New law will enable first responders to take troubled to triage center

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By Diana Hefley
Herald Writer
Published: Friday, June 12, 2015, 12:01 a.m.

EVERETT — Tucked around the back of the large Compass Health building on Broadway is a door that leads to respite.

Inside are clean beds, hot meals, a place to wash clothes and medical and mental health services. An exam room staffed by nurses around the clock is painted a pale lavender. Five or so comfortable recliners are ready for anyone who needs a few hours just to relax. There also are small dormitory-style bedrooms for those who need to stay longer.
Drawings and collages line the halls and paper flowers brighten the dining room. The other day a young man watched television while a woman wrapped in a blanket worked on a puzzle. Down the hall a patient in blue scrubs met with a nurse.

Last year, more than 1,200 people suffering from a mental health crisis were admitted to the Snohomish County Triage Center. Since it opened in 2011 the center has seen a more than 20 percent increase in referrals.

New legislation passed this year could make it easier for first-responders to get people there. Eventually the law will allow private ambulances and public emergency medical services to directly transport patients to the center.

As the law stands now, paramedics are only allowed to take someone to an emergency room, even if they believe a triage center is more appropriate.

The county facility was opened as an alternative to jail or emergency rooms for people in crisis. Some clients arrive in the back of a police car while others are sent there from the hospital in a cabulance. Staff work to stabilize people and then help them navigate community resources to get services once they leave.

The triage can be a soft place to land for someone who in the past would have been dropped off at the county jail or shuffled in and out of an emergency room or left to find their own way once released from Western State Hospital.

“This is the ‘someplace else,'?” said Chris Starets-Foote, director of inpatient and residential services for Compass Health.

The center is a joining of forces between Snohomish County and the North Sound Mental Health Administration, which contract with Compass Health to run and staff the facility.
Clients can't walk into the triage center off the street. They must be referred by police, hospital emergency room staff, community mental health agencies and others who come into contact with people in crisis. The building is locked for patient and staff safety, but clients are there voluntarily and can leave.

Last year there were 1,715 referrals to the center. That was up from 1,566 the previous year, according to report by Robin Fenn and Nate Marti with the county's Human Services Division. The majority of the referrals come from emergency rooms, primarily at Providence Regional Medical Center Everett. Police officers made 417 referrals last year. The majority of those came from Everett police and Snohomish County sheriff's deputies.

Since Sheriff Ty Trenary set booking restrictions at the jail for low-level offenders, referrals to the triage center from deputies have more than quadrupled. Last year, the sheriff's office worked to have all of its deputies and corrections officers tour the facility.

The third-largest source of referrals are from community mental health agencies.

Not everyone is admitted to the triage center. It's not intended to be a detox facility, although the majority of people arrive under the influence of drugs or alcohol, said Maria Ruiz, the center's clinical nurse manager.

If their impairment is too great, they are not admitted. In some cases a patient's medical needs exceed what is available at the facility.

In April 2014, the center added nursing staff, which has broadened who can be admitted, Starets-Foote said. Federal regulations limit the facility to 16 beds.

Data show that at least once a month people are turned away because there isn't an available bed.

It's unclear if the new law will increase the number of referrals to the center.

Local fire and law enforcement officials supported the measure, saying it should remove barriers that prevent some people from getting help. It could save resources, too, Snohomish Police Chief John Flood said.

Police officers often are the first to respond to reports of someone in mental health crisis. They are left with two options: take someone to triage in the back of their patrol cars, or call the fire department for an expensive ride to the emergency department.

A trip to Everett can take officers from rural areas off the street for up to two hours, Flood said. That's time the officer isn't able to respond to 911 calls.

Also, someone in crisis may not understand that he isn't under arrest when he's being put in the back of a patrol car.

“You can end up making the problem worse,” Flood said.

Tim Key, of the Everett Fire Department, testified in Olympia in favor of the legislation. There are times when firefighters and paramedics drive right by the triage center with a patient who would be better served there.

“Right now we are handcuffed by liability and we have no ability to recoup costs,” Key said. “Legally our only destination can be an emergency room.”

The new law orders the state Department of Health and the state Department of Social and Health Services to establish protocols for ambulance services to take patients to mental health and chemical dependency treatment facilities. The guidelines must be completed by July 2016.

At the Snohomish County Triage Center, the average stay is three to five days. Some people will need longer to stabilize and it can take more time to create a release plan for clients. One of the biggest challenges is finding housing for patients.

In the meantime, they are encouraged to participate in group sessions, such as relapse prevention, and to meet with a mental health professional. They are expected to be active in their recovery, Ruiz said.

Sometimes that doesn't happen right away, Starets-Foote said.

“It may take 17 tries but then something clicks and they're vested in their recovery,” she said. “We're here to help them make that happen.”

Diana Hefley: 425-339-3463; Twitter: @dianahefley