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How Hennepin County’s mental-health outreach team is serving clients during COVID-19

A crisis line for adults in mental health distress, Hennepin County’s Community Outreach for Psychiatric Emergencies has been forced to shift to phone-only services due to coronavirus, assessing callers’ mental states in new and different ways.

woman on the phone
Photo by Siavash Ghanbari on Unsplash

These days, Nancy Olesen is working on expanding her senses. A senior psychiatric social worker and responder for COPE, Hennepin County’s Community Outreach for Psychiatric Emergencies crisis line for adults in mental health distress, she cut her teeth as a member of the program’s crisis outreach team, making in-person visits to clients and relying on her vision to assess the state of their mental health.

Since COVID-mandated closures forced COPE to temporarily shift to phone-only services, Olesen has had to adjust her style, assessing her callers’ mental states in a new and different way.

“I need to rely more on my sense of hearing and my listening skills than I would have in a face-to-face visit,” she explained. “On the phone, I’m listening for callers’ speech patterns and whether their voice is soft and low or if their breathing is rapid.” She said that in the weeks since the change she has learned to rely on auditory cues and discovered that it works better than she ever thought it would.

‘It’s an interesting challenge’

“When you’re on the phone, you aren’t able to see a person’s grooming, or the appearance of their apartment to help you determine their mental state. You have to read their presentation in other ways. It’s an interesting challenge, a different way of communicating, but it actually seems to be working well.”

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Created in 2006 as a way to help keep people with mental illness in the community rather than confined to more restrictive treatment settings, COPE relies on in-person crisis visits as a way to serve clients, said Kay Pitkin, Hennepin County administrative manager of emergency metal health services and COPE crisis team manager.

“Our team is designed to provide face-to face mobile visits at the place of the person’s choosing,” Pitkin said. “It could be a home, a community setting, work, school — any place where a crisis may be occurring.”

The crisis team, seasoned mental health professionals combined with practitioners working toward licensure, is trained to focus on finding solutions that help people find the assistance they need within the community.

“In the past it used to be that people would go into mental health crisis and would be removed to a more restrictive setting like a hospital or a jail,” Pitkin said. “This crisis team is a very serious attempt to decrease the need for that sort of placement.”

Most who seek help stay in the community

The COPE approach works, Pitkin explained: “About 80 percent of the people that we see in those visits end up staying in the community with a short-term care plan like getting connected or reconnected with a mental health professional.”

Nancy Olesen
Nancy Olesen
When managers determined that it was safer during the pandemic for clients and staff if the program became a remote-only service, staff moved out of COPE’s Minneapolis call center and began taking calls from of their homes.

“We’ve retrenched and pulled back and became a remote call center that provides all of the services that someone would have gotten except it’s not face to face,” Pitkin said.

Once the decision to go remote was final, the switch had to be made quickly, a feat that required serious commitment and time from all staff members.

“The positive part is we’re happy to still be able to provide the service regardless of the pandemic, which is amazing,” Pitkin said. “We had to make this change completely quickly and do everything differently. Luckily crisis people are well equipped to respond. That’s how we work. Being able to flip the call center in a day’s time is an example of how resilient people are.”

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‘You can convey a lot of compassion and kindness in your voice’

When she heard that COPE was going remote, Olesen recalled, “I thought, ‘Oh boy. A lot of change and a lot of reliance on technology,’ which for me seemed like a challenge.”

After experiencing what she calls “some bumps in the road,” on the technology front, Olesen quickly figured out how to answer calls on her laptop using a “softphone,” and how to log calls into medical tracking software. “It hasn’t been as difficult as I thought it would be,” she said.

All COPE technology is privacy protected, Pitkin said, a fact that staff makes clear to all callers. And Olesen said she’s also found it surprisingly easy to answer calls at home, rather than in COPE’s call center.

“I don’t feel like I’m bringing people’s problems into my home,” she said. “I have a space for my work with a desk that drops down. When I’m done, I fold it up and stop thinking about it for the rest of the day.”

But is separating work and home really as easy as Olesen makes it sound? Pitkin believes there are a number of good reasons why COPE staff normally work side-by-side, including the ability to pull colleagues together quickly for consultation and emotional support. While all this can be done online, it’s not the same as being in the same space. It can be a tough job, and responders sometimes need emotional support, too.

“I worry a little bit about people’s self-care,” Pitkin said. “We’ve been doing a lot of reaching out to the staff and providing chances to touch base and keep things going like we normally would.”

Open 24/7 all year

The COPE line is open 24 hours a day every day of the year. Responders work shifts so that there is always someone available to assist callers. “We work as a team,” Olesen said. “When I’m done with a client, if they need to call back they can always call and reach another team member. That client is never alone. No matter what time, we will always have someone available for them. They don’t have to rely just on me.”

In the past, the mobile crisis team was dispatched after a phone call. Now, because every interaction takes place over the phone, the crisis assistance begins immediately. Responders can consult with each other and, in the case of a life-threatening crisis, with law enforcement in real time, using remote-meeting software like Microsoft Teams.

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While COPE callers can choose to remain anonymous, Olesen explains that responders usually try to gather names and contact information, especially when there is a concern that a person may be in danger of harming themself or others: “If there is an emergency during the call or if they are suicidal with a plan, we usually try to get their name and a phone number. We can then pass that information on to police.”

That option works well, Pitkin explained, because the crisis teams had their origins as an extension of law enforcement.

Kay Pitkin
Kay Pitkin
“We used to have crisis staff in each of the five precincts in Minneapolis who were doing a co-responder approach with the police,” she said. “The police co-responder was very much in the field and had a lot of face-to-face with people.” That partnership helped forge connections and understanding that continue to this day.

Olesen said that while her concerns about adapting to technology occupied her mind at first, she was also equally concerned that she would not be able to provide the same level of care for clients over the phone. In the weeks since making the shift, however, she’s found that phone crisis care can work.

“I feel like you can convey a lot of compassion and kindness in your voice,” she said. “I actually feel like the service in its current form has been very beneficial for many of our clients.”

COVID crunch?

Are fears about a global pandemic driving more people to call the COPE line? Pitkin said that call numbers have actually sagged a bit over the last two months from an average of more than 100 calls a day.

“Overall, calls have gone down about 20 percent,” she said. “At the beginning we were all thinking that our calls would go up. As it turns out, the change in the type of service we’re offering has likely changed the number of people who give us a call.”

While the numbers of callers may have dropped during this crisis, most people who call the COPE line list COVID-19 as a significant source of their distress.

“Everyone is isolated in one way or another right now,” Olesen said, “but many of the people I’m talking to these days are particularly isolated.” She’s heard from older people or people with disabilities who haven’t been in contact with anyone for months. “They say they don’t even get phone calls. They don’t have contact with family or friends and they just appreciate a call.”

One recent caller was a woman who said she was feeling abandoned and depressed. Olesen spent time on the phone with her making a mental health assessment and providing a list of care resources. A few days later, she reached out to the caller for a routine follow-up.

“She was so thankful,” Olesen recalled. “She said, ‘I don’t get calls from my adult children and I really appreciate you calling me back.’ It was just a short follow-up call but I could tell it meant so much to her.”

Pitkin said that staff has not had time to fully track the data, but she believes that in time they will find that pandemic fears are impacting the mental health of nearly everyone who calls the line.

“It’s apparent from our calls that COVID is causing a lot of extra stress and pressure for people,” she said. “There are some people who, before COVID, were not having particular mental health issues, but it definitely does rachet up people’s anxiety. In some cases it really can be the final stressor that makes things fall apart.”

What the future holds

While the remote version of COPE is working much better than expected, Olesen and Pitkin said they still long for the day when crisis teams can come together and head back into the field to help people in mental health crisis face-to-face.

That personal contact is what the program was built on, Pitkin said. “From the beginning, our main business has been providing mobile services. Having to step away from that and work remotely is a big loss for us.” Staff members are, she said, “feeling a little antsy and wish they could provide mobile services again. It’s the frustration of knowing the things we like to do but we can’t fully do because of this pandemic.”

In the future, COPE staff may find ways to incorporate some of the things that have worked well during this time of isolation into their regular way of serving clients, Pitkin said.

“Some people are telling us they are happy about us being a phone-only service. They say it was very helpful for them and they liked the way it worked.” And realizing that the service could accomplish such a quick flip in a moment of crisis was reassuring, she added. “Learning how to work remotely will benefit us in the future in case of other types of disasters.”

Olesen said she believes this experience has been a lesson in the power of flexibility. “These changes have brought about some positive things,” she said. “When we finally do leave the shelter-in-place behind, we will likely adopt some new, good practices, things that we’ve learned can really work for our clients. Maybe we will continue doing some visits by phone. Who knows? I think this is an opportunity for us to be flexible and creative.”