DSL MEMO SERIES 2001-03

April 24, 2001

STATE OF WISCONSIN
Department of Health and Family Services
Division of Supportive Living

To:
Area Administrators/Assistant Area Administrators
BRC Implementation Advisory Committee
Bureau Directors
Consumer Organizations
County Departments of Community Programs Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Certified Crisis Programs
Certified Community Support Programs
Certified Day Treatment Programs
Certified Mental Health Outpatient Programs
Mental Health Council
NAMI Wisconsin and Local Chapters
Program Office Directors
Tribal Chairpersons/Human Services Facilitators

From:
Sinikka McCabe, Administrator
Division of Supportive Living

Re:
Emergency Mental Health Services Crisis Phone Response Rule Interpretation

The Bureau of Community Mental Health (BCMH) and Bureau of Quality Assurance (BQA) have prepared an interpretation regarding Administrative Rule HFS 34 crisis telephone service. This rule interpretation applies to all HFS Chapter 34 emergency mental health services that are developed under the authority of Chapter 51.

People who call a crisis line are under stress so assistance needs to be offered in the least complex way. Therefore, without exception, when someone calls a crisis line a person should answer the phone, not a recording. Advertised crisis hot line numbers should be 800 numbers, or collect calls will be accepted. Callers should not have to know extension numbers or names of crisis service providers. When 911, sheriff department, or other crisis response service are designated as "after hours" emergency crisis phone backup, calls should automatically forward to the designated backup phone.

Crisis phone responders should assume that most callers are genuinely seeking assistance and are willing to cooperate by sharing relevant information so that the crisis phone responder can help. However, callers may be too frightened, disoriented, hostile, sedated or otherwise uncooperative to provide information the crisis phone responder needs/wants. Although the front line crisis phone responder may not be a highly trained clinician (unless otherwise indicated by the code the program is certified under), training and supervision are essential for all crisis phone responders to learn how best to work with the broad range of potential callers, including those who may be ambivalent, hostile, and emotionally stressed. The crisis phone responder is expected to have training and/or experience in crisis counseling and in assessment and triaging of mental health emergencies, including risk for suicide. He/she must be prepared to respond to the full range of potential needs presented by the caller, from referral and linkage to immediate, emergency, on-site response. Crisis phone responders must have the capacity to immediately arrange for clinical backup and other needed emergency services, i.e., law enforcement, ambulance, and face-to-face mobile outreach.

The front line crisis phone responder should stay on the phone for as long as it takes to feel assured that the caller is not in immediate danger before breaking the phone contact. The crisis phone responder will remain on the phone until the caller expresses a sense that the intervention or planned intervention would ensure his/her safety. A good crisis program is built upon a system of live contacts, minimizing the need to use pagers, callbacks and/or requiring the caller to place another call.

Under Wisconsin Administrative Code HFS 94.08 and in accordance with state statutes 51.61(1)(f), people have the right to expect prompt and adequate treatment. Therefore, breaks and delays in service should be minimized as much as possible. Advances in phone technology should be utilized to achieve direct person-to-person "hand-off" and to identify a caller’s location. This may include multiple phone lines, cell phones, caller ID, call waiting, automatic call forwarding, etc.

To be a certified Emergency Mental Health Service Program under Chapter 34, programs are required to develop and implement a training program and policies. This memo specifies the training and policies that need to be developed for crisis phone responders. This policy needs to include and cover procedures to be followed when crisis phone responders need to arrange for immediate backup and must disconnect or temporarily break contact with the caller to make the necessary emergency arrangements. The policy needs to also include a plan to reduce or eliminate the occurrence of callers getting a busy signal when calling a crisis line. All policies and training programs must be kept on file and all telephone responders must be aware of these policies.

Meeting the above crisis phone response guidelines assures that the primary goal of providing direct, 24-hour access to services for persons experiencing mental health crises is realized.

Regional Office Contact:
BQA Certification Staff

Central Office Contacts:
George Hulick
Bureau of Community Mental Health
Division of Supportive Living
1 W. Wilson St., P.O. Box 7851
Madison, WI 53707-7851
(608) 266.0907
e-mail: hulicgh@wisconsin.gov

Otis Woods
Bureau of Quality Assurance
Division of Supportive Living
1 W. Wilson Street, P.O. Box 2969
Madison, WI 53701-2969
(608) 266-3878
e-mail: woodsol@wisconsin.gov