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A Day in the Life of a Crisis Mobile Outreach Worker

October 17, 2013
Lisa Darcy - Ho‘omoana Foundation executive director , Maui Weekly

Times are changing fast. We have the ability to change with them. October marks several national and international mental health awareness campaigns. Mental Health Awareness week provides us the opportunity to reach out locally and in unison with communities around the country participating in sign waving and walks to raise awareness and donations to help educate about mental illness. Every step taken is a step forward.

It's an honor reserved for our civil defense, fire, public safety, emergency room doctors-- and the Tina's of our world. Highly skilled, they go above and beyond the call of duty, and possess qualities that are often innate.

Maui County has a small and dedicated group of individuals who are making our islands a safer, better place to live. They are Crisis Mobile Outreach (CMO) Workers. Unlike other selfless professionals who work along-side others, they often work alone, navigating highly challenging situations.

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It’s the small moments and successes that keep her going. Reflecting on those moments of change are critical to capturing and promoting more successes.

The other night, I was driving past Ho'okipa admiring the elegance of the full moon at dusk. I was awed by its beauty and intensity. It was striking and I was fascinated by the soothing effect it had on my mood. As the bluish-grey dusk hovered over the tops of the waves, I was transfixed as they broke and rolled over the beach. Luminous, it qualified as one of those moments when the world felt absolutely extraordinary and time stood still. It was in that moment that my mind ricocheted to Tina. In all of this beauty, I wonder where Tina is right now?

Tina is the Maui CMO team leader who supervises about 15 staff. At any time of the day or night, they receive calls from the state crisis hotline (called ACCESS) and have 45 minutes to respond. This means being willing to get out of bed and getting to the so-named location with haste.

It was time to catch up, so I called her. I literally pulled over and called her. There was no answer.

It was about 6 p.m. and Tina had been sitting in the corner of the room at Maui Memorial Medical Center for three-and-a-half hours waiting for the treating psychiatrist to conduct an evaluation. The room was small with a metal twin bed bolted to the ground. The bed was made up with one sheet and plastic foam mattress--stark white. The smell of sanitizer permeated the chilly air. Tina occupied the hard white plastic chair in the corner of the room.

Her mind raced as she tried to remember games to occupy the 10-year-old. After about three hours, she had exhausted her phone-supplied repertoire. She was waiting for the lab work to come back. There was nothing to do but wait.

Tina recalled, "As a CMO, your brain goes everywhere. How come the ER doesn't have coloring books? What was I like at 10 years old? How do you play Wheel of Fortune on your phone?" More importantly, "How can I make this child more comfortable?"

The process requires great patience. But "your mind starts running and you want to have input into his treatment, but then you remember--you are not a part of the treatment team and do not need to be," she said.

The call came in at 1 p.m. A family dispute developed into a physical altercation. The boy had become aggressive with his parents and the police were called. The child had a history of mental health needs. When Tina arrived, a therapist was also present in the home. The decision was made by the treatment team to transport the boy to the hospital for everyone's safety. Transporting to the Emergency Room is a routine part of Tina's experience.

As CMO Team Leader since 2006 for Aloha House, Tina oversees our tri-island county. With trained staff on each island to handle crises, the acuity and needs are increasing. Tina recalls the difference in need over the years and how it continues to increase. The first year of the contract, her team responded to about 200 calls, and last year there were almost 600 calls that required a response.

The toughest part of the job is "managing 15 staff and telling them at one point you will have to drive away from a situation where there are not enough resources and it hits you in that moment that you don't know if that person is going to be safe."

Tina's candor about her work is genuine; she acknowledges that crying is part of the job.

The second hardest part of this job is developing a long-term relationship with someone and then finding out about a sentinel event.

"You lose consumers," she says, which is why "you need to stand by the ocean to feel how small you are." As to her dedication, "Every consumer I have had and lost in the past seven years--I remember their names and the call stating "they bear their souls to you."

It's the small moments and successes that keep her going.

"You know that you helped save that life today," and in some small way, "your response kept them safe--even if for one night." Her face lights up when she reflects: "When someone sincerely says 'thank you,' it reminds me to continue "to stay present."

That is a challenge--the art of staying present. Tina recognizes if she has a history with this person, "as a team leader, and you can't bring along what happened before, being jaded you have to remain present."

As for her personal life, she said, "When I leave a crisis, I leave it where it's at. I don't drag it along with me. When I was growing up, my family had a thing about 'don't bring it home and take it out on us.' If you are having a bad day, the people in your personal life don't deserve it-- they deserve you being present."

Later that night, she apologized for not taking my call. We made plans to have breakfast together the following morning.

There's an aspect about Tina that is contagious. She's a gentle fighter. As I finished my banana pancake at Tasty Crust, she told me a story about Michael. She catches the ferry from Lahaina to Molokai weekly and is recognizable to many who hang out--often inebriated and lost. Each time she would see Michael, they would talk story and she would give him her card. A couple of times, she gave him $2 for a bus pass. Recalling the moment he went into treatment lights up her face and even her eyes smile when she reports he is sober, working and reestablishing relationship with family on Mainland.

Reflecting on those moments of change are critical to capturing and promoting more successes. She believes it might have happened sooner if he had a place to go talk story or if there were more programs that helped with substance abuse.

What is needed is "a drop-in center that is open 24 hours so people can go in at any time and sleep... which is the first step before a shelter," Tina said. "The best thing the community can do is give locally. And even if you think it won't help," it will.



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