Mental health response team proposed for county


Probate Judge Scott Hassell speaks at a Martin Luther King Jr. Celebration in 2020.

By Emma Kirkemier, Staff Correspondent

A woman walked down the middle of a county road with a shotgun. She was severely mentally ill and off her medication. She was confronted by an Etowah County sheriff’s deputy.

This story could have gone any number of ways, but the deputy was able to talk to the woman and persuade her to put down her weapon, averting a potential crisis.

The above was the story told by Probate Judge Scott Hassell, Ph.D. on June 29 to the Etowah County Commission as he requested funding for his proposed Mobile Crisis Assistance Team, a specialized mental health response team that he hopes will prevent situations like these. This confrontation, he said, happened just the day prior to the meeting.

“I can go on and on and on and tell you how that happens not monthly, but every single week, between Gadsden PD and Gadsden fire, Rainbow City, the county, you name it,” he said.

One less favorable example of these confrontations happened in 2018, when a mentally ill man was tased by Etowah County officers after approaching the sheriff’s department building. He died shortly after the encounter.

“Law enforcement officers, well, all across the state and even the county, law enforcement officers and public safety professionals, firefighters, medics, are called to go to a scene with someone who is mentally ill,” Hassell said. “We’re asking them to do a job that they’re not trained to do, not equipped to do.”

The mental health crisis in both the county and the state is a serious one, Hassell said.

With few resources provided at the state level, limited hospital space and police regularly having to answer mental health-related 911 calls, the county has limited options for treating its mentally ill population.

“During COVID, [CED Mental Health Center] saw no one face-to-face,” Hassell said. “The mentally ill in our county have not seen a face-to-face therapist in over a year.”

He said that while “in the old days,” long-term hospital care for a severely mentally ill person could last “three, six, eight months,” in recent years that number is more like “three, six, eight days.”

This lack of long-term care, he said, can allow the mental health of these patients to once again deteriorate after they are released.

“I’ll give you another scenario,” Hassell said. “A person, potentially the person that encounters the deputy, we send them to Gadsden Regional to be stabilized. … We give them an injection of Invega for schizophrenia. They’re good. They’re stable; they’re home; they’re functional. We put them on outpatient orders, so they’re supposed to go get that medication once a month. Remember, I said CED’s not going out. … So you know what happens at the end of that month? They don’t go get their meds because they’re feeling good. They don’t get them. They decompensate, then we’re right back to where we started with a shotgun in the middle of the county road.”

Hospitals, he said, lack state assistance and are limited on space.

“Guess how much money the state of Alabama gives us?” Hassell asked the commission. “Or let’s make it even easier. How many bed days? That’s one bed per day in Etowah County per month to serve our mentally ill population. Anybody want to take a guess? One. We get one bed day, and we share that with Cherokee County and DeKalb County.”

Hassell explained that with the county unable to rely on state funding, local hospitals must step up — and they do, but there’s only so much they can offer.

While Hassell said he was grateful for the work of Gadsden Regional Medical Center in caring for mentally ill patients, “their only goal, the model now, is emergency stabilization.”

This means that long-term care, Hassell said, often falls once again to police confrontation.

“Now, in reality, we do have a very large psychiatric facility that you (the commission) fund 100 percent, and I’m very grateful for it,” Hassell said. “It’s called the Etowah County detention center. If you look at the psychotropic medication bill and medical costs that you’re paying every single year, the taxpayers are, so many of those folks are mentally ill.”

Hassell’s proposed solution aims to take some of the burden off of police and instead allow two healthcare professionals — a medic and a mental health professional — respond to mental health-related 911 calls.

“By putting a team like that in place in our county, I believe that it will not solve our problems, but it gets us a lot further down the road hopefully in preventing those issues and providing a meaningful response, taking some of that burden away from our law enforcement and our healthcare professionals,” Hassell said.

This program, which Hassell is calling “MCATs,” has been modeled under other names in other cities, including Eugene, Oregon and Denver, Colorado.

The team would also check in on outpatients of the hospital psychiatric ward, he said, providing a “meaningful follow-up.”

Hassell said this would include visiting those due or overdue for a monthly injection of their medication at the hospital, hopefully preventing the need for an emergency confrontation with someone suffering from an unmedicated mental illness.

Commissioners Jamie Grant (District 3) and Craig Inzer Jr. (District 6) agreed that this could be a potentially beneficial program.

“I think it’s a great idea,” Grant said, adding that the commission might form a committee to look into the program.

Inzer agreed, especially where emergency resources were concerned.

“It is a problem because we’re wasting a lot of other money,” Inzer said. “We’re wasting a lot of other efforts in dealing with this that this (program) might be able to help. In the long run, this might be able to save us more money.”

Hassell alluded to the emergency response expenses just in Rainbow City.

“They tell me it’s $200-something every time that [fire]truck rolls out, is that about right?” he said. “So if you do the math in one municipality, you see that it is crippling us.”

While his program would have an up-front cost of “$488,324.96 and some change” to establish it, that money would fund MCATs through 2024 and, Hassell believes, save the county both money and effort in the long run.

This would just provide for two people in one unit, instead of 24-hour coverage.

“This is uncharted waters for us in Alabama,” Hassell said. “But the proposal I think is very comprehensive.”

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