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“How CIT Works in a Small Rural County”
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“How CIT Works in a Small Rural County”


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Presented by: Sheriff Kevin Frye …

Presented by: Sheriff Kevin Frye
Avery County, NC and Ann Robinson
Emergency Services Coordinator
CIT Coordinator, SMC

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  • 1. “How CIT Works in a Small Rural County” Sheriff Kevin Frye Avery County, NC 828-733-2071 [email_address] Ann Robinson Emergency Services Coordinator CIT Coordinator, SMC 828-759-2160 [email_address] Smoky Mountain Center 1-800-849-6127 Crisis Line
  • 2. Reporting to the Hospital ED Going to the Magistrate Contacting First Responders (Mental Health Provider) Calling a Dispatcher
  • 3.
    • The consumer might contact their mental health provider who is called their “First Responder”
    • First Responders are expected to handle emergency cases involving their consumers up to the point of requesting authorization for the state hospital system
    • First Responders are expected to make their consumers aware of how to reach them in a crisis
    • First Responders then meet with the consumer and activate the consumer’s crisis plan
    • If there is no First Responder, Mobile Crisis Provider must be contacted.
  • 4.
    • The consumer might contact a dispatcher at 911
    • Depending on the acuity of the situation the Dispatcher then contacts:
    • - Law Enforcement and/or
    • - First Responder or
    • Mobile Crisis Team
  • 5.
    • Law enforcement, the consumer’s First Responder, or Mobile Crisis Team may be deployed to go out and meet with the consumer – not necessarily at the ED
    • The consumer may then be assessed and a crisis plan may be initiated to divert the consumer from the hospital
  • 6.
    • The Involuntary Commitment (IVC) process is invoked
    • Law enforcement has 24 hours to find the individual and bring them to the hospital ED
    • Hospital staff are required to assess the individual and draw lab work
    • Only a physician can nullify the IVC order
    • Law enforcement or their delegate sit with the consumer until a placement is found
    • This is by far the most dangerous method for the consumer and law enforcement
    This process often ties up valuable time and resources!
  • 7.
    • Hospital staff are required to assess the individual and draw lab work. Mobile Crisis/First Responder may be contacted.
    • If an IVC appears to be needed, the magistrate must be contacted. Law enforcement involvement is required once involuntary commitment is issued by magistrate.
    • The IVC requires an assessment (First Examination) by a mental health clinician and MD/Board Eligible Psychologist
    • Paperwork is completed and a placement is found if inpatient psychiatric care is required.
    • This process can tie up valuable time and resources!
  • 8. Psychiatrist 24/7/365 (by Phone) Nurse or LCSW or Psychologist LCAS or CCS or CSAC QDDP or ADDP Para- Professional NR responders are licensed or license-eligible LPC, LCSW, LPA, LMFT and LCAS MC teams are organized differently across the state. Contact your local MC team to determine how your team responds in your area.
  • 9. Expect responses to new consumers within these time frames: Emergent-immediately by phone, 2 hours for Face to Face Urgent-10 minutes by phone, 48 hours for Face to Face Routine-10 minutes by phone, 7 days for Face to Face
  • 10.
    • It is not clear whether an involuntary commitment order is needed
    • If you would like to consult with a mental health professional.
    • If you would like to make a referral for services.
    • The consumer’s Crisis Plan has failed
    • The person is requesting or agreeable to speaking with Mental Health Services
    • Emergency dispatch can be reached at: 1-877-492-2785
  • 11.
    • Law Enforcement must contact the MC team personnel in their county to determine how the CIT and Mobile Crisis can compliment one other in the community.
  • 12.
    • Develop a dialogue and keep an open line of communication.
    • Law Enforcement and Mobile Crisis work together to develop a protocol outlining expectations
    • Meet once per month to review CIT cases with Mobile Crisis involvement.
      • Discuss areas of potential improvement.
      • **Identify what did work**
  • 13. First Responders or Mobile Crisis to the consumer as soon as feasible Deploy Delay involuntary commitment actions until the consumer has been assessed by the First Responder or Mobile Crisis Team Divert the consumer from the Emergency Department when possible This saves time and resources for you and frustration for the consumer!
  • 14. Avery County
  • 15. Background
    • Avery County Population 18,000
    • 247 square miles of territory
    • Seasonal population of about 25,000 per day
    • Population over 65- 17.6%
    • Median Income- $36,068
    • Person below poverty – 17.6%
  • 16. Critical Incidents that led to looking for new ways to deal with involuntary commitments
    • Sworn in as Sheriff on Dec 4 th , 2006
    • On 01/08/2007 while trying to serve an involuntary commitment, deputies after a five hour standoff, shot and killed armed person.
    • 2008 report from NAMI ( National Alliance of Mental Illness) of Wake County stated that Avery County ranked first in NC for time spent on involuntary commitment transports based on population
  • 17. Steps Taken
    • Developed relationship with local mental health facility, New River Mental Health and Smoky Mountain Center
    • Initially sent 2 deputies out of a total road staff of 12 to C.I.T, since then we have sent 6 more and hopefully by the end of 2011 will have all deputies C.I.T certified
  • 18. Results
    • Improved community relations
    • Improved officer safety
    • Improved team approach with local mental health facility and regional organization
    • Improved information on people in the community with mental illness
  • 19. Most Important
    • In one year the Avery County Sheriff’s Office has:
    • Decreased involuntary commitments by 26%
    • Decreased costs to the citizens by $16,245.00
    • Increase time on patrol instead of sitting at a hospital.
  • 20. Questions?