Making changes after Jan. 10 |

Making changes after Jan. 10

(Nevada County1s sense of security was shaken Jan. 10, 2001, when three people were slain and three others injured during back-to-back shootings at the Department of Behavioral Health Services and Lyon1s Restaurant.

In a three-day series, The Union looks at what1s happened in the year since then. Today: How mental-health care has changed for patients, advocates, providers and administrators.)

Nevada County’s Behavioral Health Services employees are now teaming up on clients to provide better treatment and quicker intervention for people caught in a downward spiral of mental illness.

A former Behavioral Health patient apparently caught in one such spiral, Scott Harlan Thorpe, is accused of the Jan. 10, 2001, shootings that left three people dead and three injured.

“What I’m hoping is that the new team structure and the fact that we’ve got more people who know more patients … will help us to be more cognizant of when people are having difficulty and for us to intervene appropriately,” said Robert Erickson, director of the behavioral health program. “I’m hoping that would go a long ways toward prevention.”

The team approach is one of several changes at Behavioral Health since the shootings a year ago this week.

Erickson started as Behavioral Health director in March. He replaced Diane Chenoweth, who retired in August 2000.

When Erickson started work two

months after the shootings, the department was down 20 employees. Most of the missing workers were traumatized from the attack and unable to return to work.

Clients faced a six-week wait for an appointment, according to a civil grand jury report issued in late May that concluded the department was underfunded and understaffed.

The wait for an appointment is now down to a week, said Erickson, and the facility is back up to staffing levels prior to the shootings. Two positions – one full time, one part time – remained unfilled in late December.

He said the county’s move to bump up salaries 4 percent helped.

While Behavioral Health has the same number of employees, the organization has changed how it uses them.

Erickson created the position of full-time medical director, a lead psychiatrist who directs the medical and treatment program, and hired Dr. Douglas Crisp, who started June 13.

Until Crisp was hired, all the psychiatrists were part-timers under contract to the county, Erickson said. The title of medical director was previously held by George Heitzman, a part-time psychiatrist who worked under contract with the county until shortly after the Jan. 10 shootings.

Having a full-time medical director – believed to be the first in the program’s recent history – is a more effective way to do business, Erickson said. He can accomplish his agenda by meeting with one doctor, Crisp, who is responsible for five or six part-time psychiatrists, rather than meeting with each of the part-timers.

Phyllis Murdock, director of the county’s Human Services Agency, said the position helps strengthen the Behavioral Health department.

“(Erickson) thought this was the best way to provide some strength and stability to his new organization,” she said, “and I agree that it has been a very successful choice in having Dr. Crisp and in having a full-time psychiatrist.”

The grand jury report had also noted a lack of medical supervision and recommended the county hire a full-time medical director.

Erickson also restructured the department’s workload, organizing its staff into two community treatment teams.

Each team is responsible for 300 people, which amounts to one half of western Nevada County’s adult inside caseload. The teams are made up of a master’s degree-level therapist, two part-time psychiatrists, a nurse and more than a dozen other employees.

The teams are responsible for people treated within the Behavioral Health facility – those with more serious mental illnesses. They receive treatment by a team of Behavioral Health practitioners including a case manager, therapist and psychiatrist.

Other clients are treated outside the facility by 30 contract therapists, if they are deemed to have a less serious illness and have Medi-Cal coverage. Outside cases are handled by private practitioners who have solo practices.

The department seeks to become more careful about which clients are referred to the outside therapists, and seeks to keep the more seriously disturbed people inside the facility.

The department also has a remote-services team that follows the progress of 30 people placed outside the county in short-term acute care hospitals and long-term care facilities.

That team is more actively following people than before, Erickson said. Periodically, a team member visits clients outside the county, making a circuit that could include facilities in Eureka, Merced, Redding, Sacramento and Napa County.

Beyond that, Erickson has proposed the creation of three clinical supervisor positions. Erickson submitted the proposal for the positions in August and asked for a 10 percent raise for employees taking on the position. The request is currently under consideration for inclusion in the county budget for 2002-2003.

In all, the three supervisors altogether would oversee 30 employees.

“Basically, what we’re trying to do is flatten out the organization … make it more manageable, so there can be more clear direction about how we care for people,” said Erickson.

Behavioral Health has a total of 1,200 clients, including some Truckee residents treated by a fourth team, and outside clients followed by contract therapists.

In addition to more management and a team approach, Behavioral Health has changed its office building as well, Murdock points out.

Many of the changes were put in place last year to improve security after the Jan. 10 shootings. More are on the way.

The building has an armed guard at the door, a bullet-resistant reception window, and a bullet-resistant door.

Erickson said he considers the Behavioral Health facility a safe place to work – safer than the drive home after a day in the office.

He said the county approved remodeling of the building’s downstairs. It will provide a separate entrance and waiting room for families and children, keeping them apart from the adult clients. The family entrance will be beefed up, with a secure door replacing a glass door.

Also planned is a room to provide observed therapy for families. A therapist will sit outside with a speaking device, coaching the parent on empathetic ways to interact with a child, Erickson said.

Law enforcement personnel will have a room to conduct interviews in cases involving children. One in-depth interview will be recorded and observed by all sides. That would reduce the number of interviews for the child, assuming defense and prosecuting attorneys accept it.

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