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The A-Team 

Mecklenburg's new Mobile Crisis Team saves lives and money

Bill Cook is someone you don't really ever want to meet. As a clinician dispatched to accident scenes to help victims cope with tragedy, a task which often includes informing arriving family members that their loved one has died, he's the closest thing to an in-the-flesh Grim Reaper there is. It's a job you would think no one would want, but to Cook, director of Charlotte's new Mobile Crisis Team, people at their emotional nadir are the most in need of help.

Cook has seen it flubbed up before.

Recently he responded to a fatal motorcycle crash. The victim lay dead in the middle of the road, covered by a tarp, when Cook arrived. An older woman came rushing towards the scene, her urgency suggesting she knew the victim and her age indicating she could be his mother. Cook didn't get to her first and heard a man nearby tell her: "Don't worry. Everything is OK. Your son is fine." Euphoric relief flushed out the panic in her face. Then the man added, "He's with God now."

Cook recalls the story with horror. "This woman went from intense grief to elation then back down in a matter of seconds," says Cook. The correct way to handle the situation, he says, is to matter-of-factly state the facts. "Ma'am. I need to let you know that your son is dead." Then, let the victim deal with it how they will and adjust your approach accordingly.

Cook has seen denial, fits of rage, inconsolable crying, but what he eventually saw from this woman who had lost her son in the motorcycle accident was a first. She exhaled a deep sigh of relief and said, "Thank God. I thought it was one of my grandchildren. So how'd it happen?"

The Forest Gump cliché holds true in how humans handle life-shattering news, Cook says. "You never know what you're going to get."

The crisis team started in Mecklenburg County in July of this year to fill in a gap between primary emergency responders and long-term mental health providers. They are dispatched to diffuse situations in which the only options in the past -- the hospital or the jail -- were costly to the county and not always the best solution for the individuals involved. The scope of situations they are trained to handle is broad: from intervening in domestic and parental disputes to talking down potential suicides and solacing rape victims before they are transferred over to Rape Crisis. Eventually Cook hopes the team can play a pivotal role in hostage negotiations. It's a key social service catching on statewide as legislators have identified the across-the-board benefits such a team of trained clinicians can provide.

Still in its infancy, the team averages between one and one and a half dispatches per day. Underutilized, they could handle up to four calls a day. Cook briefs hospitals and police officers about the service and hopes to get 911 dispatchers to recommend the team more often, especially for major crisis incidents, but he understands that outreach takes some time to stick. In Anna Arundel County, located in Maryland, where Cook worked on a mobile crisis team before moving to Charlotte, primary responders called the crisis team to almost every Dead-On-Arrival accident in the county.

For critical incidents, the crisis team serves as both a liaison between the police and traumatized victims and as a counselor to shell-shocked witnesses. A few weeks ago, Cook was called to a crash site where a bicyclist had run into a woman's car. The bicyclist died shortly after being taken to the hospital. Before the crisis team started in Charlotte, the woman driver would have been left alone to her thoughts.

At the scene of the tragedy, clinicians try to steer victims away from interpreting feelings about the event, believing it's still too raw to process. Usually victims' narratives are steeped with a healthy amount of emotion anyway. When Cook asked her what happened, the woman recalled the events alarmingly flat. Finally the emotion erupted out of her. She began to sob, questioning if she did all she could to avoid the cyclist. When her family arrived, Cook informed them of post-traumatic stress signs to watch out for and passed along phone numbers for immediate and long-term help.

The responders aren't emotionless drones and standard procedure is to debrief with another clinician. Cook's most heartbreaking call was for a 15-year-girl who had some rare undetected condition and died suddenly while watching television on the couch. Cook saw her on a hospital bed and noticed a strong resemblance to his own 15-year-old daughter. It was all he could do not to break down in front of the girl's grieving parents. (He still tears up at the story.)

For suicide calls, restraining the victim is only necessary with imminent threats. More often, the victim just needs someone to speak with and to be set up with a therapist. Forced hospitalization, protocol in the past, can be humiliating and detrimental to the victim's mental health, not to mention costly.

Cook says face-to-face interaction gets better results than guidance by telephone. Two Sundays ago, he got a call from a depressed woman with suicidal thoughts. After discerning she had a suicide plan in place, a history of attempts and the resources to do it, he took the team's silver RAV4 with "Mobile Crisis Team" written on the side to her home. There he learned the woman's boyfriend was threatening to leave her. Cook had to play couples counselor, knowing that strong familial support is the most important preventive measure to a mental health episode. After spending two hours with the woman, her mood improved and Cook was able to proceed with the last step of the crisis intervention process: referral and scheduling a follow up visit the next day.

"I see it as a win-win-win," says Cook. The first win is for health providers and law enforcement, the second for consumers, and the third is for the clinicians. "There are very few jobs in the mental health field where from any given moment you may be dealing with somebody who is homeless, who is exercising very poor judgment to somebody who is depressed and suicidal to somebody who's witnessed some kind of trauma. That range really hones your skills as a clinician."

One of Cook's three full-time staffers, Heather Harp, who's worked as a therapist at Behavioral Health Center, says: "A lot of times, you're seeing them in a state a therapist doesn't get to see. If someone is in crisis, they're not going in to their therapist; they're not seeing their doctor. It's a different place to intervene with people. So it's kind of an exciting place where you can help people move along."

To request services from the Mobile Crisis Team call 704-566-3410.

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