Sherri Witwer: Rethinking How We help People in Mental Health Crisis

Welcome to Why Not Me the World? Podcast hosted by
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alone in this world. Hopefully you gain more awareness, acceptance,
and a better understanding for autism around the world. Hi,
I'm Tony Mantor. Welcome to Why Not Me the World?
Humanity over Handcuffed the Silent Crisis special event. We're delighted
to welcome from Sherry Whitwer, a dedicated and passionate advocate
for mental health and community well being. With an extensive
career spanning numerous roles, Cherry has made significant contributions across
a wide range of sectors. This includes community, nonprofits, government,
and corporate environments. She currently serves as board president for
cit Utah, sits on the national Advisory Board for the
ct Assists Program, and holds a position of board Vice
chair for the Utah Housing Coalition. Additionally, she is a
founder and board member of Peers Empowering Peers Utah, an
organization devoted to advancing mental health peers support. It's an
honor to have her with us today to share her
wealth of experience and insights. Thanks for coming on.
Thank you, thank you for the opportunity.
Oh, it's my pleasure. I understand that you are the
president for cit Utah. Can you expand on what that is?
Yeah, I guess As a matter of introduction, I'm a
long time mental health advocate, have worked in various capacities
in our mental health system, primarily in public policy advocacy.
I'm a family member of someone with a serious mental
illness and that's what has driven my work and my
interest in the mental health system. As part of my work,
I have been and in working with other families and
people with lived experience with mental illness. I have been
an advocate for crisis intervention team training.
That is training for.
Law enforcement, behavioral health providers, and families and people with
lived experience.
They come together to provide training.
For law enforcement and more importantly, to have an effective
crisis response when someone is in crisis, that law enforcement
has the training and the support of the mental health
system to help them respond effectively and get the person
to the treatment that they need. Now, really positive development
is that with our crisis response systems. We have developed
mobile crisis outreach teams that are driven by behavioral health
providers with peers, people with lived experience who can respond
to the overwhelming majority of those calls, and that really
provides better outcomes and helps us to treat mental health
as a mental health condition. However, there are times when
law enforcement needs to be involved or behavioral health team
is uncertain in their response, and so they can co
respond or have law enforcement take the lead in that response.
But having that training and that understanding is critical to
having better outcomes for everyone.
With what you're involved. I believe they have created a
new number for crisis response other than nine to one one.
Correct, right, there's a nine eight eight number now that's
been developed that people can call and get that behavioral
health response, and that has been a huge significant improvement
in crisis response. So ciit is still an important piece
and I don't want that to be overlooked in our
crisis response systems because they're just are times when law
enforcement needs to be involved. They are called out and
to recognize, oh, this is a mental health crisis and
we need to get our CIT team to be able
to respond differently to that situation.
When police are involved, the goal is of course to
improve outcomes and prevent situations from escalating. They responded to
the training efforts aimed at teaching the offices to quickly
assess situations and make decisions given their limited time and
of course the budget constraints. Have you seen as good
a response as you hoped for?
Yeah?
I think first of all, when you talk to law enforcement,
they are inundated with mental health calls and they really
would rather not be responding to those calls, so they
welcome mobile crisis outreach teams and some of these responses
with really takes the burden off of law enforcement and
having to make all of those decisions. Still, there are
times when they need to and that's where having best
practice CIT program is involved, and that means having everyone,
have all law enforcement get basic mental health training and
build those relationships, know who the partners in the community
are that they can call in crisis response. It also
is in having a specialized CIT team that responds, have
them follow best practices, and that means that they self
select that there are people who say, yeah, I would
like to work with this population and build these relationships
and know the system and know the civil commitment process
and take their education and their tools and training down
that path. When you are talking to law enforcement about this,
they get it that having that support and response and
having the best tools and training for their officers is
a win win for everyone.
A good CIT program has oversight.
That involves people with lived experience and family members who
can help inform that crisis response as well. It's just
a very unique partnership when done correctly, and it can
make a huge difference in how things are addressed.
Okay, let's do a scenario here. A police officer responds
to a call about a person whose behavior might typically
suggest they're under the influence of drugs or alcohol. Erratic movements,
slurred speech, other telltale signs. This individual is also holding
a knife or a gun, something that could drastically escalate
the situation with only seconds to react. How does the
officer distinguish between someone experiencing a mental health crisis like
psychosis or someone who's simply high or intoxicated.
They definitely will encounter people who are using substances, as
you point out, but this is part of the CIT training.
They do this very thing where they have different scenarios,
scenario based trainings, and they help to create some time
and some distance from what's happening to be able to
make those calls. And there's no question they often don't
have a lot of time, but that's where having officers
who have had some time on the street first of
all before they become CIT officers, so that only time
and experience can really help them differentiate between what are we.
Dealing with here and then.
Having that training and ongoing recertification for officers because there
are always new things that come out that they need
to be aware of. And I just think that kind
of training is so critical and CIT is critical in
helping to divert people. So rather than taking people to jail,
if there are receiving centers, which is another thing that
has been developed and is starting to get traction, where
rather than taking people to jail or even an er,
they go to to a receiving center which can do
an initial assessment and decide what level of care the
person may need, and it helps law enforcement and being
able to take the person to a safe place. That's
a real tool as well that has been very important
in crisis response. We need more of those in assisting
law enforcement and behavioral health in crisis response. Again, having
to helping to take all of the decision making off
from law enforcement and have them get behavioral support. Behavioral
health support in that response just makes a big difference
for everyone.
I'm really interested in getting back to that center you mentioned,
But first, could you tell me what a typical day
looks like when you're setting up a conference for police
officers or other first responders. What does the schedule involve
as they go through the process of learning all this
material which seems like a lot to take in.
So forty hour training for CIT in Utah, and I
can just speak to how it is. It's a forty
hour training in order to get that certification, and they
bring in experts who can talk about here's what mental
illness if. Here are the different medications, here are the
different ways it can present. Here is how someone who
is in psychosis can present and talking about a condition
called anisognosia where the person does not have insight to
their illness or that they're ill. And it's not just
denial or being difficult or belligerent, they truly do not
believe they have a mental illness and helping law enforcement
to identify that and bringing in speakers who have expertise
in civil commitment law, who are family members, who are
people with lived experience, having them spend time at different
locations with people who are in recovery is really important.
So it's just giving an overview of this system. The
big part of CIT is helping to build those partnership
so law enforcement knows who to call, who are the contacts,
where are the resources in our community that they can
lean on, And really it's creating relationships. So much of CIT,
and frankly with the whole mental health system, so much
of providing an effective mental health system is building those
partnerships and relationships and points of contact so that people
know who to call and how to have an effective response.
And that's what the training is now.
You mentioned a treatment center when someone reaches a point
where intervention is necessary. You mentioned a treatment facility where
they can go to for diagnosis in support. What factors
determine whether they end up in jail going through that
legal process or are directed to a treatment center instead
where they can get help and potentially avoid incarceration.
That is a big question and that's constantly being discussed.
How do we help law enforcement get as much information
about what's taking place as possible. Part of this is
we encourage families to be able to talk to law
enforcement and give them information and give them some history
and background. Having the behavioral health contact in that crisis response,
a lot of times the behavioral health system will know
the person and will be able to enlighten law enforcement
and what's taking place and be able to have an
effective response that way. And so it's about helping law
enforcement to get as much information as possible. This means
also there needs to be effective training for calltakers dispatchers
and help them to get that information as well.
Right when someone calls nine to one one for assistance
but provides insufficient details, it leaves the responding officers unprepared
for what they might encounter. Situations evolving civil disservices can
be particularly volatile, making them some of the most dangerous
scenarios for police to handle without the proper information.
That's right, and it's not always possible in every area,
depending on the size of the police department, but ideally
there's time to say we need a CIT team to
respond to this, and that's ideal where we have these
trained teams that respond and are able to use their
skills in that response, I would say overall, we really
need to provide more avenues for families to be able
to give information and explain what is happening and provide
background in history to the situation as well.
When individuals enter this facility you spoke about, does it
remove the legal aspects or do these legal elements remain
in place? How does this all connect and work together?
Yeah, so they're going to sort things out there. There
are twenty three hour stays and so it gives the
time to sort things out, to decide what level of
care the person needs, and then let the legal system
and that's got to work its way through as well.
But again, understanding that behavior is driven by a serious
mental illness or psychosis or anisagnosia is important information in
knowing how to help the person from there and with
the lead system, how to manage the court system with
that person.
As well as someone who's been involved for about twenty years,
what positive changes have you observed, particularly in the last
five or six years. It often seems like five years
is the window it takes for things to process and
start working effectively. So in the past five years. What
specific changes have you seen that you'd say are definitely
positive and moving in the right direction.
Well, I think we've been talking about one area, which
is crisis response.
I think that has been a big improvement.
I think having a number that people can call nine
to eight eight to be able to get assistant and
just help to sort things out on their end, a
person with lived experience or family.
To have that resource.
So I think the establishment of mobile crisis outreach teams
that use behavioral health providers and peers is very significant,
very important. Receiving centers are very important as well, So
I think those are big areas.
I think in some ways.
At least for general mental health and wellness, we're talking
more about that.
I think we're focusing more.
We understand that mental health is something we need to
address and try to andtervene early. Focusing on mental wellness.
I think that has been significant for.
The most part.
I think we've addressed stigma in a significant way, although
for people with very serious mental illness in some ways
it may be rougher for them where there's less tolerance
and patience around that.
But for the general.
Population, I think we've made some big improvements in that way.
Having observed these transitions, what key areas do you believe
still demand greatest scrutiny and effort. While these topics may
have been initially explored, they clearly warrant deeper attention and development.
Can you identify any areas where you would assert, Okay,
this absolutely requires us to prioritize and address it thoroughly
because you see the need for it to get better
for everyone.
Yeah, I think we do need to be focusing, first
of all on access for everyone.
How can people get timely access?
When someone decides, yes, I need help, how do we
help them get help quicker and in.
A way that works for them.
So there's that, But if we look at this population
with serious mental illness, we need to be focused on
how can we provide better services for them.
This is a.
Population that cycles through different systems, our criminal justice system,
the ers, hospitals, and too often are the care we
provide is facility based and so focused on Okay, now
they're in this facility.
Now they're in this facility, but.
We're not talking about how do we help people get
from point A to point B? And that really is
care coordination and that needs to happen on a high
administrative level where you have partnerships in place between agencies
and departments, where there are points of contact that the
buck stops with this person and helping to address people
with mental illness. Because people with mental illness will show
up in various different systems, there has to be a
point of contact within the mental health system that the
other systems can go to for assistance.
And that means wherever.
A person with mental illness appears, the mental health system
needs to be there and be there also to help
that person be diverted and navigated to the services they need.
So on an administrative level that needs to happen, but
also on boots on the ground level, we just.
Need more peers.
We need more case management, one of the most cost
effective interventions and one of the most effective interventions when
we can have people who can help people with serious
mental illness just get from point A to point B.
When someone is very ill, to tell them, okay, you
have an appointment downtown at ten o'clock on a Tuesday.
That can be very difficult for them to navigate and
there are a lot of barriers to them just with
transportation and being able to know how to find this
location and get there, so to have case management assigned
that can help, to have peers that can help talk
about their experience, that who know here on a granular level,
how we can help walk this person through and help
them feel hope and help them look at building a life.
I will say when I started in this work, I
had legislators tell me that no one funds mental health
because it's like putting money into a black hole and
no one ever gets better. And I think we've made
great strides in at least recognizing that people can do
well if they can get treatment and get the services
they need. But there are people who need more than
just basic out patient treatment. They need that intensive case
management within the system to help them get from place
to place. It's a simple intervention, but we really don't
do it very well as far as coordinating care for
that person. The other big challenge that we have had,
and you see this nationwide, is the lack of housing
for people. And we need deeply affordable housing, but we
also need permanent supportive housing, which is provide on site
supports and services for people with serious mental illness or
just people who have had a lot of experience being
unhealthed or being in the criminal justice system, that they
need more intensive support on site to help them get
from again point A to point B and have a
safe place to live so they can even focus on
getting and building a life.
How do we get legislators to truly understand the value
of funding systems like health care and judicial support for
the mentally ill beyond just knowing they exist. They often
dismiss it as throwing money into a black hole, missing
how it's a long term investment. I've spoken with people
who say they've lost ten years navigating these systems, fighting
for the right medication, battling through the court system before
finally thriving. How do we move past vague calls for
education and make law macacy that this isn't a bottomless pit,
but a step by step process that, though it may
take years, ultimately transforms lives and benefits society.
A key component of that is to be able to
show outcomes. And I can only speak for the system.
I know we're not great at showing outcomes and showing
what interventions work.
I think the mental health system has.
To be able to make that case and be able
to show here are outcomes. How do people lose ten
years of productivity and in that time, what the damage
that has done to that person's life, their family, their employment,
their life situation and involvement utilizing resources and typically multiple systems,
it is a cost savings mechanism for everyone to be
able to have an effective, accountable mental health system, to
make sure it's properly funded, but also that it's targeting
interventions that we know work and we do know what works,
and using best practices and evidence based practices, and really
being able to identify these issues earlier on, and really
wrapping services around people who need them, not make people
have to fail several times and cycle through too often.
What happens is we blame the person, and person blames themselves,
and that compounds their feelings of worthlessness and difficulty when
really we are asking people to navigate systems that are
incredibly broken, fragmented, siloed, and so then the thinking is, oh,
we really need to just use a hammer, and then
people tend to spend more time in the criminal justice system.
There's a lot of discussion there has been for decades
now about how jails and prisons have become the new
mental health providers and that does not work. Jails and
prisons cost trauma. They compound the problem again, and it
is far more cost effective to have interventions that are
community based, that have people living in the community with.
Wrap around services.
We know it's more effective, we know it's cost effective,
we know people can do well. I guess my answer
twofold being more accountable in the services that are provided,
and two really focusing on again point A to point B.
So we have this great program, and once the person
is released from that program, then what And I think
that's the question we should continually ask. Then what Okay,
the person's released from jail, then what charged from an
impatient facility? Than what how do we get them from
that to a home in the community where they can
live and engage and live a life. And we know
that people can do well if they can get access
to those services.
While we could dive into countless fascinating topics and keep
this discussion flowing for hours, yeah, I'd love for you
to reflect for a moment. What's one critical insight, idea,
or piece of wisdom you feel compelled to share with
our listeners, something you consider truly vital for them to
grasp and carry forward in their lives.
Yeah.
So I come to this work as a family member,
and I think we really need to hear more from families,
from people with lived experience about what works and what
works on again that very granular level, I think too
often we have people building programs and systems service delivery
models that when you talk to the person with lived
experience or their families, they don't know how to access
or they say that won't work. And so rather than
continuing to build things that people don't want or won't use,
we really need to have more voices in that space.
And if we could get our systems to be curious,
to show some curiosity around why do we continue to
have these issues and these problems, and not be so
protective of the status quo, but be willing to hear
fresh voices, hear from.
People who are living it.
They could get the most important data of all, and
that will help them determine how to build effective systems.
Yeah, that's great information. This has been a tremendous conversation
with a lot of great information. I really appreciate you
taking the time to come on.
Yeah, thank you, appreciate it.
It's been my pleasure. Thanks again, thanks for taking the
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