The young woman was facing the wall the night Janella Kirkman first walked into the Emergency Department at Sierra Nevada Memorial Hospital. Held at the ER due to a mental health crisis, staff members were off looking for space at a psychiatric hospital for the woman, who sat alone in the sterile room.
Having suffered from the ravages of methamphetamine, Kirkman could see the woman had facial wounds due to picking at herself in agitation.
“The first thing that hit me when I walked in that room was that I was looking at me at a younger age,” Kirkman said. “Just like me, she’d gone from the social fun of the drug into full-blown addiction, and now she was in crisis.”
At first, Kirkman sat quietly with the woman, then she began sharing her own story of addiction, hardship and mental illness. She told the woman, “I’ve been exactly where you’re at.”
Slowly, something shifted in the woman’s demeanor, and her shoulders dropped, and she began to relax and turn around. It was clear Kirkman was only there to offer support, nothing else.
“I told her she wasn’t alone, and I began to see a calmness come over her,” said Kirkman. “We talked about safe places where she could go, and I had her visualize herself in a beautiful field. Then she looked at me and said, ‘I want to go to sleep now.’”
Kirkman is part of a group of trained peer counselors from the SPIRIT Peer Empowerment Center who offer direct and immediate support to people in mental health crisis at SNMH. The peer counselors — who themselves have experienced mental health challenges — are trained and screened to work alongside the crisis team from Nevada County Behavioral Health. Working in concert with the hospital, crisis peer counselors are on call 4-10 p.m. daily. In addition to offering comfort to patients who have been put on “involuntary psychiatric hold,” peer counselors provide follow-up phone calls and connect those in crisis with community services in the hopes of avoiding a repeat visit to the ER. The pilot program, funded by the California State Mental Health Services Act, began in early 2013 after thorough review by a broad range of community groups.
County crisis workers and emergency room staff were initially skeptical of having a peer counselor on hand in the midst of an intense psychiatric situation, fearing it may trigger emotions and create yet another crisis.
“The ER was a little leery at first — they questioned the peer counselors’ qualifications,” said Linda Layton, who works as a crisis worker for Nevada County Behavioral Health and serves as crisis manager for Placer County. “Now they really rely on them. One of the reasons they’re good is that they’ve learned about crisis and how to deal with it. While we’re off spending hours trying to find a psychiatric hospital for the patient, the peer counselors can comfort them, play cards, get them a blanket or simply sit nearby while they’re sleeping. I love the peer counselors — I wish we had more of them.”
Layton said there has been a significant increase — “almost record numbers” — of people seen in the SNMH Emergency Department for psychiatric crises. The numbers rival that of Placer County, she said, which has a population more than three times larger.
“And we have less services than Placer,” she said. “People can’t support their families here. They’re losing their homes and having a hard time coping. It’s scary — there used to be days when we didn’t need to go into the ER to do an evaluation. Now it’s common to have two or three a day.”
The Outreach to Emergency Department Program was the brainchild of Barbara Lindsay-Burns, executive director of the SPIRIT Peer Empowerment Center, a Grass Valley self-help center that is open at no charge to people facing challenges to their mental health.
There are no other known programs like this one, she said. A key component is that each peer crisis counselor has a team leader on call, should they have questions or need back-up support.
“Initially, the program was slow to start,” she said. “But over time, the staff at the ER have begun to understand the power of a peer. Patients immediately understand that our counselors are not there to poke or prod them and ask a bunch of questions. I’m so impressed with how the crisis workers are able to be really present. They’re not afraid of a crisis — we’ve all been psychotic. We’ve all been there and patients feel that.”
Crisis peer counselor and team leader Julia Robles Scott says the follow-up portion of her job is critical.
“In my early 20s, I attempted suicide,” she said. “I just remember waking up in the ER. They asked me a bunch of questions and then let me go. I’ve been that person, and there was no one there for me. They just let me go without any follow-up. That was in 1980, and I absolutely didn’t get the help I needed.”
A bunch of information scribbled on a piece of paper is not enough once patients are released, said Lindsay-Burns. Having contact with a person the next day who cares can make all the difference, and that’s where the peer crisis counselors come in.
“I’m a heart with ears — I tell patients there are resources and people out there who have gone through similar situations,” said a peer crisis counselor who prefers to be identified only as Angel. “I used to think I didn’t have any gifts, that I had nothing to give. I finally realized the gift I have is showing people that there are others who do care. When I help people, both of us are healing. Even if I’m just sitting and watching them sleep, they eventually wake up and see that they’re not alone.”
To contact Staff Writer Cory Fisher, email her at email@example.com or call 530-477-4203.
“I finally realized the gift I have is showing people that there are others who do care. When I help people, both of us are healing. Even if I’m just sitting and watching them sleep, they eventually wake up and see that they’re not alone.”
peer crisis counselor