APS TARC Webinar: Behavioral Health Link – APS and Mental Health Working Together
the broadcast is now starting all attendees are
in listen only mode hello everyone my name is Leslie McGee with the APS Technical Assistance
Resource Center welcome to today’s presentation Behavioral Link APS and Mental Health Working
Together being presented by Stephanie Culhane before we get started I would like to share
a little bit of information the APS the Adult Protective Services Technical Assistance Resource
Center or APS TARC is a project of the U.S. Administration for Community Living Administration
on Aging Department of Health and Human Services and administered by the WRMA Incorporated
contractor’s findings conclusions and points of view do not necessarily represent the
official policy of the federal government this webinar is being hosted by the APS TARC we
work with states to enhance the effectiveness of APS programs by working with partners on use
of data and analytics applying research and evaluation to practice and encouraging the use of
innovative practices and strategies we’re here to help APS programs in any way we can just reach out
to us using the contact information that will be displayed at the end of the webinar the APS TARC
works with the National Adult Protective Services Association or NAPSA to present monthly
peer-to-peer calls these calls provide a forum for workers supervisors and managers and
administrators to dialogue and share ideas with each other about the issues and concerns facing
APS programs the calls are held the second third or fourth Wednesday of each month depending
on which peer group you will want to attend registration information is sent via the
APS listserv each month please email us if you are not a listserv member and would
like to receive the registration information a copy of today’s slides is posted under the
handout section in your GoToWebinar control panel and can be downloaded from there you may
use computer audio or your phones to access audio for this webinar we ask that you please mute your
phone’s headsets or computer mics unless you are speaking so that we can eliminate any background
noise if you experience audio problems during the presentation we recommend that
you sign out of the webinar and re-enter this is intended to be an interactive discussion
and there will be opportunities for questions and comments during the presentation however if you
prefer to submit your questions or comments in writing you may type them in the questions
box at any time during the presentation even if we have moved on to another slide and
your question will be relayed to Stephanie this presentation is being recorded and
will be posted to the web at a later date we will notify all attendees via email when it
is posted online everyone attending today will receive an email in approximately 24 hours with
a link to download your certificate of attendance now we want to run a quick poll to get a feel
for the makeup of our audience my colleague Andy Capehart will launch this poll now and you
can vote by clicking directly on your screen and making the selection that best corresponds
to the profession you identify most with Andy thank you Leslie so we’ve launched that poll
and it’s up on your screen right now just click on the category that corresponds the closest to
your profession and the question of course is which of the following categories do you identify
the most with do you consider yourself an APS professional an other social services professional
a medical professional a legal professional or do you not really fit into any of those categories
and you’d consider yourself other so we’ll leave that open for just a few more seconds to give
everybody a chance to vote looks like the votes are coming in right now the answers
leave it open for just about 10 more seconds and we’ll then close it out and share the results
with everybody so I’m going to close that poll now and it looks like overwhelmingly 81% of the
folks today are APS professionals 13% are other social service professional
2% consider themselves medical and 4% other so thanks for responding to
that poll I’ll turn it back over to you Leslie Leslie are you there we can’t
hear you if you’re speaking and yes I was halfway through
Stephanie’s introduction so thank you now I’d like to introduce Stephanie Giangrande
Culhane she is the BH Link healthy aging liaison Stephanie has nearly 30 years of experience in
elder care and human services she is a graduate of Roger Williams University with a bachelor of
arts in psychology and a concentration in forensics she began her work in eldercare at the Cranston
Senior Center when she was just a teenager and has since worked in a variety of settings
as a director of activities case manager prison discharge planner nursing home social
worker and community relations coordinator Stephanie’s experience as both a protective
services case manager and nursing home social worker has given her a firm background to assist
the state’s office of healthy aging and BH Link when helping people over 60 obtain the help they
need in treating behavioral health illnesses I am now turning this over to Stephanie thank
you so much Leslie and Andrew hello everybody thank you so much for having me I first want to
caution everyone if you hear barking that’s my dog Tessie she wanted to be a part of this and
if you hear lawn mowers it just so happens that the lawn guys decided to show up right when I
was logging on to this so I apologize for that but thank you all for taking time out of your
very busy days to join me for this presentation I was a protective case manager for about five
years working in Rhode Island I was the lead protective case manager at a community action
agency through our division of elderly affairs which we now call our office of healthy aging
so seeing that 81% of you on this call today are protective case managers I understand the
work you do thank you so much and I understand that during this last year of COVID your work did
not stop even if you were not able to be out in the community doing those home visits some of you
were I’m sure your work did not stop just because COVID sort of put a damper on being able to do
that important work so be gentle with yourselves and thank you so much for the really important
difficult and sometimes thankless work you do so let me welcome you to BH Link we can go
to the next slide BH Link is a partnership here in Rhode Island with the company that I
work for which is Horizon Healthcare Partners Horizon Healthcare Partners is a conglomerate
of five community mental health agencies here in Rhode Island those community mental
health agencies work together to partner to provide better health care to our partners here
in Rhode Island it’s also a grant that is funded by BHDDH here in Rhode Island and in Rhode Island
BHDDH is the organization that heads up state’s mental health care and Community Care Alliance is
a member of Horizon Healthcare Partners and they are actually the organization that runs the BH
Link Horizon Healthcare Partners holds the grant with BHDDH but Community Care Alliance have all of
the case managers clinicians peers and community mental health workers that actually work at the BH
Link so let’s go to the next slide please what is the BH Link so again as I said we’re a five year
grant program and what BH Link actually is is an emergency triage center so for a lot of people
when you think about emergency mental health care you think about going to your traditional
emergency room okay and if anybody has ever gone to an emergency room for a behavioral health
crisis or if you know anyone that has you know how daunting that can be it is a really difficult
task to go to an emergency room first of all it’s difficult to admit you’ve got a behavioral
health issue whether it’s a mental health crisis whether it’s a substance use crisis it’s really
brave and it’s really difficult to admit that you’re in a position that is tenuous enough
that you need help now if you’ve got to go to an emergency room a regular traditional emergency
room in a hospital that can be really awful because you are sitting in that emergency room a
busy really sort of frenetic emergency room with other people who are there for a variety of
medical issues and you’re sitting there and you’re waiting because let’s face it if you’re
next to somebody who’s suffering a heart attack maybe your mental health emergency as much as it’s
an emergency for you isn’t really going to be seen as emergent to those medical professionals
as the person sitting next to you or you know conversely if you’re going to a mental health
emergency room you’re sitting with a variety of different people and they’re triaging who needs to
be seen first based on the mental health emergency and sometimes you know in a lot of cases and I’m
certain that a lot of you have probably seen this with some of the people that you work with you’ve
sent people in your work to an emergency room for a mental health issue 12 hours later they’re
back on the street right and I know right now some of you are shaking your heads going oh my
god that just happened yesterday because I know it happened to me so why BH Link is different
is all we do is behavioral health all we see are people for behavioral health issues we
are open 24 hours a day seven days a week people can walk into our center and it is
so different than a normal emergency room we’re small we are in an office park so it’s very
unassuming when you walk into our building it’s different because we’re completely voluntary so
people aren’t coming to us because they’ve been traditionally certed to an emergency room
is the term that we’ve used in the past and that we still use today the doors are locked
coming in but they’re not locked going out so if you’ve come to us and you’ve decided you know what
this isn’t for me we’re going to try to encourage you to stay to get the help you need but we’re not
going to force you to stay so you can leave if you want to and our center looks very different from
other emergency rooms it’s quiet it’s dimly lit sometimes we have aromatherapy going we have quiet
music everybody has their own individual room that they can go into and the work begins the minute
people come in the door you are met immediately by a peer I will tell people that the most important
person that you’re going to meet is the peer peers are people that have a shared experience
so it could be somebody that has you know a mental health issue and they’re now a certified
peer it could be somebody that had a behavioral health issue and now they’re a certified
peer but that peer is going to meet you and ask you what you’re there for what’s going on
what brought you to our center you’re going to be brought into one of the bays during you know now
during COVID everybody’s been screened for COVID temperature checked and you know screened with
all of those traditional COVID type questions we’re going to screen people for any kind of
medical issues that might preclude them from going maybe to a hospital setting and I’ll sort of get
to our APS clients in a couple minutes to sort of understand the differences between why
a senior client might not come to us but once somebody has been
medically cleared to stay with us excuse me they’re then going to go into one of
our triage units into one of the quiet rooms and then they’re going to meet with a clinician
we have licensed mental health counselors we have licensed clinical social workers and
that social worker is going to sit with you and do a full-scale psychosocial they’re going
to ask you what you’re there for and we are truly working on person-centered care so we want to
know where you are and meet you where you’re at we want to know what your goals are we want to
know where you’ve been and where you want to go for some people their next best level
of care is going to be a hospitalization some people truly do need to be hospitalized we’re
going to work to get you that hospitalization some people might need medication management
we’re going to work with that some people might want to be induced for medicated assisted
treatment we’re going to work with that some people might want peer recovery we’ll work
with that some people might just want to start seeing a psychiatrist or a counselor
we’ll work with that we’re going to do whatever we need to do to get you to your
next best level of care without judgment and without any kind of force we want to make
sure that you have that next best level of care we provide transportation to our center so we have
several vans and we can make sure that you come to us and we can make sure that you get to your
next as you see here post stabilization service people can come to us walk-ins people can have
a friend bring them we can have an ambulance bring you police can bring you we have ambulance
contracts so people can come a variety of ways we also have a couple other programs that we
work with we have a 24 hour call center so sometimes people don’t want to actually come
to our triage center they might want to make a phone call first so our call center has people
answering the phones 24/7 we also answer the National Suicide Hotline and so for those of
you that are familiar with the National Suicide Hotline our center answers all of the calls that
come into our state so anyone that’s calling the National Suicide Hotline from a Rhode Island
number will be answered at our BH Link call center excuse me and we’re really super proud because we
were recently recognized by the National Suicide Hotline as having the highest call answer rate
in the nation so we joke around a lot in Rhode Island that we really kind of end up being
last for a lot of things but we were first for this and we’re really very proud of that
and then the other line that we answer is the recovery house hotline it’s called 942-STOP and
it’s a statewide grant program that for people that are looking to get into sober housing
they can actually call our 942-STOP hotline and we will connect them with the sober housing
grant it provides funding up to a year for people that are looking to get into recovery housing
so we’re really excited about that option and my grant I’m gonna discuss a little bit further on in
the slides is through the office of healthy aging and I work with people that are 60 and older in
getting them the services that they need through our center and through other organizations as well
so we’re really very proud of all of the work that we do we also have mobile clinicians that go out
into the community and meet with people so as I mentioned we’re completely voluntary but we also
do have the ability to cert people if we need to we’re going to want to try to make sure that
people buy into the idea of getting the help but if people are a danger to themselves or
others we’re going to make sure that they get the help that they need because we don’t want them
to be in an unsafe situation and the only people that would not be able to stay with us would
be people that are physically violent either to themselves or to others or people that
are medically compromised next slide please so why did the state decide
that BH Link was a good idea so emergency departments really aren’t a
great idea for anyone for a number of reasons one the cost is tremendous anybody that’s ever
gotten an itemized bill for an emergency room knows exactly how expensive it is we’ve
all heard the stories about the 25 aspirin the x-rays all of that it’s just
not a great setting for somebody that’s in a behavioral health crisis for a number of
reasons one it’s just not a good setting and two it’s not a good way to tease out what your issues
are when you’re going to a traditional emergency room you know a lot of times they’re really
looking for your medical issues and those staff really aren’t trained specifically in behavioral
health issues you know some of the other issues we have the law enforcement and first responders
they want to be helpful but they don’t always have the access or the education to really be
able to know how to help people so their first initial reaction would be to bring somebody to an
emergency room but that isn’t always going to be the best option and in a lot of ways that only
ends up exacerbating somebody’s situation and then access isn’t always great because it’s just
not an appropriate level of care for people so we treat people who are 18 plus in Rhode Island we
have another program for kids that are under 18 we help to fill the gaps of our current crisis
in emergency care and with emergency behavioral health we’re working to strengthen the
state’s response to the opioid crisis and we’re trying to offer appropriate care for
people that are having behavioral health crisis now you might be asking yourself well what’s
a behavioral health crisis Stephanie well what we believe at BH Link is that no one’s there’s no
one behavioral health crisis my behavioral health crisis might be that I’m actively suicidal I have
a plan and I’m ready to act on it your behavioral health crisis or maybe your client’s behavioral
health crisis might be that they are you know an older client whose spouse just died and they’re
grieving and they’re really debilitated by that grief and they don’t know where to turn they need
grief counseling maybe it’s a client that you’re working with and they just had to sell their
home and for the first time in their life they’re looking at having to move into a congregate care
setting and they’re really grieving that loss so we don’t want to quantify what a crisis is
we just want to meet people where they are and try to help them and their families to find
that next best level of care next slide please so as we’re talking about some of the
challenges and how a program like BH Link addresses the current systemic challenges
I don’t think it’s any secret or I’m shocking any of you to say that behavioral health
care really has challenges nationwide emergency room visits are costly and they’re
not always appropriate care particularly for the seniors that we work with I think the last
place anybody wants to be an emergency room is an emergency room but particularly when we’re
dealing with our seniors or particularly when we’re dealing with our seniors that have any
kind of mental health issues or any kind of related dementia issues the really just sort
of loud noisy bright area of an emergency room is the last place that that particular client
needs to be we talked a little bit about how law enforcement and first responders want to help
individuals but they don’t always have the tools and obviously we all know that access to treatment
is difficult so our hotline and our triage center is really working to connect people with treatment
and recovery resources for not only to be cost effective but to also get people the treatment
they need okay can we have the next slide so this is what the center looks like as you
can see this is the back of our center it’s very unassuming if you drove by it you wouldn’t even
know it’s there we have a small little sign on the outside you know a couple people have said to us
why don’t you have better signage well because we don’t want to have a big giant sign that says hey
we’re a mental health clinic right there’s enough stigma going on right now behind mental health I’m
sure I’m hopeful that most of you know that May is Mental Health Awareness Month so I’ve been blowing
up my social media and BH Link has been blowing up our social media talking a lot about how we’re
trying really hard to break the stigma and so we want to create a better experience for our clients
and that’s why having this particular facility has really helped us in trying to break that
stigma because it doesn’t have a big giant sign outside that says come get behavioral health
in fact even our name BH Link you know BH does imply behavioral health but we’re not called
behavioral health link it’s just BH Link because we want people to understand we’re trying to link
you with the care that you need next slide please so when we talk about who are the behavioral
health care visitors it’s something that I found that’s very interesting so you can see here and
these numbers are you know these numbers are a little bit older because we’re trying to collect
some data but now that we’re here you know in the time of COVID it’s been a little difficult
to really sort of aggregate all of our data but this right here you can see what we’re looking
at and these are the people that are going into behavioral health emergency room visits the thing
that I found that’s most interesting is for that our seniors for our clients that are 60 and older
what I found most remarkable but that’s probably not shocking to any of you is that the majority of
people that were going into our behavioral health care settings were not going into these settings
for any type of actual mental health diagnosis they were going for substance use disorders and
they weren’t just going for alcohol they were going for opiate use now I worked in a nursing
home and I always found it interesting because I can’t tell you how many clients I had that had
true opiate addictions and I’m guaranteeing you that some of you are shaking your heads right
now doctors for some reason think nothing of prescribing 80 year old women massive
amounts of opiates and I understand very clearly that there are some people that do truly suffer
from chronic pain and they need help right we need to treat people’s chronic pain and so
these medications for many people do help them but how many people do we know that abuse these
medications and they abuse them in the name of treating their pain and how many doctors are just
so quick to be able to write these prescriptions without really taking some time to get to know
their patients and really discuss with them some other options that might be better options to
pain management other than writing these opiate prescriptions for our older clients and that
even goes with talking about mental health issues I think it’s interesting to be able to talk
about that with our mental health patients in people that are 60 and older how many of us
have talked to our clients on protective service sorry that’s my dog taking a little
drink right now if you’re hearing some slobbering how many of us have talked to our protective
service clients you know who’ve talked to us about wanting to try to find you know a
counselor wanting to try to find a psychiatrist and they’ll say I don’t want to talk to my doctor
I don’t think my doctor’s going to understand that you know doctors unfortunately are really poorly
equipped with the ability to know how to talk about these services for their clients I think
they want to they mean well but they just don’t have the ability to be able to do that and so
it’s interesting when I talk to so many of you out in the community because you’re faced with
the same issues and that’s one of the things that I found that’s been so wonderful with BH Link
is because all we do at our particular center is behavioral health care our clinicians
and our case managers have really been able to hone in on the fact that we can look for
different clinicians different psychiatrists different counselors that take insurances that our
clients have it’s hard to find that sometimes you know I’m sure many of you have had situations
where you’ve got a client that’s got Medicare where do we find a psychiatrist for someone
that has Medicare where do we find a counselor but we’re really fortunate in that our particular
case managers all they do is behavioral health as opposed to going to a traditional emergency
room sometimes you know they don’t have that at their fingertips so we’re really fortunate
so in looking at you know what we’re seeing here depression and anxiety are the most common
diagnoses you know I think when we talk about behavioral health and mental health people tend
to have a picture in their head of what a mental health disorder is and unfortunately that
picture ends up being like the big diagnosis like you see at the end right schizoaffective
schizophrenia people have this idea that a mental health issue looks like something but it
doesn’t it looks like you and me it looks like anybody that we know it could look like your
grandma it could look like your best friend mental health issues don’t have a picture they
don’t have a face and as we see here depression anxiety are truly currently in our society today
the most common mental health diagnoses right now and I think unfortunately what we’re seeing is
that people aren’t because they’re not the big ones right schizophrenia bipolar disorder
people are so easy to say well it’s not that bad well it’s only this or it’s only that so that’s
not true some people need help for those issues some people need medication the only way that
we’re going to be able to get rid of the stigma is to really start talking about it
could I have the next slide please so as we look here this is the traditional
community crisis flow right we have all of these people that somehow end up at the hospital
ED and then once they’re leaving this hospital ED these are the different places they go
and I think we here if you look at on the right side where you see services declined those are
our APS clients right how many times have we seen we refer one of our APS clients to a hospital
to an ED right and we get excited about it right we finally visited them we get
a clinician who certs them we think finally we’re getting them to the
hospital and then we get the phone call from the discharge planner hopefully I’m gonna
say seven times out of ten nobody ever calls us we just find out from somebody that they ended up
back home and all the services that we were hoping were going to be completed were declined so
now we’re left with this APS client who we were really hoping was going to get some type
of continuing care that we were working on and they’ve declined the services so now we’re
still stuck with homelessness unemployment the mental trauma social isolation which has
been a huge issue this year as we all know and now they’re just stuck in that cycle of APS
right how many of us have those I hate the term but for lack of a better term you’re saying it
right now the frequent flyers the people that we know are going to show up on our case loads once
a month every six weeks every couple of months they keep showing up so let me tell you a little
bit about what my grant is and that’s going to be in the next couple of slides as well so my
grant is through the office of healthy aging so our office of healthy aging is our division
of elderly affairs and so what my grant is through the office of healthy aging and along with
BH Link so I work with people who are 60 and older and part of I think the original intention behind
this grant was to bring people into our center so the hope I think originally was that people
who were suffering from mental health issues we’re going to come into BH Link and were going to be
seen by clinicians and were going to get services but I think all of us that are here today all know
pretty well that people who we work with in APS really don’t want to go and get treatment the
people that we work with in protective service are not the people who are really self-motivated to
want to say I need help so what a lot of what my program has become has actually been threefold so
our call center will actually get phone calls from from seniors and it will be seniors who
are struggling with mental health issues who are struggling with issues of homelessness
who are struggling with a variety of issues you know today I got a phone call from a woman who
is on disability she’s been couch surfing staying with some friends the most recent friend that
she has been staying with for the last month is losing her apartment and now this particular
woman is going to be homeless at the end of the month so you know even though she
doesn’t have any mental health issues someone gave her my name because I worked through
the office of healthy aging to try to see what I could do to help her because she called BH
Link and said I don’t know who else to call so that’s the first piece of what my role is is to
work with these clients that will call BH Link that are looking for help with mental health
either at our center or that call into our call center the second piece of what I do is I work
with our state’s protective service case managers so our protective service case managers in Rhode
Island are all contracted through community action agencies I’m guessing that it’s similar throughout
the country and I visit with all of those groups and you know make sure that they know that
I’m available I’m not going to exactly triage their cases from the onset once they
get those cases but what I’m going to do is I’m going to help them when they’ve sort of
done everything that they feel that they can do and they’ve sort of come to that round circle of
doing everything and they’re at their end of their rope and they need some extra help they’ll give me
a call and I will help them to triage those really tough cases with clients who have some pretty
profound and severe mental health issues I’ve gone on home visits with them before so I’ll
actually go out into the community with them so I don’t exactly have a caseload but I sometimes
have a little bit of a caseload because I do help the protective service case managers in the
community with managing their cases the other piece of what I do is I go out into the community
to senior centers I speak to assisted livings to nursing homes to doctors offices to home care
agencies to talk to them about BH Link and why we’re a better alternative to sending clients who
are 60 and older to an emergency room because I’m pretty certain that every single one of you
have had a situation like I mentioned before where you’ve had a client who has needed to go to
an emergency room and that issue has been really unsuccessful and it’s a huge frustration of all
of ours because at the end of the day we’re not looking to pass on our problems or our problem
child client onto someone else right we just are hoping that that’s going to be an outlet to be
able to get that client the care they need right how many of us have had a client that has really
been very difficult has not been successful in the community not taking care of themselves
self-neglecting for whatever reason probably because of an undiagnosed mental health issue
non-compliance with medication a host of issues they get sent to an emergency room they get sent
to a nursing home and we think it’s like the sky’s opened up and this is going to be the answer to
everything because finally they’re going to get placed somewhere and then we get the letter from
the ombudsman and they’re going home and it’s like oh god I finally thought this was going to be
the answer and again it is not at all because we’re looking to take our problems and put them
on somewhere else or because we want to take our caseload and shorten our caseload it’s truly truly
because we want what’s best for these clients and generally it’s truly because these clients
have really severe and profound mental illness and unfortunately for so many people that are
in protective service we don’t have the ability to get what they need right we don’t have
the ability to say I’m gonna get you that you know that mental health help that you need
so that’s why my role has been so wonderful here in Rhode Island and that’s why I’m so proud
of the fact that our office of healthy aging and our state was able to come up with
the funds to be able to support this grant through BH Link because I’ve been able to get out
into the community and talk to so many providers and so many case managers like yourself about
the importance of digging a little bit deeper and looking at the needs of the clients
when it’s come to mental health issues so the other piece of what I do and it’s my
favorite piece of what I do and it’s been so hard not being able to do it during COVID I
go out into senior centers and to community events and I actually speak with seniors about
mental health and behavioral health so I’m not a clinician I’m bachelor’s level for psychology
and social work but I’ve been doing this a long time so I’ve picked up a lot of knowledge
along the way and when I go out to the senior centers I basically just sit and I talk with the
seniors about demystifying what mental health is and I’ve had some wonderful sessions with them
at some high-rises at some senior centers and at some community centers to talk with them
about I basically just start my conversations when I say behavioral health what do you think of
and I get a whole bunch of silence and I’ll say anybody remember having that aunt that people at
family dinners would say we don’t want to talk to her and someone inevitably would say oh my god I
had that aunt everybody just said she was crazy and it would spur a conversation what do you
think really was the situation with that aunt and somebody inevitably would say you know we
had an uncle and we knew he always drank too much but we never knew why and then years later
I found out xyz about what happened to that uncle and I can’t tell you the wonderful
conversations I’ve had with these seniors who’ve really started to learn to unpeel the
layers about what mental health and behavioral health really is and how it has really helped
them to understand a little bit more about their own behavioral health and mental health I’ve been
able to work with a few groups of grandparents who are helping to take care of grandchildren who
have unfortunately been you know the grandparents who are taking care of grandchildren because
of the opiate crisis we’re seeing a lot of that right now and I’m certain that maybe you’re even
helping some of these clients in your APS work navigate the system of you know older people who
are now left with taking care of grandchildren who never really thought that they’d be in this
position right now so as we’re looking at all of these things I’m so thankful to be able to
have this program and I can only hope that this will grow you know throughout other states
as well can we have the next slide please somebody asked me recently do you think you’ve
saved lives at BH Link and I include this slide because this was an actual email that we received
I know we’ve saved lives I know I’ve helped people in the work that I’ve done with the seniors that
I work with we had recently just before COVID here in Rhode Island all of our major networks
local tv networks as well as our PBS networks so we had seven stations simultaneously broadcast
a show called it’s okay not to be okay and it was all about BH Link and all about mental health
and it was during May so it was May of 2019 I don’t know I’ve lost track of time I think
lately when I talk about last year I don’t mean 2020 ever I just mean 2019 because I feel like
2020 wasn’t even a year but it was all about behavioral health and breaking the stigma and we
had one woman who was a client of ours at BH Link early on during when we first opened and she was
a middle-aged mom living in the suburbs she had a job she had kids she was a member of the PTO she
had a group of friends just like all of us and she was an alcoholic and she was suffering with severe
depression and she had suicidal ideation and she had plans to end her life and her husband didn’t
know what to do and he reached out and brought her to the hospital and thought that solved
the issue and it didn’t and she came home and nothing really was helping and then he did a
Google search and he found BH Link and he took her to BH Link and we got her hooked up with services
so she has told everybody who will listen that we saved her life so I know we’re saving lives I
know that the work that I’m doing through the office of healthy aging is making a difference
I’ve had case managers tell me how thankful they are that I’ve been able to shed light on the
fact that a lot of the work that they’re doing really is affected by behavioral health crisis and
by the lack of access that seniors unfortunately face in getting help not only because they
don’t want to have it but also because they can’t always access it because of insurance
issues and things like that so I’m really proud of the work that we’re doing and I’m looking
forward to seeing the work grow next slide please so this is where I come to the things that
I’m actually doing you know it’s funny they allowed me to create my own title and here
in Rhode Island a couple years ago we have a new director of division of elderly affairs and the
first thing that she did was she changed the name so she changed it to the office of healthy aging
and I am creeping up on 50 so I’ll be getting that AARP card soon enough and you know I laugh all
the time and I’m like I don’t want to be a senior I don’t want to be elderly I know I’m older
healthy aging I like the term healthy aging so you know they wanted me to be have the
liaison in my title because that is what I do I’m a liaison between providers
between seniors between APS workers so I wanted it to reflect the office of
healthy aging and I really feel that it’s it’s meaningful you know I try not to get too
caught up between all of the terms out there but I think that if we can empower older
people to realize that aging in place is wonderful and growing older is healthy that we
can sort of end some of the stigma around aging so that’s how I chose the title so what I do is
I help seniors provide triage services at BH Link I provide support for adult protective service
case managers that work with our office of healthy aging I provide support for community providers
such as senior centers nursing homes assisted livings doctors even police officers so all of our
communities have police advocates and quite often I will have senior police advocates contact me via
phone or email you know sometimes they’re working with a case manager but quite often they’ll just
contact me apart from the case manager because they need some assistance on you know boots
on the ground they had to do a wellness visit what can I do how can I help this particular
older person that I’m working with I did a home visit and I’m concerned can you send out a mobile
clinician can’t tell you how many times I’ve done that the value of our mobile clinicians has been
amazing and I hope all of your communities have access to mobile clinicians because I really
feel that that is where the future is headed for mental health and behavioral health
services both for older people for you know for younger people even for kids I
think being able to go to people where they are is going to help people get better access is going
to help end stigma and is really going to help be able to get people the care they need exactly
when and where they need it so I’ve been so grateful and I know our police officers and our
communities have been so thankful to be able to have mobile clinicians that can actually go
out on the spot and sometimes go with them you know I can’t tell you how wonderful it’s
been for older adults and their families to be able to have connections both with our
case managers and with my particular office to be able to not feel like they’re alone
in being able to help their family members being a child of an older person that’s
lived a life with mental illness is a really difficult thing whether it’s somebody
that’s an adult child of an alcoholic or someone that’s an adult child of someone
that has just lived a life of mental illness is really tough particularly when they’re aging
in place and now not only are they left with having to pick up the pieces of having you
know lived a life with this person who’s been so severely mentally ill but now this person is
in a weakened state and you know that’s my mom and I’ve got to take care of her that’s my dad and
I understand you know he’s had these weaknesses but I have to help him how can I help him being
able to help people has been really empowering and I’m really glad to be able to have this
position and our center to be able to do that and again the best part of what I do is
being able to offer these presentations and help demystify behavioral health for seniors and
really when I can make that click with a senior that it’s okay to talk about behavioral health
and it’s okay to talk about their mental health I can’t tell you how wonderful it is because I’m
somebody that suffered depression I’m someone that’s you know was in a a day program after
suffering from postpartum depression with one of my children so I talk about it and I feel
like it’s empowering for me so when I can see other people particularly our older clients be
able to be honest and share their stories too it’s so amazing and I feel so wonderful about them
being empowered to be able to do that next slide so adult protective service cases
we see ways we can help our clients I cannot think that there’s anyone that’s
on this call it’s looking like there’s 193 of you so thanks everybody for sticking with me
for 46 minutes I can’t imagine that there isn’t one of you that’s here right now that hasn’t
dealt with someone that hasn’t had some type of mental illness now I’m gonna guarantee that a
bulk of the people have been clients that have had undiagnosed mental illness so you’re out there
you’re working with this client that you know has something and there’s no name to it they won’t
admit it maybe you even talked to their general practitioner and the general practitioner doesn’t
want to admit it but you know it right because this is what you do how do you help that client
what can you do to help that client it’s not an easy thing and it can also be a difficult thing
to navigate a difficult position for you to be in so the best thing that I would say is to
start off slow and just start off easy and to you know be gentle you certainly don’t want to
jump into it particularly with an unwilling client by you know saying you need a psychiatrist
even if that is exactly what the person needs but sometimes even if it’s a client who’s at least
willing to listen sometimes even saying hey have you considered that it might not be a bad idea
to talk to somebody about the way you’re feeling here I’ve got some brochures even if you’re not
certain a quick Google search on your local mental health clinics are going to give you everything
you need are going to have stuff at your fingertips I’m going to guarantee that most of you
have community resources and have connections with your local community mental health clinics
maybe even reaching out to them and having them you know trying to find a partnership
with them if you don’t have that already you know to be able to figure out a way to have
somebody at your fingertips it’s one thing that I always recommend to all of my case managers is to
have a little bit of a toolbox to have a toolbox of a couple phone numbers a couple people you
know remember that one discharge planner at the hospital that finally answered your phone
call never lose that phone number even if that discharge planner rolls their eyes every time you
call never lose that phone number ever because that’s your go-to person you know the community
mental health worker that maybe is outside of the catchment area of the client that you live
in do not lose that phone number because that community mental health worker is going to know
another community mental health worker for the catchment area of that client that you’re working
with so it’s really important to have a toolbox to be able to help clients navigate these
issues when it comes to mental health because nine times out of ten the things that are
bringing these clients to self-neglect are probably mental health issues you know the
abuse end of it is a completely different aspect and sometimes you know a client can
find themselves in an abusive situation or in an abuse situation because of some mental
health issues either from the abuser or because of their own mental health issues but that ends up
becoming a whole different issue but particularly in your self-neglect cases a lot of those cases
do end up being a direct result of some type of mental health issue so you know like I said if
you can have a toolbox you know if you can work with that general practitioner to say
listen I’m a professional stand up for yourself even if you are just a bachelor level even if
you don’t have a degree I know our particular case managers here in Rhode Island
most of the case managers have to have at least a bachelor’s I don’t know where you
guys are across the country and where you live but even if you don’t stand up for yourself
you are an adult protective case manager you are a professional so do not ever let
anybody demean you whether they’re a doctor a licensed clinician you’re a professional in your
own right and make sure that you honor that and make sure that you let other people that you’re
working with know that because at the end of the day you’re working in the best interest of the
client and you know have that toolbox together to do whatever you have to do to be able to help
that client in the best way you can next slide questions so I have spent the better part of 49
minutes talking well not really because Leslie and Andrew spoke a little bit I don’t think
Leslie thought I could talk this long well thank you Stephanie I think that was
really helpful info and you were mentioning toolbox I put a link in the chat for our attendees
the APS TARC just recently published a toolkit on mental health and you’ve got the link there in
chat if you’d like to look at that of course it’s from a national level so it won’t have local
resources but it’s a good place to get you started so FYI it’s a good place to check
that out I thought I would mention that we do have a few questions Stephanie so I’ll launch
right into those we’ve got a few minutes left the first one is BH Link only
available to Rhode Island residents so currently we can see let’s put it this
way in Rhode Island if anybody comes into BH Link we will see them we don’t take we don’t
charge anybody for our services if someone has insurance we may bill their insurance for
like the clinicians or the peers those services and right now we’re only going to be billing
for Rhode Island insurances but we’re certainly not going to say no to anybody the issue
would become that next level of service so let’s say you were nearby Massachusetts
we might have some difficulty placing you depending upon what your insurance was
or say you had Connecticut insurance or you know New Hampshire we might have trouble
getting you to your next level of care based on what your insurance was so I don’t want
to say only for Rhode Island residents we wouldn’t say no to anybody but it might be difficult for
us to get you to where you need to be sure sure it makes perfect sense okay and our next one
this one’s a little bit long so I’ll read it twice many of our cases involve mental
health crisis of an adult child or the senior resulting in emotional and physical abuse of
the senior how does your program deal with these situations so again many of our cases
involve a mental health crisis as a result of emotional and physical abuse of a senior how
does your program deal with these situations so honestly any cases that come my way are
first triaged by the APS worker that’s assigned to the case so I don’t have an actual caseload no
case is gonna sorry about that that’s Tessie she’s trying to answer no case is gonna be assigned
to me first directly so if I had a case that was coming to me say I was working whoever
the you know person that was asking that if you came to me and you had an issue where let’s
say the person was being abused by an adult child who had a mental health issue I
would try to figure out a way to help that client navigate away to get some help for their adult
child if it was the client themselves that had the mental health issue we’d try to figure out a
way to get that client the mental health help they needed but it would all start on my level with the
APS worker because I’m not directly assigned to the cases but we would just work the best way we
could and you know if it was a situation where it was an emergent situation and we needed to either
you know separate that client from the abuser then we would do what we had to do within our
office of healthy aging and the attorney general’s office to make that happen great that’s a great
answer and that kind of feeds into the one of the other questions we got any tips for convincing
clients to accept mental health services again yeah that’s a big one so getting clients to
accept mental health services any tips you have so one of the things that
I’ve always used in my toolbox is I’ve always tried to convince my
clients to get help by telling them that by helping themselves they’re going to be helping
their families right that’s always been one way that I you know I’ve said even like let’s say like
the home care issue right you’ve got that client who’s like I don’t want anybody to come into my
home yeah but you know what Mary by you getting the help you need you’re going to be helping your
daughter take better care of you so that’s always been one approach you know with the mental health
issue and even in some cases when it’s like that true mental I’ll open up about myself you know
I’ll say listen I know it’s a tough subject I see a counselor I take some medication I’m not ashamed
of it I know it’s something I need so sometimes if you can make a personal connection if you know
a story about someone or it’s about yourself sometimes that can be really helpful and that can
just be the door that you need to slightly open sometimes you know the first thing you have
to do particularly if it’s a brand new case you’ve got to build trust so you see this first
time don’t think you’re going to be able to make that connection on that first visit you might have
to go back a couple times because the first thing you need to do before you’re going to get that
buy-in is building trust yeah sure of course yeah another question that just rolled in how does
your organization deal with clients who have no official diagnosis wow that’s always
tough and that’s a lot of our clients so you know we will you know try to see what we can
do to at least you know get them to a psychiatrist to see if we can get that work up done so long as
they’re willing to go you know and then if they won’t you know will at least
maybe work with a general practitioner to maybe see if that general practitioner will give like a
general diagnosis unfortunately most of the people that we work with don’t have an official diagnosis
either because the general practitioner doesn’t want to deal with it unfortunately that happens
or because the client is just never presented in such a way that a doctor has taken those steps
so you know it all depends upon the situation yep and that certainly is common with APS
clients that they will not have a diagnosis I’m sure you know that one other question that
speaks to something you touched on a little bit before we started the Q&A part of the program
can you describe your mobile crisis services sure so we have several we have one of our mobile
crisis units is actually called our SOR team so it’s a state grant so much of what we do
in Rhode Island is through grants that come either from SAMHSA which is the federal mental
health grant or through state grants but the SOR is the state opioid response and it started
out as ways to address the state’s opioid program so it is through community mental health agencies
they go out based on location so it would all be county based and a mobile clinician would go out
you know they’d have the driver that would go and it doesn’t have to just be for an opiate issue
now it could be for any mental health crisis so it could be initiated by an APS worker might call
the community mental health agency and say hey I’ve got a client we really think that they’re in
a crisis they need to be seen potentially certed could you send somebody out there so that’s
one of our programs and then at BH Link we actually have somebody who works on
site she’s our mobile crisis clinician and it’s a very similar thing although she
doesn’t necessarily she’s not just going out just to cert people she’ll go out just to put
eyes on people and offer a number of services so she’ll go out and talk to somebody she’ll go
out for crisis she’ll go out to cert she’ll go out just to give information to a client but that’s
all initiated either through our call center through an APS worker through myself
anybody can actually call BH Link and request a mobile crisis team and then if we
have availability we’ll send someone out good deal well thank you so much Stephanie we’ve reached the
top of the hour so I think we should wrap things up we really appreciate you doing this for us
I think it’s very important to hear about hear from someone who’s had experience with both APS
and mental health a lot of APS workers you know have not worked in mental health before not had
a lot of experience with mental health clients so our clients with mental health issues
so thank you so much for this information if we go to the very last slide you’ll see
some contact information for the APS TARC where you can reach out to us there’s an
email address and a web address there you know check out our website if you haven’t already
there’s lots of good resources on there including recorded webinars about two dozen of them
that we’ve done over the past several years so you know take a look at those they’re good
educational opportunity and again thanks to Stephanie for speaking to us today
I think it was really helpful information and have a great afternoon everyone thanks so
much for joining us thank you bye-bye thank you
The webinar discussed the role of the Rhode Island Office of Healthy Aging’s APS division’s grant for a Healthy Aging Liaison working with then state behavioral health triage center. BH Link is a triage/mental health crisis facility providing 24/7 in-person assessments, recovery support, healthy aging behavioral health education & consultations, and more. (Webinar date: May 25, 2021)
Presenter: Stephanie Culhane, Healthy Aging Behavioral Health Liaison, BH Link