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W. Swan Hover, MSW
Wayne County Mental Health Center
310 North Herman Street
Goldsboro, North Carolina 27530
(919) 731-1133

Crisis services are generally divided into three areas: Intervention, Stabilization, Prevention. Briefly, Intervention means dealing with an imminent or full-blown crisis situation. This involves assessing an individual in crisis and facilitating interventions necessary to return that individual to his/her previous level of functioning. Stabilization means following up an individual who has been assessed to try to make necessary (possible) changes in his/her environment in order to forestall/ delay future crises. Prevention means making structural and policy changes (programs) which are tailored to the needs of the various categories of clients. In North Carolina, each area program is mandated to have a crisis program in order to centralize monitoring of the welfare of severely mentally ill/substance abusing/developmentally disabled clients and reduce the number of inpatient admissions.

The basis of this presentation is one person's experience with starting a cross-disability crisis program in the mental health center of a small county (pop. 110,038) in southeastern North Carolina. The county has an air force base, a state mental hospital, a federal prison, and a limited manufacturing base. The bulk of the population is rural, with cotton, corn and tobacco as the traditional crops. It is politically conservative. Standards for crisis services delivery are created at the state level. The state department of human resources is subdivided into three divisions; mental health, substance abuse and developmental disabilities. Standards for treatment and service delivery are generated by all three divisions with oversight for crisis services being allotted to crisis division. The relationship between the state and local governments tends to be adversarial especially in the area of social services. The county is governed by an elected Board of County Commissioners which exerts absolute fiscal control over all county expenditures and has the power to veto expenditures for state fundedprograms at its discretion (any expenditure of over $100.00 by any county program must be reviewed and approved by the county manager). The mental health center is administered by an area director who serves at the discretion of a mental health board which, in turn, is appointed by the county commissioners. The county bureaucracy could aptly be described as byzantine.

Our crisis unit was begun in December, 1995, with the hiring of the crisis coordinator (now director). The primary initial tasks were to- acquire staff (2 f/t MSW's and a ½ time clerk); identify the target population (MI/SA/DD)- identify available resources, identify organizations which were also instrumental in the welfare of the target population; create a structure for service delivery; create statistical instruments for monitoring outcomes; and finally, to begin serving clients. Initial priority was given to the seriously persistently mentally ill (SPMI) on the assumption that these were the least well served and therefore most likely to be hospitalized repeatedly. The initial challenges were to: introduce the notion of consensus among the various 'players when approaching the needs of the target population and hence enhance scarce resources through sharing- have a fluid infrastructure in place by the time hiring of staff was completed so that a long delayed program could become operational as quickly as possible; create referral channels for the target population; to prevent deallocation of funding.

Our crisis program is now fully staffed. Funding is secure and increasing. The need for community cooperation is being acknowledged and in some cases acted upon. A number of creative alliances have been formed. A fluid internal structure has developed. The areas of crisis intervention and stabilization are being addressed on a 24/7 basis and the groundwork is slowly being laid for crisis prevention.. Our initial target population consisting of the severely persistently mentally ill has been expanded to include severely persistently substance abusing (SPSA) clients. The community of consumers is aware that our services exist and word appears to be circulating that we can be trusted. We exercise cautious optimism.

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