What happens when you call the crisis line?

By MultiCare Health System

In Pierce County, you can dial the Pierce County Health Crisis Line, 800-576-7764, to help with emotional and mental health crises.

The line is a free service available 24/7 for anyone to call — someone in crisis, their loved ones or friends, and even first responders who encounter a person in crisis during the course of their work.

But what happens when you dial the line? Who answers the phone? What kind of crises are handled through the line?

We talked to the Mobile Outreach Crisis Team at MultiCare Behavioral Health, one of the local organizations that helps handle calls from the line, to get a behind-the-scenes look at the process.

Silvia Riley is the manager of Crisis Services for MultiCare Behavioral Health Services. Ian Callahan is the supervisor of the same group, as well as a designated mental health professional (DMHP) who works in the field when a crisis calls for an in-person evaluation.

Who answers the Pierce County Health Crisis Line?

Riley: Initially the line is answered by a company called Protocall, which is staffed by master’s level clinicians. Protocall handles some of the crises, such as if someone calls asking for resources. Calls are transferred to the Mobile Outreach Crisis Team (MOCT) if it’s an adult in crisis who requires face-to-face evaluation or risk assessment, or Catholic Community Services for children 17 and under.

Who can call the line?

Riley: Anyone can call — not just the person in crisis but their loved ones, family members, neighbors, physicians, law enforcement. It’s anonymous, if the person calling would like it to be.

How do you define ‘crisis’?

Riley: The client defines the crisis, or the family of the client. The crisis spectrum is so big. What may be a crisis for you may be very different from what’s a crisis for me. We don’t discourage anyone from calling.

Callahan: Sometimes it’s a stress-related crisis, life stressors. We all have them, and it takes a lot of strength to reach out when you have a stressor in your life, but there are people who understand and want to help you through those times.

What are the most common kinds of crises you receive calls about?

Riley: Suicide, substance abuse, erratic behaviors, increase in violence and aggressiveness, paranoia, dementia, homelessness.

What happens when I call?

Riley: You’ll be asked to share a brief description of the crisis, as well as demographic information (unless you request that the call be anonymous). If the call is not resolved by Protocall and it qualifies to be transferred to the MOCT, we talk to the caller, gather information and provide an estimated time of arrival.

If family or friends of the person in crisis calls, we’ll discuss the situation and give them ideas of how to help, then encourage them to call again the next time they see the person so we can do an in-person evaluation.

How long does it take to respond to calls?

Riley: Because we cover the entire county and we’re responding 24/7, sometimes it can take up to two hours to respond. But the response time is generally based on the level of crisis, as well as the location of the caller.

Who are the people arriving in person to do the assessment?

Riley: There are three types of professionals handling the calls in person: peer specialists, crisis intervention therapists and designated mental health professionals.

Peer specialists are current or former consumers of the mental health system who have become employees. They can connect with clients at a different level and really instill some hope.

Crisis intervention therapists are mental health professionals who perform the risk assessments and have the credentials to do a more formal evaluation for the caller.

Designated mental health professionals (DMHPs) are similar to crisis intervention therapists but they have the ability to involuntarily commit a person. It’s truly a last resort and involves going in front of a judge or commissioner to justify that a person wasn’t agreeable to help and, as the result of a mental health disorder, they meet three criteria (with specific legal definitions that must be proven): danger to self, danger to others and grave disability.

What happens when you arrive to a caller’s home/location?

Riley: When we arrive, the first thing we do is make sure the caller and their family/loved ones/neighbors are safe. Then we start asking questions. Our main goal is to perform a risk assessment and determine what kind of care and/or services the person in crisis needs. This can range from connecting them with local services such as counseling or substance abuse treatment, all the way to involuntary hospitalization.

Based on the information from the caller, we may bring an ambulance or police to support us. We’re mental health professionals, but we’re not medical staff. Plus, we’re going into people’s homes and we don’t know what we’ll find — weapons, drugs and so on. Police do their part to keep the scene safe and we do our evaluation; we work together in tandem.

If we’re worried the caller is suicidal, we use a five-step suicide assessment and formulate a plan to help lessen their risk. We look at whether the person has a mental health diagnosis, if there are other risk factors such as a recent divorce, loss of a job, homelessness or whether they have a history of talking about suicide (also known as suicide ideation), whether they have a plan, several other questions. If the person has guns, we’ll talk about whether to call law enforcement and have the guns removed. If we’re concerned they’re going to intentionally overdose on pills, we might call the person’s best friend to discuss a way to limit their access to the pills.

Callahan: We’re really focused on what resources the person needs here and now to bring them out of crisis. If they’re amenable to referrals, we’ll make outpatient referrals. If they require a higher level of care and they’re amenable, we’ll suggest voluntary outpatient or inpatient mental health treatment. If they meet the three criteria mentioned earlier, we do have the right in Pierce County to involuntarily commit them to 72 hours of psychiatric inpatient treatment. But our goal is to find less restrictive alternatives.

Riley: We really want involuntary hospitalization to be a last resort. It’s a lot better when someone can get help on their own, versus having to take away their rights.

We believe that every person, regardless of the crisis, has an opportunity to use the crisis moment as a way to get help and initiate recovery. We can turn around a moment of crisis to get them the help they deserve. Help comes in many ways, certainly not only with hospitalization.

There are people who get well and better every day, so calling the crisis line is an opportunity to begin that journey.

Callahan: People in my field go into it to help people. As DMHPs we’re thrust into crisis situations with life or death implications. It’s interesting work where we ultimately get to help people stay alive, reconnect with their family, community, themselves — allowing them to increase their quality of life and move forward. We take great pride in being part of that continuum.

More information about the Pierce County Health Crisis Line

Pierce County Health Crisis Line: 800-576-7764

King County Crisis Line: 866-427-4747

This article was originally published January 2018 and updated September 2018.