Head of New Orleans' mental health crisis unit discusses lessons learned

Health professionals, students and criminal justice officials are gathering in Minneapolis today to discuss ways to improve services for people with mental illness.

The University of St. Thomas is co-sponsoring the one-day conference called "Addressing Mental Health Issues in Underserved Populations: Lessons from Real Life."

The keynote speaker is Cecile Watters Tebo, a Louisiana social worker who leads the New Orleans Police Department's mental health crisis unit.

Tebo joined MPR's Steven John on All Things Considered to share her experiences working to diffuse mental health crises.

Steven John: We know a lot about the physical toll of Hurricane Katrina, but what did it mean for those of you dealing with mental health emergencies?

Cecile Watters Tebo: It was a real mental health crisis. What was so devastating after the storm is that the mental health programs were the last to come back. And you would think with a tragedy of this magnitude that it would be the first, but it has been such a struggle in securing mental health help, and still is today.

Almost five years later, we are still fragmented and still working so hard at piecing together that system. New Orleans hosts a huge number of folks with chronic mental illness. We seem to be a draw for it I think because of some of our drinking and partying and stuff like that. And people just hop on the bus and they end up in New Orleans. And we need to take care of them, and we're really working so hard at meeting their needs as they are rebuilding as well.

So, you had your work cut out for you before the hurricane hit. And then did you see a spike in suicides, those kinds of crises?

Absolutely. What was interesting is that prior to Katrina, the majority of our calls really were people with chronic mental illness, schizophrenia, bipolar disorder. They were sort of self-medicating with drugs and alcohol, not taking medication.

After Katrina, I would say for almost two years the majority of our calls involved people that had no mental health history and that were completely feeling utterly hopeless and helpless as they were trying to rebuild their life. The storm took so much, but the rebuilding and the lack of government response and issues with insurance companies and FEMA, it was just a disaster.

And it continued to rob people of their lives. We lost so many lives after the flood waters went down. People were killing themselves. And to date, we are still three times the national average in suicide rate. So it's still very prevalent. It's hard to imagine five years later that it would be, but the reality is, it is.

So, has the healing process begun to take hold?

To some degree it has. For those who have good mental health, have rebuilt their homes, are back working, their children are back in school, their families are back intact, they're doing better. But you have folks who are just still returning to their home, that are just gutting their home five years later.

So you have sort of different levels of healing in New Orleans. You have those who are doing pretty well. You have those that we call the 'walking well.' They're walking around, they're moving, but you can just see depression and anxiety. And then you have that group, the chronically mentally ill, that have moved back in, that are living in our city, that are desperately in need of that nice continuum of care, in and out-patient services. And that's what we're still piecing together.

The co-sponsor of today's conference is the Barbara Schneider Foundation, which was formed in response to the death of a Minneapolis woman who was shot by police ten years ago during a mental health crisis call. Do you think enough is being done to train police officers in how to deal with people in crisis?

We've come a long way with that. Crisis intervention training has just taken off across the country, and that involves selecting certain officers per district per shift that receive forty hours of mental health training. They become the first responder. In New Orleans, we have a crisis unit that is manned by volunteer mental health technicians, many of whom have a family member with mental illness. They are fantastic on the streets.

We grew out of making sure that incidents like what happened to Barbara don't happen in New Orleans, and very rarely do we have someone with mental illness who is hurt, because we're there and we're able to do the intervention and do the assessment and get that person to the next safest place.

Tell us how the system works in New Orleans when a call comes in for a person in a mental health crisis.

We're part of dispatch. We're on the police radio, and because of the unpredictable nature of responding to a call of a person with mental health issues, what are dispatched is two two-man cars, a rank, and the crisis unit. And once our officers clear the scene, it's safe for us to go in, we go in.

You see me in uniform. I've got a white uniform top. It looks different than the regular police officers and it's more symbolic of medical. And often when the person just sees us, gets the visual of us, they know that we're there to help. And it just really automatically starts to calm the scene down. Because the services have been so inadequate, I've found that my role has really become sort of the walking yellow pages of mental health resources. And I can share with families what does exist and where to go get help.

We have a crisis line...that has been so valuable that people can call and get help as well. And if the person is suicidal, homicidal, gravely disabled, then we're able to safely get them to the emergency room where we take them through the triage.

That's been a little tricky because the hospitals still do not have psychiatric beds in-house. So their motivation is going to be to get that person out, and what our job is is to make sure that they don't get them out without being seen. We have to really talk about what's going on and the severity of the situation, talk to the doctor and make sure that these folks are going to get services.

Why do you think more big cities haven't followed the lead of New Orleans with a similar crisis unit?

You know, I don't know. That's why I'm so glad that you're doing this, because they should. We save the department over $300,000 a year in manpower hours because once we're on the scene, we can take over and the officers can get out there and get back to the job of taking care of the bad guy and let us deal with this mental health issue.

I think the response has sort of been more of the [Crisis Intervention Training]. I would hope that more people would do this model. One of the beauties that came out of this program as well is we've just partnered with NAMI, the National Alliance on Mental Illness. And all of the folks that I get picked up, they're sent as a referral over to NAMI, which now has a sort of mobile case management program. So these folks can get a referral to a case worker who can start seeing these guys in their home...And once they get involved in this program, usually we don't see them again.

It's fantastic. I think that's sort of the wave of the future. As hospitals are closing, budget cuts, mental health is first on the block, we really need to get into doing more of these mobile units. In New Orleans, our transportation still is horrible. So to get from point A to point B is almost impossible, but now we have mobile units that include doctors and nurses and case workers that are going into the houses, administering medication and care. And we're really seeing that it's making a difference. We just don't have enough of it.

This can be dangerous and, I'm sure, demoralizing work, dealing with people with severe mental illness. How do you keep your volunteers coming back?

Well, a huge part of our training is safety, safety, safety. We need to be going home at the end of the day...My sergeant...has been with the program for 28 years. He started it, and his biggest fear is that one of us will get hurt. And he will say to us, 'If you do get hurt, you stepped outside the bounds.' We do not walk into that scene without officers who do have tasers and weapons and vests. They're going to go in first to make sure that it's safe for us to go in.

And we have to rely a lot on instinct. Most of our folks are being transported by us, but if there's somebody that's so combative, so out-of-control, way out on drugs, whatever, I can simply put them in the back of the police car and meet them on the ramp and take over at that point.

Have you had close calls?

There've only been like three injuries in our unit, and I'm one of them.

What happened?

I always said it would be by a woman. We're tough. We're tough. And it was. It was a woman with chronic mental illness, with schizophrenia, and she was completely loaded. And I had picked her up before, so she really was not happy being in my presence.

Completely loaded on alcohol?

On alcohol, very intoxicated, and very, very combative. I was actually getting her out of the restraints before I should have, and she got a hold of my thumb and just about ripped it off. So I did have surgery. She did get a hospital bed out of it, though. This was like two years after Katrina, when there really was nothing available. So I have my permanent scar.

So you took an injury so someone else could get better care.

Took an injury, and you know what? I was trusting that she was going to calm down, and she didn't, and that is a risk. So we have to be careful.

How is your experience helping people with mental illness in New Orleans applicable to cities that haven't faced a disaster like Katrina?

Well, one of the things that's so interesting is that all of us were actually part of the disaster ourselves. And what I noticed after Katrina when we would roll up...it was not uncommon to see an officer with their arm or hand around an individual. And I can't say I really saw that before the storm, but because we were all a part of it--.

My whole world had crumbled. I had lost my home, my neighborhood. My kids were displaced, and I was responding to these calls for service and handling my own personal crisis as well. And it just kind of bonded you to that individual. So when we respond to calls of helplessness or hopelessness, and we're offering hope, we know through our own experience that things really do get better. And they do, they do.

You became emotional when you started thinking about the past five years. It's still pretty raw, isn't it?

You know, it is. You would think that it wouldn't be. It was such a time of such utter turmoil, and I think part of my emotion today is that I got through it, and that I'm continuing to do what I love more than anything in the world.

When you're on the bridge and somebody is wanting to take their life, and they turn around and they take your hand, and say, 'You know what? I will try to give this another day,' it's pretty powerful stuff.

I didn't know if I would be able to continue because I didn't know how my own world was going to turn out, but it all worked out so beautifully. And I'm so glad to be in New Orleans. I've watched my children grow through this disaster, and they've turned into some pretty giving kids, and that's what it's all about.

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