Oh, I'm sorry. Shaakira might have -- I apologize. BHGD could speak on that. I'm sorry. (Witness approached Witness table.)
And please state your name for the record and respond, please.
Shaakira Gillette. And I'm sorry. Can I have that question again?
Yes. I'm just asking about your what data you have for the outcomes of certain dispatches? And from that data, how many of the dispatches are actually resulting in involuntary commitments?
Okay. Great. So from December 1, 2022, to January 31, 2025, there was a total of 1,775 encounters for CERT and 2192 follow-ups. Out of the 1,775, only of those individuals were arrested. As far as 302, there was 568 involuntary commitments. And then there was also as far as individuals who said that they wanted to go into the hospital, there was 356.
12 What was the date again? You said 13 December 1, 2022 until when? 14
17 January 21, 2025. Okay. Thank you 18 very, very much. 19
Yes. Thank you. Councilmember Lozada had to step out. She had a question about you mentioned the teams are stationary and then you deploy when the call comes in, right. Do they travel in their personal vehicles or is it like your van or some --
They have vans that were included in the budget that they purchased for mobile crisis transport.
And she has a separate bill around an issue about providers in her District which is why she was asking this. And then she had a follow-up question about classifying these folks who are responding as first responders, because that would then exempt them from the law that she was looking at. So I just wondered how are they classified now so I can give her that information?
They're not classified. I think I'm the one that is advocating for calling them behavioral health first responders, and I don't know what that would require to make this not just for Philadelphia but for Pennsylvania as well, so that the staffing, the training and everything is standardized across the state, but particularly across the Commonwealth of Philadelphia.
That's wonderful because that changes how they're viewed in terms of our city, state and the nation, because it elevates the role of needing this service and that mental health is part of health and any crisis in our health spectrum should be addressed.
Okay. I will definitely convey this information to her. Thank you so much.
That's a good point because they're doing the job. They should get the designation. With that, there are no 9 other questions on this panel? (No response.)
One of the colleagues -- one of the things that I heard about this potential hearing is that when we call people to testify we need to be more welcoming because they were kind of apprehensive about what we were coming at them for and what did they do wrong. No. Every now and then we want to acknowledge that you're doing things right. That goes with these hearings as well.
Thank you. Please be seated. Thank you for your patience. Please state your name for the record and begin your testimony. Good morning still.
Okay. I will start. My name is Lindsay Eshelman. I'm the Deputy Director of Crisis and Residential Services for John F. Kennedy Behavioral Health Center.
Good morning. I'm Tenera Styles, the Clinical Supervisor for JFK Crisis Services.
My name is Rebecca Stewart. I am on faculty at the Center for Mental Health at Penn, co-leading the Crisis 2.0 Evaluation.
So first, I'd like to thank the Committee for having us here today to share about the services we provide to citizens of Philadelphia. I'm going to start by discussing how we promote safety and improve client outcomes. I'll then discuss how mobile teams fit into Philadelphia's Crisis Continuum and will conclude by sharing how we ensure staff are appropriately trained and adequately reflect the populations they serve. I'll then turn it over to Tenera, who will provide some real-life examples of dispatches that our teams have handled. Sorry. Just need to make sure I'm close to this. So how we promote safety, how do we do this: So first, by meeting people where they are. So we'll go to wherever the crisis is occurring. So this could be in a home, at a shelter, in a library, on the street. We're never asking someone to come outside and meet us. We're going to them. So this really increases comfort. Second, by prioritizing confidentiality. So teams arrive and we're wearing plain clothes, so we're not dressed in a uniform. And we'll identify ourselves through the use of badges such as this. Some teams might have small insignias on their shirts, but we're not overtly announcing to passersby or to neighbors who we are. We also preserve client confidentiality by asking where the consumer feels comfortable sharing with us. So if we go to a library, we might ask if there's a free room 8 that we can speak to the person in. If we're in the home, we might ask where they feel comfortable sharing with us because they might not speak freely in front of family members. So one team member could speak with the consumer in crisis. One team member could speak with the family. We can make sure that everyone's heard, that we're gathering all the information simultaneously and providing the best outcomes. Lastly, we promote safety by creating safe spaces. So we really want team members to notice nonverbal cues, both their own nonverbal cues and the nonverbal cues of those that they're serving. So this means we want everyone to have open body language. We don't want them crossing their arms. We want them to notice if maybe a consumer is clenching and unclenching their fists. This might indicate to us that we need to disengage, give the person more space or try to redirect them. Lastly, we train them in active listening. So we don't only want to hear what the consumer is telling us. We want to ensure that they feel heard as well. So all of these factors contribute to us creating safety for both the clients, the communities and the teams that are out there. So improving outcomes. We achieve this by providing person-centered approaches. So each of our interventions are tailored specifically to the person we are meeting. So because the City has expanded the number of teams providing services, this allows us to spend time thoroughly gathering information, harnessing natural supports and truly valuing client input. And by doing this, we provide meaningful solutions that reduce reliance on crisis response centers and promote the usage of and linkage to community supports. So now, where do we fit in on Philly's crisis continuum? So we see ourselves as the second layer of support with the Philadelphia Crisis Line being the first layer. And they do an excellent job at providing resources and resolving many of the less-acute crisis situations. But there are occasions that necessitate an inperson intervention. So this might be a health and welfare check. There might be circumstances where a delegate is unsure or unable to determine if the information presented is domestic in nature or mental health-related. There are also instances where they just can't de-escalate someone over the telephone or maybe they don't feel comfortable creating a safety plan without having eyes on the person first. So once the teams receive a dispatch, the primary goal is to get to the scene as quickly as possible to avoid any changes in the circumstances.
So the faster we arrive, the higher the chances are that the person in crisis, A, hasn't left the scene or, B, hasn't changed their mind about receiving services or, C, the situation hasn't changed necessitating some other type of intervention. So as DBHIDS previously said, our new dispatching program, Behavioral Health Link has improved response times by offering geo locating technology. That allows dispatchers to see which team is closest to the crisis. So once teams arrive on scene, they identify themselves and begin the assessment and information- gathering process. So in addition to implementing evidence based- techniques, teams utilize existing health care and community resources that are integrated into the crisis continuum as a means of preventing need for hospitalizations or CRC referrals. So similar to emergency departments, we triage needs based on acuity, allowing us to expedite certain supports. So for instance, a client that's seen by a JFK team can be referred to our Fast Track system. This gets them an intake appointment within 72 hours of service. And in acute cases, it can be same day. So this cuts down the wait time for an intake appointment from potentially months to a mere few days. Additionally, as DBHIDs referred to previously, the new Merakey walk-in clinic can provide great treatment options. So if a team notices that someone's experiencing a crisis because they don't have access to their medication, we might transport them to the Merakey walk-in clinic where they can receive a Bridge script. So if they do have current services, they just don't have an appointment in the near future, they can get a Bridge script for three weeks. Merakey walk-in clinic can also write new prescriptions. They have peer-support specialists, case managers, short-term provider treatment options. And if we do notice that someone needs to go to the Merakey walk-in clinic, we will give them a call in advance to let them know that we're coming. And we also will provide them with a warm handoff so they know what the situation is. In sum, we're kind of a second layer of support. We can provide expedited linkage to needed supports and we also do onsite stabilization plans. So if we don't need to bring anyone anywhere we'll at least create a stabilization plan and then we'll do follow-up to ensure that they're following that stabilization plan. Finally, how do we ensure staff are appropriately trained and adequately represent the populations they serve? So our staff consists of registered nurses, certified peer specialists, licensed mental health clinicians among others. So when screening for appropriate candidates, we not only want to see credentials that look good on paper, but we also look for qualities that translate well into real-life application. We need individuals that function well under pressure, have the ability to multitask and also think outside of the box. Once hired, supervisors will conduct scenario trainings to give staff sort of a broad view of different crises situations. New staff will also shadow teams to gain an understanding of how they function, what they do and who they serve. So all staff also receive onboarding and ongoing training in areas such as suicide prevention, motivational interviewing, trauma- informed therapy, cultural competency, among others. All staff also receive ongoing supervision by a Master's level mental health clinician. Additionally, the ongoing support of this program has allowed us to hire supervisors that are in person nearly 24/7. And so, for those few hours where we don't have an inperson supervisor, there's always someone that's on call. So this allows teams to have extra guidance through complicated situations. Also, if a critical incident occurs, they'll have access to a supervisor for debriefing services. And this is really important because as DBHIDS had mentioned, there is a high degree of burnout in this field.
And so, having that supervisory of support is essential to staff retention and it's also critical to the goal of achieving compassionate care to the communities that we serve. So in terms of diversity, staff provide support by drawing on both lived and clinical experience. So we ensure that staff live within the communities that they serve so that they can draw from that knowledge base when providing assessments and building rapport. JFK ensures that teams know, hear and recognize the communities they serve. And with that, I'm going to turn it over to Tenera to give you some examples of dispatches.
Good morning again and thank you for allowing us to speak in front of the Council.
Tenera Styles. Due to our teams being diverse, well-trained and supported as well as fully integrated into the crisis continuum, they excel at onsite stabilization. An example, for instance, is where a team went out to a personal care home to assess a resident who was agitated and restless. The team was able to de-escalate and redirect the behaviors through brief interventions counseling as well as being able to identify that resident's triggers, which specifically had to deal with family dynamics. The team was also in a place to provide staff with insight as well as support to help them mitigate any future escalation of behaviors in that situation. Also, they were able to make contact with that individual's therapist to move their appointment up to the same day as well as passing off pertinent information to help with that day's session of importance to what that episode incurred. The intervention used by the team was also able to help avoid the use of this crisis response center as well as providing support with personal care staff and then avoiding the possible termination of that resident's agreement with the home. Another occasion the team responded to an individual that was in crisis experiencing a suicidal ideation after they had a very recent serious attempt. The team built rapport with that individual, offering understanding, compassion and was able to identify and let the individual express their unmet needs, fears and anxieties going forward. They worked with the individual to develop a comprehensive safety plan that included natural supports as well as providing follow-up through JFK in connection with our services. Through this interaction, the team once again was able to avoid the use of a crisis response center and allowing the individual to stay home, maintain their autonomy and allow them to willingly agree to benefits and services.
Thanks again for allowing us to share and I'll turn it over to our researcher.
Hello. My name is Rebecca Stewart. Thank you for having me and also to DBHIDS for including me --
Closer really? I'm a clinical psychologist and assistant professor at the University of Pennsylvania. Today I'm speaking on behalf of my co-investigator Molly Candon and our team at the Penn Center for Mental Health. 0, which Dr. Williams described so well. It's a citywide initiative aimed at improving the experiences of Philadelphians having a mental health crisis, which includes an expansion of adult mobile health crisis services which is why we are here today. In short, I can report to you that mobile crisis services in Philadelphia are decreasing the need for expensive inpatient care, which results in cost savings to the city. We already know that mobile crisis services work. One way that researchers measure their effectiveness is if mobile crisis services help individuals de-escalate and connect to community-based care while avoiding other costly and potentially traumatizing outcomes. The effectiveness of mobile crisis services, especially in decreasing hospitalization rates, while facilitating access to community-based care has been demonstrated in other cities for many years. For example, a rigorous study in Atlanta from 24 years ago found that mobile crisis services resulted in a statistically significant reduction in psychiatric hospitalizations compared to crises handled by police. A more recent study from Connecticut concluded that mobile crisis services reduced the use of emergency departments, another very expensive level of care. Researchers have also found that most individuals in crisis do not want police involvement and prefer trained mental health teams. Mobile crisis services do just that, by connecting individuals in crisis to the appropriate expertise and minimizing criminal justice involvement. 0 evaluation, we have some exciting preliminary analyses to share with you today. One of the biggest challenges in evaluating programs like mobile crisis services is constructing a comparison group. That has a similar group of individuals who do not receive mobile crisis services, so we can compare their outcomes to a group who did not receive mobile crisis services. Using administrative data from here in Philadelphia, we compared Medicaid-enrolled individuals in crisis who called 988 and received crisis services in '22 and '23 to a group of Medicaid- enrolled individuals in crisis who called 911 and received care from ambulances in 2018 and 2019 before we had these teams. We found that half of individuals who used ambulances ended up in a psychiatric hospital within 30 days of their encounter compared to only one-third of individuals who used mobile crisis services. This amounts to a 34% reduction in inpatient care. And based on our estimates, the decline translates into roughly 5 million in cost savings in the city over two years. Our evaluation team is doing more than just looking at administrative data to understand and improve the delivery of mobile crisis services in Philadelphia. We've convened a community advisory board of experts along the crisis continuum, including Philadelphians with lived experience. We're serving staff, talking to this retention issue of local agencies to better understand the barriers and facilitators of providing high- quality mobile crisis services safely. This year our team will interview Philadelphians who use crisis services, including adult mobile crisis services with the hope of pinpointing areas of strength and opportunities for improvement. We will be thrilled to share the findings with you in the future. To close, I commend the City for providing these much- needed services and I extol the Department of Behavioral Health and Intellectual Disability Services and Community Behavioral Health for pursuing a rigorous evaluation of its rollout and for their commitment to continue to improve mobile crisis services. On a personal note, I'd like to share with her permission that of my co-investigator Molly Candon. A decade ago she had her own mental health crisis.
Like many Americans, she resided in an area without mobile crisis services. Her episode escalated and she was involuntary committed to a psychiatric hospital before being connected to the community- based care that helped her. We are committed to this work in part because we believe she would have had more effective and less-traumatizing care had she been served by mobile crisis services. 0 and I'm happy to take any questions. Thank you.
Thank you all for your testimony. For the record when I cross my arms like this, it's only because I'm cold. Don't want you reading to anything that is not there. But a couple of questions: One, what percentage of the people that you are engaging are senior citizens? I heard that you have actually gone to facilities to have to intervene. What percentage does that represent?
So I don't have an exact number. I can give you one at some point, but I would say it's probably about if I just had to guess maybe 20% of our callers, maybe 25%. It kind of fluctuates depending on the month. So I could also provide you with data that's over a few months' span.
And conversely, what percentage of your respondents are juveniles?
So that's actually a question that I couldn't really answer because we have specific children's mobile crisis teams. So JFK is an adult mobile crisis team. We will handle children calls if there's an influx of those at one time, but we only get about maybe two or three a month in that capacity. But I could certainly pass that along to the child mobile crisis teams to give you some data on that.
Yeah. I think those are important demographics that we need to kind of codify. Your 72-hour referral process, does that pose a problem sometimes where -- when does that kick in versus immediate care?
Right. So we typically will refer someone to an intake within 72 hours if we're able to stabilize the crisis at that time and we feel comfortable with an onsite stabilization plan. And again, we can do same-day referrals in urgent circumstances. So that is a possibility. But we continue to do follow-ups usually within 24 hours, so the person that we do make a referral for will have a follow-up call the next day.
And finally your vans, do you transport people in those vans? And if so, describe for me the interior of the van?
So we do transport individuals in the van. They're really just typical vans. There's nothing that's adjusted inside of them with the exception of one of our vehicles that does have a divider between the front where the team is sitting in the back, but that's just one of the vehicles. And team members kind of can choose which vehicle they feel the most comfortable going out into the field in.
So that's very different than if someone was being restrained or arrested?
Thank you, Mr. Chair. Thank you so much for your testimony and thank you so much for your work. I guess I should have known this, but I was actually really startled by DBH's testimony about the low rate of pay that we were initially offering to people on our mobile crisis teams. And I know that we've made some strides, right, through our joint budget advocacy with Treatment Not Trauma. But I wanted to just get on record what is the actual starting rate and salary for each role on the mobile crisis team? And how does that compare to other jobs that similarly-skilled people might be seeking?
So I'll have to get back to you with the actual numbers on that. And it's also different based on agency. So not each agency pays the same pay rate. JFK maybe being an exception because our staff is unionized, so it's a little different than the other agencies. But a certified peer specialist, the average rate would be between $15 and $20. For a mobile crisis team mem -- and that's per hour. And for a mobile crisis team member, between about $25 to $32 an hour depending on the agency. But again, I can give you precise numbers once I gather them from the different agencies as well.
I would love to -- I think the whole Committee would love that information, particularly as we're headed into budget. And what are just your -- I know you have to get us concrete data and I appreciate that. But do you have an initial sense on how competitive those rates are?
So if we're talking about a Master's level clinician being paid let's go with $30 an hour, it would be about $14 to $15 lower than a comparable job with that clinical background.
Okay. So that's a problem. I think we can note that.
Thank you. And I just wanted to thank Ms. Stewart for the invaluable research that you've been conducting. It'd be great to have a copy of that if we don't already. And I would also say in particular I like that you were able to quantify the specific cos saving. I know that we have a certain number in mind that we're trying to get to for the mobile crisis response in the city. But as a baseline, right, we should at least be or I would argue that we should at least be adding that cost savings into the budget because clearly this is a good return on investment for the city. Did you want to respond to that?
Of course. I'm just really thrilled with your focus on the low salaries. We do not pay for mental health in this country, and that goes all the way up to the low reimbursement rates from Medicaid. And so, this affects everything from the salaries to what our providers can pay for to salaries at Penn Medicine in psychiatry. It all goes back to these terrible reimbursement rates that happen in our country for mental health. The second thing I really wanted to add as part of our evaluation is we're doing a workforce survey. So we've partnered with DBHIDS and we are almost finished collecting data. We have data from over 230 first- line crisis workers. And so, we've asked them about a variety of things, including their psychological safety and also their satisfaction with various factors in their position, including obviously compensation but also the sorts of supports that they receive. We've asked their satisfaction and then also how important they rate these factors in their jobs. I mean, many of these individuals do not go into these jobs for pay. But then we also ask their turnover intentions, and then we're going to try to follow up with them in six months. And then see how they rated these factors and whether they have turned over and where they're leaving. One of our hypotheses is because they are receiving better rates in the private sector, particularly with all these telehealth startups, that many of our workforce in the public behavior health system are moving out into the private sector for better rates of pay and for other reasons. But anyway, stay tuned. The data are going to be almost completely collected in the next week or so. And so, we'd love to be invited back to report some of those findings to you.
We would be highly interested in that. Thank you so much. Thank you, Mr. Chair,
Thank you so much. This was really important testimony from all of you. I have a question for JFK Behavioral Health. You mentioned cultural competency. I just wanted to know, you know, we have diverse communities living here with language access issues. Is there something you are doing -- and I don't know if it's just you as a provider and this is something probably if this is a standard requirement of all providers -- to be able to bring services that could help in the cultural competency of addressing the needs of the client?
So I'll start by saying all of our teams have access to interpretation lines, but we also will work collaboratively with the other agencies. So maybe there might be a team that's more appropriate for the given call than another team. So then we might not prioritize rapid response time. We might prioritize having a more appropriate team go out and respond. So let's say there's a Spanish-speaking team while another agency doesn't have a Spanish- speaking team available. We might prioritize that in a situation. And I'll let Tenera Styles speaks towards training since she conducts the trainings.
Thank you. We try to make sure that all of our team members are aware of the different cultural aspects in our city as well as their traditions so they can assist all of these members within the confines of what works for them versus what they may think work.
Thank you. Yes, I think this would be great, and I'm speaking to the previous panel as well, to have this as a requirement in training for those who provide these services to see what exactly they're doing. The language lines that you mentioned, the interpretation lines, they can be extremely spotty in their quality. I've tested it with speaking a different language and what exactly gets said. And so, I just worry about quality control there and depending on it so much whereas if it was more built in, knowing our city and knowing geographically we have diverse communities, just building that into how we address it would be really helpful and useful.
And I will speak to that because we do have more agencies and because we can spend more time with the consumer, there are instances where we do harness the natural supports. So we might ask a family member who is down the street to come over to help assist us. And that really can make things more familiar and more comfortable. Because, as you did say, I mean using a language service line isn't ideal because it's also strange to have someone on the phone while you're both in person, so I do understand that.
That's right. Well, thank you. Just wanted some more focus on that across the board from everybody. I had a question about your response. You said that you were able to avoid the -- so I'm just trying to understand how you respond for that person from the personal care facility, they called 988 and then you -- how did that happen? How did you get that call versus sending another team? I just wanted to understand that process.
So they called 988, so the service provider at the group home called 988. And then PCL or the Philadelphia Crisis Line fielded the call. And then they dispatched JFK based on geolocation technology.
Because I heard you say you didn't have to use the crisis response team. Aren't you the crisis response team? I was a little confused with terminology maybe.
So the crisis response center, so they didn't have to transported.
SO it didn't go to the crisis response center. It came directly to you?
The team went out and they were able to have a stabilization plan, so there was no need for the team to transport the individual to a crisis response center for high level care.
Okay. But the responses from whoever can respond, it comes through 988 and is just streamed to whoever is available or is appropriate for responding. I just wanted to be clear about that.
And going to the question about salaries, it's a cultural shift in our country not just locally. But we need to keep talking about it so people understand what the value is, of what the service is and why it's important to reimburse at a correct rate, at a better rate. And that's where I think all of us can be involved in being advocates for talking about that. So please feel free to reach out to us, to me specifically because I'm the chair of Public Health and Human Services. And I think it behooves us to really amplify the fact that we need people ready, well, with good salaries, with the state of mind in order to be able to do this work regardless of what training they have, right. It's the work conditions we're talking about. So please use us outside of just budgetary concerns to amplify this and lift this up because we can talk to. Even if the federal government doesn't listen to us right now, we can talk to our state level places, particularly the Governor to say, how do we fill and backfill some holes that might be left and how can we be an example to the rest of the country about what we do for our providers. So we look to that. Thank you.
Thank you, Member. That's very important that we maintain adequate and appropriate salaries so that we don't have this turnover problem. You are trained professionals and all you have to do is -- even in this building when we deal with constituents that in our office sometimes will have a crisis. It lets us know how difficult that can be, how traumatizing it can be for us to have to kind of address that without you. We don't know what we would do and I've had those kinds of situations and I'm thankful, thankful for being able to call upon professionals that can tell us how to intervene. And it resulted in crisis identification for my staff that if somebody is having a problem, how we should approach it. So thank you for what you do. Chair recognizes Member Harrity.
I have just a couple quick questions. First ones are for Penn and then I got a couple for JFK. So, Penn, if, a family needs a mental health intervention team to assist with a 302 of a family member, what options do they have as calling a hotline rather than the 911 system?
And if the family member is a -- so if the family member is hard to manage or difficult? What are the options when it comes to somebody, a child or a son, whatever living at home and the parents are scared, like we've seen, would happen and we had that tragedy, what options are there? Because I'm a firm believer in when it comes to mental health episodes and domestic episodes, the police showing up always escalates everything. So could you just tell me a little bit about how that goes and how you guys interact with the family members to help them to get the other family member into care?
So there are a few options if a family is pursuing a 302. So perhaps if there is an acute crisis happening in the home currently, another family member who has seen the behaviors within the past 30 days could go to the CRC and file for a 302 petition. The other way is of course calling 988, having one of our teams go out. And because we are teams of two, this allows us to maybe separate the family member from the consumer in crisis. So a team member can consult with the consumer in crisis while another team member gathers information for a 302. Other situations we have is sometimes it's difficult if someone goes to a CRC filing for a 302, it's difficult for a delegate to tell if it's truly a mental health crisis because some people don't understand what the criteria for a 302 are. And in those circumstances, they will send out the mobile crisis team to be the eyes on the scene to understand, okay, is this just a situation where someone wants to get someone out of the house or is this a substance use issue, which of course substance use and mental health and a 302 can go hand-in- hand, but sometimes families really want to force treatment upon people by going the 302 route where it's not appropriate. So these are really the options that are available. And of course, the hope is that if someone does call 911 that it'll get patched over to 988 if it's not a circumstance that necessitates a law response.
And since we're on that, just a little follow-up, what is the percentage of -- what's your rate of you getting there and actually having to 302 somebody or getting them to voluntarily go because it's very different?
Yeah. So about 80% of our calls are a result in community stabilization. And I would say anywhere between -- it's probably about 15% that do result in a 302 and what we also do --
Excuse me. For the listening audience that may not know what a 302 is, could you --
Yes. A 302 is an involuntary commitment. It's a warrant for involuntary commitment. So about 15% might result in the 302 and we also do track on our end the amount of 302s that are upheld once they do come go to the CRC. And typically I would say 95% are upheld, and there's about or that are discharged. So it's a pretty high rate in terms of the 302s that are written and the 302s that are appropriate. So about like I said 95%. Does that answer the question? Was there anything --
Yeah, I appreciate that. And while we're on the subject, how do you distinguish with, as you said, somebody who is suffering from substance abuse and somebody is calling about mental health? Knowing from experience, somebody can have a substance abuse problem and still be having a mental health incident rather than it -- it could be caused by the substance abuse, but they're so intertwined, you know.
So the differentiation is really what we would say that the qualifiers are for a 302. So if someone has a substance use issue and they're not caring for themselves, they've lost pounds in the last few weeks. 10 They might have defecated on themselves. They might not be oriented to person, place or time. These would be factors that could add up to an inability to care. But there are people that are using substances that aren't really -- they're not showing signs of mental instability, per se. They're using substances, they don't want treatment, but they're still caring for themselves in some way. They're still oriented to time and place. They're not a harm to anyone else. I mean, certainly using substances can be a harm to yourself, but that's not active suicidality. So those are things we consider when deciding whether it's strictly substance use or substance use with a co-occurring mental health issue.
Are there any numbers or studies on whether or how many mental health issues we're getting in different areas of the city? Are there hot spots in other words in reference to since we bought it up at the Kensington thing, you know what I mean? Is there areas of the city where you see more of this happening and is that because the substance abuse issues also?
So we do have that data. The data is provided to us by DBH on a monthly basis that we review. So they do have a heat map that shows us the high-volume areas, which one of the high-volume areas is the southwest region, which would be the concern about consortium, the 19143 area code. But we do also get data on what percentages are substance use, what percentage are psychosis, suicidal, homicidal, so we do track all that data. I don't have it with me on hand, but we get it monthly from DBHIDS.
Can you guys see in those numbers any disparities in low-income areas, so mental health, right?
Yes, there's definitely a high degree of disparity. I didn't mean to laugh or anything, but a high degree of disparity between lower-income area areas and higher-income areas. Again, I don't have that exact data with me, but we do have it from DBHIDS which we can be more than happy to send to you after this session.
And does that have anything to do with the amount of care in those areas also? Are they underserved is what I'm trying to get at? Should we have more mental health people in certain areas of the city for different reasons?
Yeah. So access to services is a real hindrance. I mean, as I maybe mentioned earlier wait times for let's say case management could be up to three months. And case management can provide services for employment, transportation, medication management, because a lot of these individuals are experiencing crises because of social determinants of health. They don't have stable housing, they're experiencing food insecurity, any number of these things. And so, this is something that could be resolved if we had more case management access really. So I think that that would be something to consider.
Thank you so much for your testimony and thank you for what you do. One of yous said earlier, which struck me which I always say about different jobs, that people that get into this don't do it for the pay. So I thank you. We have a couple groups like that, police, fire, you know, our emergency responders and also our social workers and mental health professionals. So I thank you.
Thank you, Member. Yeah, those were good questions and stimulated other questions. Member Gauthier.
Quick point just following up on my colleague. I haven't seen the map, but I imagine if there were a map about where you're doing the most service calls, that it's the same map of where the most gun violence happens --
-- it's the same map at where the housing crisis is most impacting people. It's the same map of where we have the most quality-of-life concerns. I'm imagining that all of these things tie together, and maybe assuming research is not dead in the United States of America, maybe that's the next research study or maybe it already exists. Thank you, Mr. Chair.
Yeah, that did spark the connectivity between other social issues and this issue. And so, if you can provide a map, I think it'll be telling to what is happening. And, Member Nina Ahmad.
Just a comment on how to separate what is a mental health crisis because of certain social determinants of health versus somebody who has a mental health disorder that is most likely off a chemical basis, right. So how do you parse that and the data that I know was just asked for in terms of the overlay of where you see this, we have to be careful that we don't conflate these two things, right. So I just wanted to make sure that the response that you all are giving can separate that out.
So in the guidelines or -- yeah, I guess it's the guidelines for crisis teams, they did implement a social determinance of health assessment in June of 2024. So that is one of the assessments that we conduct. So we can see clearly what someone might be lacking in a situation. We also conduct risk assessments and because we have the time to spend with individuals, we also get their information in terms of what their mental health diagnosis might be, what medications they're taking. So we are pretty thorough and being able to understand what is mental health-related, what is substance use-related, what social determinance of health-related and what's a combination of these factors.
I would also for the record like to acknowledge President Kenyatta Johnson is here. Would you like to say anything, Mr. President?
Okay. One other quick question. When you're doing this mapping about poverty, when you're doing the demographic analysis versus young people versus seniors and the like, can you add members with language issues and cultural issues? There's a difference between certain cultures and how they deal with mental health issues, whether it's Islamic, whether it's Asian, there's a different kind of acceptance, if you would. And if you can kind of asterisk that in the map to the degree that you can.
So I will ask DBHIDS to do that because we don't create, generate the reports, but certainly JFK individually we do track that information personally.
This is more geared toward DBHIDS, if that's okay. I know that there will be a transition with the Consortium. The Consortium is the primary organization that has been engaging in mobile therapeutic crisis services throughout the city of Philadelphia. And so, now that there will be a transition I just want you to go on the record and tell me what does it look like in the future if we're not using the Consortium?
Can members please come back to the witness table. (Witness approached Witness table.)
Thank you so much for your testimony. It was in inspiring actually that we can actually move things in the right direction. But we're going to keep it moving by way of supplementing and dealing with the income issue to Member President Johnson's question please.
Dr. Marquita Williams, Interim Commissioner for the Department of Behavioral Health and Intellectual Disability Services. Good afternoon, President Johnson. It has not yet been determined that there will be a transition. But in the case that that would happen, we have been having meetings around looking at providers in the area that we could transfer services to, making sure that there's continuity of care, making sure that the level of services that Consortium provides would be accommodated for all of the clients so that there is no delay or gap in services.
I just wanted to go on the record because I know the work that the Consortium has been doing, and this started when the young man was murdered by the police officer in West Philadelphia, and then we took a proactive approach and worked with the Philadelphia Police Department making sure we have to mobile crisis units are on the scene any time that these types of incidents take place where a person is shot and/or murdered or have an episode, so to speak. Because I have a large constituent base that utilizes the support from the Consortium, and when it comes to this particular topic I just wanted to make sure that whoever the provider will be this still becomes a priority. But most importantly, we're even talking about expanding it and taking it to the next level when it comes to the issue addressing trauma and support for those most in need. So thank you. Hopefully you'll become permanent one day. I appreciate your hard work and your dedication and your leadership, right.
So that you know, Mr. President, we have been on top of that issue and kind of wanted to not do it here --
-- but we are cognizant of what issue is for the only minority provider of these services that we know of. So we're on it, sir.
Absolutely. Your concerns are our concerns as well, so thank you.
Thank you, Mr. President. Without any other -- did you have a --
Without any other questions, thank you all for your inspiring again testimony. Ms. Stack, who is the next panel to testify.
Is that it? Yeah, call up everybody because we have a hard stop at 1:00.
Thank you for your patience. Please be seated and begin your testimony.
I'm glad Council President is here so you can hear the hard work that the City of Philadelphia employees are doing. Good afternoon. My name is Stephanie Bey. I work for the City of Philadelphia. I am a Program Analyst Health -- well, I'm a Health Program Analyst Supervisor for the Department of Behavioral Health. I've been there since '08. So I love my job. I am also a member of District Council 47 Local 2186, which represents white-collar supervisors. (Applause.)
and I represent the Executive board, so I'm an Executive board liaison. Although I work in our Infant and Toddler Early Intervention Unit, I did bring some resources that our Commissioner spoke of that we share in the community, that you can share with your constituents that will help you understand the services we do provide. And I'll make sure I get that to you. Although I am with the union and I work in the Infant and Toddler Early Intervention Division as a liaison for the Executive board, I also meet with our members. So I'm going to present the voice that our members are not being presented with today. And we are the Philadelphia Crisis Line. We are the ones taking it, we are the front line workers. We're the ones receiving the calls. We're the ones dispatching it, and here's what they have to say: Good afternoon, Public Safety and Public Health Joint Committee Members. A special thank you to Councilmember Curtis Jones for providing a space for us to share insight on the mobile crisis team structure and crisis response process for the Department of Behavioral Health Intellectual Disability Services, affectionately known as DBHIDS. The 988 Suicide and Crisis Lifeline offers 24/7 access to compassionate, trained professional callers experiencing suicidal feelings, substance use challenges, mental health crisis or any other emotional distress receiving counseling, guidance and direction for prompt evaluation and treatment services. 988 serves as a universal entry point nationwide, ensuring that no matter where you live in the U.S you can reach out to a trained counselor for support. The Philadelphia Crisis Line has a unique inhouse model. The Philadelphia Crisis Line, affectionately known as PCL, is the only inhouse crisis line in the country. Let me repeat that. We are the only inhouse crisis line in the United States of America. (Applause.)
Unlike other cities where crisis lines are contracted out, having an inhouse system is more efficient and cost- effective. Mobile crisis teams, they're also known as MCTs, each mobile crisis team consists of nurses, Master's level clinicians, Bachelor's level mental health workers, recovery specialists and certified peer specialists in some cases. Team members receive training through their respective organizations along with additional training provided by the Department of Behavioral Health Intellectual Disability Services. These include, but not limited to, 302 training which is involuntary committed process, mental health first aid and dispatch system operations. This is what we do and we continue to do to support those that support our families. All team members are required to complete yearly training and to maintain expertise and effectiveness in crisis response. And, Councilman, I knew you wanted to know the process of what happened when the calls come in. The crisis response process and timeline: An individual in crisis can call 215-685-6440, but that may be too much, or you can dial 988 which is simpler and easier, right. The Philadelphia Crisis Line staff answers calls and communicate with the respectives -- with the representatives to gather details about the person in crisis. This is what we do, your employees, City of Philadelphia. This is what we're doing. A dispatch is sent to the closest mobile crisis team, and you heard that they are broken down by regions. There are separate teams for adults and children. If the team determined that the individual meet the criteria for assistance, they help family or friends draft a petition statement if voluntary intervention is needed. If the individual is willing, they are transported to a crisis response center, and I have that information, our department has it on our cards that I will share with you, and response time vary based on the individual's cooperation and situation-specific. Additional follow-up team and care coordinators help connect individuals and families to person-centered resources for ongoing support. What are some of the opportunities for improvement with our mobile crisis team? We believe the mobile crisis team could benefit from a centralized training program for all team members, including the supervisors and administrators. Mental health workers which are the Bachelor's level, mental health workers often struggle with identifying and diagnosing and should be equipped with border range of options for support for the individual in crisis or the family. Some individuals may not require hospitalization but simply need guidance or someone to talk to. Furthermore, Philadelphia Crisis Line operates with one Health Program Manager. This is a 24-hour shift. We have four supervisors, and 10 to 12 I'll say social workers that are taking these calls. Although our leadership is aware that there is one Health Program Manager, they are working with him to build capacity -- and congratulations to him, his wife just had a baby -- and our supervisors say he does get on calls with them 2 o'clock in the morning during the supervision, but we need to build capacity within -- okay, we want to talk about that -- and overseeing all shifts. This leaves overnight staff with little to no direct support. m. in the morning? We have to reach out to the manager and he has to be back on the following shift. We have four shifts. So as we're looking to build capacity for the mobile crisis team and bring in resources, we want to look at building capacity for the civil servant that -- because he's a civil servant, our Health Program Manager, to build resources to support him. And the union is -- we understand that he needs additional support, but that's a lot to work four shifts and manage all the numbers that you heard shared. That's just a lot for us. Okay. So DBH mobile crisis team provider: We have PATH which is Region 1. That is the Northeast.
We have JFK which is Region 2, North and Center City. We have Elwyn, they are Region 3, North and Northwest. And the Consortium is Region 4, South, West and Southwest Philadelphia. We do have a children crisis mobile team. I didn't hear them spoken of often, but it is called Children Crisis Treatment Center, and we know CCTC. They've been around a very long time. And I want to take this opportunity to thank all of you for your ongoing support and dedication to improving crisis response services in the city of Philadelphia. And that concludes my testimony. Thank you very much.
Of course. Hello, my name is Julia Lyon. I use she/her pronouns, and I'm a licensed clinical social worker and a therapist and I work in Center City Philadelphia. I've worked in community mental health, which means mental health services that are funded by Medicaid or for those who are living in poverty in Philly for years. For the last four years, I have been a member of the Treatment Not Trauma Coalition or TNT, a community-based group which formed after the police killing of Walter Wallace, Jr. in West Philadelphia in 2020. I'm here today to share with you some of the truths that I have come to learn in my work over the last decade. And I'm here to implore you to invest in the expansion of CMCRT, the mobile crisis program which is a commonsense lifesaving solution to mental health crises in Philadelphia. The first truth is that people experiencing mental health emergencies are at their most vulnerable and are in a state of powerlessness. Because of this vulnerability, these folks need a response to their emergency that is safe, timely and clinician-led. The second truth is that when people don't have this kind of response, they suffer. I have seen it. 25% of all fatal police shootings involve a person with mental health problems. The third truth is that that kind of suffering and loss is completely avoidable. On countless occasions, I have seen my clients become endangered by the wrong response arriving on scene. And conversely, I have seen how connection, support and therapeutic intervention can change the course of someone's life or even save it. CMCRT is the best tool we currently have as clinicians, as family members, as neighbors, as Philadelphians to support someone who is at the point of a crisis. CMCRT stands uniquely apart from PPD's CERT or Co-Responder program. CMCRT fulfills an urgent and desperate need that was previously completely unmet in our city. CMCRT is the difference between finding a way out of a crisis and nothing. It is the difference between a hand reaching out for help and a gun being pointed. It is a lifeline. As a clinician, I cannot begin to tell you the value that CMCRT has had for me when helping my clients and their families plan for their safety and well-being. As a neighbor, I cannot begin to tell you the value of having a service to seek out for people who are visibly in need, in distress. As a former school employee, I cannot begin to tell you the value of having a team to call that can give the child in front of me the chance to feel safe and to begin to heal. However, this program is not nearly big enough to meet the current demand of our city. CMCRT needs to be scaled up to meet that need. Average wait times were over an hour for the first three years of the program's existence. This needs to be reduced to 30 minutes or less. CMCRT teams need to be able to get to their clients quickly, efficiently and without traveling across the city. Philadelphians need an easy to remember and clear way to access help in a mental health emergency, not a jumble of numbers, acronyms and departments. I safety plan with my clients all the time, and almost all of them don't know that CMCRT exists. Folks need to be able to navigate these systems without any expertise or insider knowledge or the advocacy help of someone with credentials. Community members need to be made aware of this program, how it works and what decisions are being made about its design and its implementation. Community members need a response that is not police, CERT and programs like it, the Co-responder model, dispatch a police officer and a clinician, and this response boils down to another police response. The presence of police makes people feel unsafe and makes de-escalation, connection to support extremely difficult, if not impossible. I have witnessed this myself many times.
Mobile crisis funding and resources should go to clinician-led programs like CMCRT that result in better outcomes like fewer 302s and cost less. Finally, the most important truth that I know, the one that has been shown to me over and over again is that humanity is fragile. Humans can only thrive and indeed survive when another person with some expertise or some compassion is available to help. We would consider it barbaric and strange to expect a person having a heart attack or a person whose home is on fire to somehow find a way to change their situation on their own. We would find it strange or barbaric to say, oh, I'm sorry, we don't have enough funding for the program, the program that dispatches someone to support you if you have a heart attack or your home is on fire. We have all seen people suffering but thought it would be too hard or too uncomfortable to help. Recently we have seen dehumanization and cruelty everywhere in our country and at the federal level. Today I ask you to put the necessary resources, money and attention into a program that works, that people can rely on when things are too hard and when people are in desperate crisis. We are beyond the exploratory phase of mobile crisis planning in Philadelphia. A clear picture has formed of what works and what doesn't. A clinician-led response works and a police-led response does not and risks violence. There is a need to take action now to save lives. I ask you to fully fund an expansion of CMCRT, to keep your attention and eyes on the program and its growth and to offer your support to those who implement it. I ask you to do all of these things so that when one of your neighbors or someone you love is utterly alone, there is someone to call to come to their aid, to your aid. Thank you. )
Yeah, I'm just here to help support. My name is Robert Harris. I'm the Vice- president of AFSCME District Council to support with any questions, but we put everything that we needed to say in our members' testimony here. And next time we will have call center folks. They are very hard to come by. They are working many hours, so we will have them for you next time.
So for me as I turn it over to my colleagues, one suggestion -- and I heard several, but one suggestion you would emphasize to make it better for people in Philadelphia?
Many things. Number one, I would say to just push DBHIDS and city infrastructure to expand as quickly as possible. I know that last year for our budget demands, TNT's recommendation was an immediate doubling from roughly around $10 million to $20 million in order to just immediately give those four provider agencies more money to hire more folks just to meet demand. So that would be to me the immediate and the most important thing. I think people like this program when they utilize it. I think it is a much, much better option than people calling 911. I think also just bumping up awareness of the program as much as possible. I cannot tell you how many times people have told me that they endured unnecessary suffering or risked losing themselves or someone they love to suicide because they were too afraid to call 911 and have police officers respond. And I want people to -- I know that that CMCRT and PCL are not perfect, but I don't want people to be in that kind of anguished decision any more than they have to be. So I would say for me those are the two biggest things, just rapidly expanding as fast as is feasible with the four agencies that already have contracts, and then to just consider scaling up the program. Additionally, long-term I think it would make sense for people who staff CMCRT to be city workers, to have even more of the infrastructure housed within city in addition to how the PCL is. I think this makes sense, and I think that it would provide a more stable long-term structure to avoid sort of rapidly changing funding streams and kind of shifts in policy choices based on political administrations.
Good response. But I did say one thing. You mission creeped all the way to all things. Thank you.
It would be -- I don't know if my mic is off. Is it on -- okay. We would say a cross-system training. One thing about DBH, Department of Behavioral Health Intellectual Disability Services, we are a heavy community- based department. We work in collaboration with many community partners and we do a lot of community outreach. We do a lot of educational training and involvement. We even open ourselves to train the community. So we can continue to do training of cross-systems and also with our community partners and with the community. What better is to train a parent of the child that's presenting with the issue. And this was previous Dr. Evans -- I don't know if you remember Dr. Arthur Evans.
His vision was treat the neighborhood. You can't just treat the individual. You have to treat the community, and that's when we opened up to do training everywhere. So my Commissioner, my leadership is right there. We go everywhere. We don't care. We're in every emergency and transitional housing. We don't say shelters anymore. That's not a nice word, but we're there every day. We're in our drug and alcohol programs every day. We were in the warming systems. We are everywhere disseminating information about the Department of Behavioral Health Intellectual Disability Services, because we provide mental health, substance abuse, intellectual disabilities, and don't forget the baby's birth to born with medical diagnoses 3 and developmental delays, and that's who I serve.
Thank you. I know you didn't testify. But would you like to give a --
Robert Harris, Vice-president of AFSCME District Council 47. I agree that we should be bringing these programs into civil service positions, that we've invested into the program. We see that it has done positive things for our city. We see that we are spending our city-earned dollars as citizens of Philadelphia. We should make sure that we're getting Philadelphians strong union jobs, that they are working for the City of Philadelphia and doing these services for the members of our community. So we should be working this program not only out into these other aids and contracting them out, we have people to do that here in Philadelphia, so we should be doing that work.
Just for the record, I want to thank you all for educating us because we learn by having these hearings on how to be helpful. So thank you. Member Gauthier.
Thanks to all of you for your testimony and for your work as well. My questions are about PCL first. Thank you so much, Ms. Bey, for just describing so comprehensively what the staff are taking on and how great of an effort they're making. You all are helping to save lives and helping people, I'm sure helping people to feel not so alone when they feel very alone. I also really loved your idea around the cross-training and really getting out more into the community. I honestly predict that as the City starts to feel more of the impacts of what's happening at the federal level to our economy we're going to need that type of training and support for people even more. I wanted to ask, you know, you talked about sort of the current staff complement and how that is difficult with the amount of calls in the situations you all are taking on. Can you talk more about the staff complement that is more desirable? And I'm sorry if I missed that in the testimony.
I don't know if I could talk to that degree because they're our members and there -- actually our members are the supervisors overseeing the staff. So just to answer your question and I just want to highlight because there's only one supervisor in 10 to staff 12 person, it's sometimes very difficult for us to take leave of absence and take vacations. These things have to be in consideration. So some of the things that they may be discussing or additional support, is that what you're asking?
Well, you so eloquently outlined why it's difficult to have so few supervisors because you're getting calls 24 hours a day. I wanted to know -- and if this is something that the union wants to get back to us about, then that's fine. What would be more ideal with the volume that you have?
Oh, yeah. So we would say we need maybe 6 to 7 supervisors, and for the staff that are handling the calls I see about or because of the volume of 11 the calls. And what would happen 12 it will allow them -- because 13 sometimes they call in and our 14 members, our staff, will have to 15 reach out to their supervisors 16 because the calls coming in from 17 the mobile crisis team may not -- 18 it's like, oh, this doesn't qualify 19 for 302. So they have to follow up 20 with their supervisors before they deny anything. We have an internal -- and I think she's -- process in place. We just can't deny 302s. It's a process. And they have to go to their supervisors to seek guidance, right, so that may extend a phone call. So if we have sufficient staff on each shift, it would allow us to prioritize, right. Move it over to the next delegate so Robert could deal with that while I'm working with the supervisor because I'm not getting the correct information from the mobile worker that's calling in for this 302. So if we could get additional staff, for me I would say I would love for us to have three to four more supervisors. I would love for us to have maybe five to six more clinicians that are taking these calls or social workers that are processing these calls. I know we're short-staffed. We have our labor management meetings with them. We know that we are short in our positions. It's hard, it's hard to find staff to backfill these positions, but we have an interim supervisor that was taken away that's acting in a role as a manager -- I mean, a supervisor acting as an interim manager, but she's a supervisor but we need help. And our HR is working with them to build the capacity. We also have Deputy Commissioner Amanda Davis that's working closely with the leadership in that unit. I mean, they're working with us. So we don't want to present they're not, right.
They're definitely working with us the best they can to help build the capacity. But it's finding the staff, right. It's finding the staff.
Thank you so much. That's helpful. I see DBH chomping at the bit so I think they want to add into this question. But I want to put one more question that maybe someone could expound upon. I know that we do a pretty good job of tracking sort of what happens when people call 911, right, when someone calls 911 how long it takes for them to get an actual answer. Beyond talking about the staff complement at PCL, if anyone can give information on how long does it take if I call 988 for someone to pick up the phone and answer my call?
That would be leadership. I'm not familiar with how long it takes.
All right. So we've got 15 minutes. I got my other members and --
Thank you all. I have palm cards for you. Am I allowed to give that to you? Can we approach or no? It's like we're in a court. Thank you all.
We had -- why don't you get your question on the record.
Okay. Thank you. I actually had a question for Ms. Stephanie Bey because she mentioned mental health workers sometimes struggle with identifying diagnosis and should be equipped with broader range of options for support. So this means you're talking about Master's level clinicians who should be addressing this? I just wanted to understand the flow --
Those are the Bachelor's level mental health workers. I believe the Master's level clinicians are the supervisors. I'm not familiar with how they meet up. But I believe it's the Bachelor's level mental health workers that are calling in when they're reporting to a scene where there's a possible crisis.
So they're having -- so that's what you said. Mental health workers sometimes struggle with identifying. So what would be useful in this --
The individuals that work in that unit, our members are saying they need additional training on how to identify diagnoses. Is it something that we could provide resources for, is this something where they should get a 302. Sometimes when they're calling them, they're just saying they're presenting with, oh, they're being defiant, they're not being respectful. This is the younger ones, right. They're cursing. They're being -- they're giving us a hard way to go. Do we have to 302 this person because the mother wants the person out of the home, the mother's afraid of them, they're scared. So they're calling with these diagnoses, right. And I guess sometimes it has our mental health workers struggling, and they have to follow up with their -- it has us follow up with our supervisor for clarity and guidance and support in the decisions that we may make. So we feel they need additional training that are going out to these sites and doing these evaluations and making a determination on what should happen with Philadelphians when they're presenting with a crisis.
So additional training. And would it be useful to have the people there asking these questions with them as part of the team?
So in addition to additional training for those who are responding, would it be useful to actually have onsite with them people who do have the ability to answer these questions? Meaning, have a broader team address it rather than people with --
And I think it's what he was also saying it's the language, right. We're Philadelphia. We have different cultures. We have from what we've learned over 99 or 100 different languages spoken in the city of Philadelphia and we represent things differently. Me working with infants and toddlers, the state mandate is we use family-friendly language, family-friendly language. We can be very clinician, we can use clinician language but we're dealing with a family that don't know clinician language, right. We have to meet our families where they are and speak a certain dialect so we all can be on the same page. So that's what we mean by, you know, going out there having more than one person, you're right, and I believe it's more than one person that goes out, not familiar. But I think it's more than one person that goes out when it's a crisis. And we want to note that City of Philadelphia employees do not go out. Only one that may go out is a manager or a supervisor, but it would be an extreme reason for us to go out. Typically, we don't go out.
So it would be the team, the providers who are responding?
I'm just trying to understand where the level of additional information is. So the team who's responding, the providers who are responding should have access to somebody who can help them make the diagnosis better --
Just trying to clarify that. So would that support come from Department of Behavioral Health and Intellectual Disability Services?