and serious thoughts of suicide, more who have not received treatment and who lack insurance to be treated. Furthermore, we have more adults with cognitive disabilities who cannot see a doctor because of costs. That puts more pressure on our police, legal systems, local hospitals, schools, non-profits and HUD. Maryland chose to prioritize programs that would address root causes. Illinois, the state in which Christensen did her internship, jumped from nearly the 30th position in 2018 to No. 10 in 2021 through aggressive funding of proven programs modeled in Maryland and other states.

In states, where community hospitals and jails are the primary treatment options for people experiencing mental illness and substance use disorder, there are huge gaps in treatment. A community hospital can usually release a person with two or four weeks of medications while they frequently wait 45 to 60 days to get continued care. Their medications run out and they aren’t getting therapy.

“There’s a lot of people that are surviving on too little support and are frequent, frequent fliers of high recidivism with only community hospitals,” said Christensen. Those hospitals lose dollars for that recidivism. Jail recidivism costs us all: court and legal fees, jail budgets, lost wages, rent and house payments skipped, evictions and repossession of cars, all of these affect the community. “They could stay out of the hospital if they just had a little bit more residential or psychiatric rehab programs in the community,” Christensen added.

Her state’s counties, like our county, have mobile crisis response teams – or QRTs – though each one varies based on the county’s spending model. (Note: Given our state’s statistics, this is a blessing and demonstrates forward-thinking in our leadership.) In Frederick County, where Christensen lives, the mobile crisis team has a social worker, EMT, doctor, therapist, RN, case manager, vocational specialist and substance abuse counselor who monitor all 911 calls. They can notify any officer responding to a call saying members of their team will come along on the call. Furthermore, Frederick County’s PD trains cadets to interact with clients in her system by visiting with staff and clients, learning about their needs and how to relate to and communicate with clients.

Other programs in her system include homelessness support. Professionals seek out tent encampments and offer basic health and safety resources to those who refuse housing. For children and adolescents, they provide in-school programs and respite services for caregivers so they can get date nights, or spend time with other children in the family. Her organization runs domestic violence shelters, as well as programs to work with offenders. The state has also recently opened psychiatric urgent care for those experiencing an acute crisis.

Christensen believes that this variety of programs makes the system work. People are unique and given the numbers of people who experience mental illness in their lives, it’s important to talk about it, destigmatize it and allow for “weirdness” by which she means a diversity of a-typical behaviors in our communities.

Christensen explained how her program supported a Gulf War veteran with severe PTSD. For a while, he couldn’t live independently because he couldn’t go into a supermarket. Once inside, he reacted because he couldn’t see the exits and after years of experiencing IED explosions near his base, he needed to know how to escape. Her team spoke to the staff at the supermarket close to where he lived. They walked him through the store, showing him all the exits, including how to escape out the back if he needed. “Now he can go to the supermarket. Just that one store, but he can do it,” which means he can live independently now. But that required trained professionals with empathy to help both the individual and the community learn how to help each other. It required paying professionals and building programs that meet each person in their condition and help them toward wellness and integration.

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