Beyond the Stigma: 24/7 NH crisis response teams help prevent ER visits

By Shawne Wickham — client arrives for an appointment with his therapist, anxious and stressed. He has a history of suicidal thoughts and hasn’t been taking his medication, and the counselor decides it’s not safe for him to go home.

Across town, a client at a health clinic for the homeless is having psychotic symptoms, and providers are afraid she could harm herself.

A Manchester mother is worried about her teenage daughter, who seems anxious and depressed.

In the past, these individuals all would have ended up in hospital emergency rooms, possibly waiting for days for an inpatient psychiatric bed, alongside car crash victims and patients with broken limbs and fevers.

Instead, the Mental Health Center of Greater Manchester’s Mobile Crisis Response Team (MCRT) was called in to help.

New Hampshire has three MCRTs, in Concord, Nashua and Manchester; all are available 24/7. The teams respond to calls from medical providers, schools, police, the Safe Station program and individuals seeking help.

Jessica Lachance, director of Manchester’s MCRT, said when the teams were first created in 2015, the primary goal was “diverting people from emergency rooms, hospitalization and jail.”

It’s a simple but powerful idea: “If we’re able to bring the assessment to the community and help people develop a safety plan, we can keep people in their homes and in their community through a crisis,” Lachance said.

Previously, she said, “The only option was to call an ambulance and send someone to an emergency room.”

Of approximately 2,600 clients the Manchester team has served in the past 18 months, just 151 required hospitalization.

On each call, behavioral health clinicians partner with peer specialists whose expertise – and value – is their personal experience with mental illness and/or substance use disorder. Lachance said about 70 percent of clients have both a mental illness and substance use disorder, so MCRT clinicians are trained in integrated treatment.

The team’s clinicians can perform the same evaluations done by mental health clinicians in emergency departments. And the peer counselors, Lachance said, “bring a whole other level of experience.”

“They have a connection with the person in crisis that a clinician does not,” she said. “They can help them feel more comfortable, help them feel more connected.”

The youngest client served in Manchester to date was 5 years old; the oldest was 96. “Mental illness and substance use do not discriminate,” Lachance said.

By the end of the school year, the team was getting more calls from school officials about students in crisis. Lachance sees that as a positive trend, as more schools recognize the team can help in such situations.

“Nobody wants to put a child on an ambulance to go to the emergency room,” she said.

Clinician Cassandra Durand said she likes crisis work “because every day’s different. Plus there’s something, I think, really rewarding about being able to help somebody when they’re in their worst moment.”
The team operates out of a former furniture store that also houses Hope for New Hampshire Recovery. There are four crisis apartments, a safe place for people who don’t need hospital-level care but do need some help to get through a crisis. The average length of stay in the apartments is one to three days, but clients can stay up to seven days.

There’s a common kitchen and living room space. A message on the wall reads: “Life isn’t about waiting for the storm to pass … It’s about learning to dance in the rain.”

Team member Sara Haislet said meeting people in their own homes also has clinical benefits. “Sometimes the environment can give you a lot of information about what’s happening,” she said.

It’s also an opportunity to help other family members understand the individual’s condition “and decrease the stigma of what’s happening with them,” she said.

Clinician Tara Rousselle said many individuals the team meets have never before connected with mental health services “and have just kind of fallen through the cracks for years.”

One of the newest members of the team is Chris MacNeil, who just graduated from New England College with a degree in psychology after a 12-year stint in the U.S. Army.

“I think this is a service that is long overdue,” he said. “If we can help these people … and then hopefully connect them to services, it’s just a great thing.”

Every day, the team “huddles” for a conference call with providers from Elliot Hospital and the mental health center to review the status of patients in the emergency department to determine who is well enough to leave or transfer to another facility.

With an ongoing shortage of psychiatric beds in New Hampshire, Lachance said, “What we want to do is make sure those beds are for the people who actually need hospitalization.”

Once an immediate crisis is over, the connection between the team and clients doesn’t end. Clinician Julie Jeannette said they make calls in the evenings and over long weekends to clients they saw on previous days, “just to follow up, see how they’re doing, make sure they’re stable.”
They call them “caring contacts.”

“That’s a big part of closing the gap, so that once the crisis is settled down a little bit, we’re able to connect people with services,” Lachance said.

In a large room dubbed the “bullpen,” team members spend downtime catching up on paperwork and emails. When the phone does ring, a charge runs through the room.

Around 9 p.m. on a recent weeknight, Durand takes a call from a 35-year-old man who is thinking of going to the emergency room.

“Why don’t you start by telling me a little bit about what you’re having trouble with?” she said.

She listens, reassuring him that everything is kept confidential. She asks a few questions: Is he having thoughts of hurting himself? Has he had any alcohol or drugs? Does he have a weapon? Is anyone with him?

Then she tells him they’ll be there in about 15 minutes. “If anything happens before we get there, I want you to call this number back,” she says.

When they were first getting started, the team worked hard to get the word out, leaving flyers in physicians’ offices, schools and other agencies. They know some clients worry that their troubles aren’t serious enough to call, but the team said that’s not the case.

“We’ll always take your call,” said Durand. “We always want to talk to you.”

There’s a painting of a tree decorated with lifelike butterflies in the hallway. For Lachance, it symbolizes the people they help.

“We think of butterflies as folks who may land here for a period of time, and we’re able to engage them and provide what we can, with the hope that they may want to engage in services later on,” she said. “These may have been people who at times may have walked into the emergency rooms.”

“We’re trying to show them there may be other options.”

Beyond the Stigma, sponsored by the New Hampshire Solutions Journalism Lab at the Nackey S. Loeb School of Communications, is funded by the New Hampshire Charitable Foundation, Dartmouth-Hitchcock Medical Center, NAMI New Hampshire and private individuals. Contact reporter Shawne K. Wickham at