Samantha Greene is a licensed clinical social worker who spent three years working as a crisis intervention specialist at a call center in Dallas.
Every interaction with our Mobile Crisis Outreach Team began with a phone call. They came 24 hours a day from school personnel, homeless shelter staff, police and probation officers, family members, or unrelated good Samaritans. Other clients called seeking assistance for themselves, hoping to find relief for chronic insomnia at 3:47 am, obtain a safe place to sleep for the night, or alleviate a seemingly intolerable amount of emotional pain.
A handful of headset-donning mental health professionals answered these calls from cubicles in a windowless room inconspicuously housed in a Texas strip center. From there, our small but dedicated team was charged with meeting the crisis needs of our communities in Dallas and its surrounding counties.
In May, The horrific homicide of George Floyd by a Minneapolis police officer ignited an overdue urgency in many communities to defund their local police departments and reallocate responsibility to social workers or other mental health professionals. Ideally, emergencies surrounding mental health or other problems resolvable with good case management would be delegated to those who hold expertise in those areas. Yet too many people do not understand the on-the-ground reality of crisis response, or what the job requires of its employees. For this approach to be effective, communities must sufficiently fund their alternative response teams, which are historically stretched far too thin, and create and maintain a healthy work culture that will make qualified mental health responders willing and able to continue their valuable work.
Through MCOT, my colleagues and I took to answering the calls like a game of Minesweeper: we never knew what would await. A crisis is in the eyes of the experiencer. For some, it involved food insecurity, a lack of safe housing, needing elder care, or assistance for a family member with special needs. Some routine callers dialed multiple times a day, using the hotline service as a substitute for other social relationships. Conversely, we could answer a bomb: frantic parents desperate to help their hallucinating child access medication to stop the voices no one else hears, a hopeless teenager crying with a knife in hand thinking suicide is the only way out of their emotional pain, spouses pushed to the brink with their partner’s alcohol or drug use hoping that a rehab facility will save their partner and their marriage, or jilted ex-lovers contemplating murder as the ultimate revenge. A myriad of reasons could lead someone to our hotline, and we worked tirelessly to help them all, placing our private stressors on the back burner.
Crises are unpredictable, which meant the job was too. Eight-hour work days easily stretched far longer, and full-time staff clocked more than their 40 scheduled hours more often than not.
Most crises were resolved by phone. It is utterly amazing how much relief empathy alone can provide. These interactions were even more powerful and productive when coupled with step-by-step action plans so our clients could move forward in managing their own lives. Oftentimes, we’d dispatch from our call center in teams of two and meet our clients in their homes, fast food restaurants, and even open fields or the side of a road. Arriving in a plain sedan and street clothes, only a plastic badge distinguished us as crisis workers. Calling clients en route proved effective for continued assessment of their situation and safety, and as a way of developing rapport before meeting. Unarmed, teammates depended on each other and our skill sets to keep us safe. Nonviolent crisis intervention training was a requisite of the job, teaching us how to get out of bites, grabs, and chokeholds while simultaneously preventing physical harm to our client, though most of us did not find the employer-provided education adequate for us to be truly adept with these skills the rare times we needed them.
Our locations were constantly monitored on a large television in the call center, and our cell phones became extra appendages, accompanying us into every client interaction. No decision was made alone; all meetings included a brief break for us to return to our car, doubling as an office on wheels, to consult with each other and a supervisor prior to concluding what recommendations and resources we’d offer, whether parenting classes, drug treatment, guiding a client’s entry to a housing program or emergency shelters, or sometimes coordinating hospitalization.
Hearing clients renewed with hope and confidence after our interactions was a stronger fuel to stay in this work than the office coffee maker could ever produce. Sometimes, however, despite our best efforts, problems still loomed and resources were just not available or had waitlists too long to be practical. For psychiatric emergencies, a lone after-hours walk-in clinic served the entirety of the massive Dallas County, plus five more. We felt the discouragement, sadness, and despair with our clients in these cases. As much as we may have needed time to breathe or cope when we experienced our own crises, there were more calls to answer and people to serve. Crisis doesn’t take a day off, and taking our own time away meant a greater burden on our colleagues.
Without support, the stress of the job takes its toll on the entire staff. At Dallas’ MCOT, newer and tenured clinicians alike became weighed down by the traumas encountered on every shift. Some left for lower-stress and higher-paying jobs. Some left the mental health field altogether, unwilling to remain a part of what they saw as a dysfunctional system that forgot to help its own helpers.
Less than nine months prior to the nationwide call to divert many of these duties away from police departments and to mental health and social work professionals, the organization I worked for shuttered after losing its funding.
For crisis response programs to succeed, especially under the increased demand defunding police departments would create, we must not forget to invest in the people who staff them. This means ensuring that clinicians have access to their own mental health care, unprohibited by cost. Flexible scheduling is imperative to allow employees to attend appointments for themselves and create a work-life balance that is healthy and functional for them and their families. Recognizing that critical incidents — those involving a person’s safety — are a professional hazard, employers must provide clinicians with the ability to easily debrief after such episodes with access to follow-up care. This could make a difference in the permanence of staff. Similarly, paid time off should be plentiful for even part-time employees, with its use supported and encouraged by those in supervisory positions. Workers should receive additional paid time for continued training and education to create more proficient, confident, and less-stressed clinicians. Mental health professionals are not immune to harboring biases, and mandatory trainings and workshops on diversity and multiculturalism should be a part of the new-hire onboarding process and continue throughout an employee’s tenure. Weaving these resources into a program’s makeup costs money, but if we are serious about shifting responsibility off of police and onto mental health workers, we must invest in them.
Right now, Dallas and cities around the country have the unique ability to reimagine programs like the one I was a part of. I implore these communities to ensure the type of resources and support these organizations provide are there not only for the communities at large but also for their invaluable staff.