On an unseasonably warm day early this winter, a young man in a too-long sweater, socks, and baggy grey sweatpants sits outside the doors of an unassuming building near the Boise Towne Square mall, staring at the sky, not acknowledging the occasional passers-by.

Just a couple years ago, this man could have easily found himself in a local emergency department waiting for help, in the back of a police car, or on the streets while suffering through a mental health or substance use disorder crisis. But since Dec. 12, 2017, Boise has offered another option: Pathways Community Crisis Center of Southwest Idaho.

After passing through a security check and taking a medical wellness screening, visitors have access to a warm place to stay for the day, food and coffee, a shower and change of clothes, and most importantly – the opportunity to leave with a plan. Having a safety and treatment plan helps visitors to not only avoid a future crisis, but to also work toward recovery from their behavioral health issues. They leave with hope. Hope in the knowledge that there is a place they can find someone to help them regardless of their financial situation. The help could be a peer specialist with personal experience in recovery, a counselor, or a crisis clinician or case manager. They know they aren’t alone in their struggle.

“They can feel the sense of urgency is lifting just as they’re working through the intake,” Program Manager Bert Schweickart said. Even being able to wash visitors’ clothes and hand them back cleaned and dried as they leave can have a significant impact on those who are suffering through crisis.

“If they have the impetus to show up, we have the obligation to let them in and do what we can to solve the issue they have,” Bert said. Sometimes, during the initial medical wellness screening, the crisis team determine that they need to be medically stabilized in a more intensive setting before using the crisis center services. When this happens, the team can refer them to the emergency department or advise them to seek other medical care so that they can return when they are stabilized. Pathways provides transportation for visitors who need to be stabilized so they can return and seek help with their crisis.

Most visitors to Pathways are self-referred, which means they simply check themselves into the center. Partners like the Idaho Suicide Prevention Hotline are also large referral sources. Law enforcement officers have also embraced having a place to bring people who they may have otherwise had to take to a jail cell or an emergency room bed. Pathways also partners with Allumbaugh House to do pre-assessments for people waiting for open detoxification beds. In some cases, people bring in a friend or family member when they don’t know how to help them. “We’ll help sort it out,” Bert said.

Every day is different for the staff working inside a crisis center. A client may come in with suicidal ideation, or may be struggling with a loss of their housing or behavioral health services. In that way, Bert says they act as a sort of “Penn Station” – helping guide visitors to a safety and treatment plan that meets their needs. And even though visitors are allowed to stay for just under a day, most people don’t – the average in Boise is about a 10.5-hour length of stay. At the Northern Idaho Crisis Center in Coeur d’Alene, it’s about eight hours.

Pathways Director of Business Development and Marketing Chris Christopher likes to say that discharge starts at Pathways when a client enters the door. “They don’t have long here, and we start planning to help them when they enter.”

“The people who come here really want a solution to their problem,” Bert said. “So, when the storm has passed, and they have a plan, they could stay longer but they want to move forward.”

Pathways offers similar amenities to other centers but has evolved to meet the needs of their community. Just past security at the front door is an “amnesty box” – where clients can drop illegal items they may have on their person without fear of arrest or punishment. Inside, the 7,000 sq. ft building is split up into male and female sides, each with 10 beds. One of the beds on each side is located in a quiet room, while the other nine are located in a central common area. Eagle Scouts donated the time to build each of the bed platforms. There are also couches, TVs and recreational opportunities like board games. Clinician and nurse offices surround the central areas. Between the two sides is a kitchen with areas for clients and staff, as well as a room packed with laundry facilities, clothing, and a variety of other donations.

“The level of improvement I have seen in people from when they get here to when they leave is almost magical,” Bert said. It’s a big part of what makes him happy to come to work every day.

Meeting the needs of those in crisis throughout Idaho

Nine crisis centers throughout Idaho have opened since 2014, each receiving significant community and legislative support. The unique Rural Crisis Center Network in northern Idaho works with partners to operate centers in Moscow, Lewiston, and Orofino, which can react to crises as they happen in the more rural areas of the state.

Each center has had to work to meet the needs of its unique area, and one of the areas this is perhaps most visible is in the Rural Crisis Center Network, where Joyce Lyons, Ph.D. works as a project manager with the local Public Health District to coordinate the crisis centers in Moscow, Lewiston, and Orofino. They opened in Fall 2019. In Moscow, the first day the center was open they were able to help avoid two suicide attempts. “That’s a red-letter day to me and is a reflection of the community need and acceptance,” Lyons said.

Like the Pathways center in Boise, these centers are designed to offer an effective alternative to hospitalization and incarceration to people who may be experiencing a mental health or substance-use related crisis. They create key relationships not only with local hospitals, providers and law enforcement officers, but also with members of the community who can donate items to help those in need. The rural centers’ availability has been well accepted by police and local prosecutors, who like having an option other than placing someone experiencing a behavioral health crisis in a jail or the hospital.

Financially, the rural model works well too, Lyons said. Where other centers may have multiple staff working 24 hours per day, the rural centers operate on an on-call, as-needed basis. For example, in Orofino, a provider agency is contracted to provide crisis center services as needed. In such a rural area, there may be times when no one requires the services, but “when the call comes in, the crisis center exists,” Lyons said. Crisis center leadership worked with partners and hospitals to determine what the identified need was and where. They’d like to establish something similar in Grangeville.

Services in rural centers are always available through the region-wide toll-free number. A clinician is on-call on the phone line and will deescalate and assess the caller for crisis and risk. This clinician will determine the need for interventions at a local center or other facility and will direct the caller to those services based on their needs. Individuals who arrive at one of the local centers are immediately assessed for behavioral health crisis and/or medical need.

A large part of this process is the human factor. “Research says services delivered closest to a patient’s support group have the best outcome,” Lyons said. “So, the closer to home you can treat them, the better.”

Rural need for behavioral health services must always find a way to work with residents who are spread over a larger geographic area, while operating with few resources. While the rural area may be larger, the Rural Crisis Center Network depends on the same support of community partners as hospitals, providers, EMTs, community organizations and more.

“Meeting the need where it’s at was the driving force behind the rural model,” Lyons said. “Our biggest success is how involved our communities, hospitals, colleges, first responders, clinics, law enforcement and stakeholders are in this process. I don’t worry that someone will respond. I know they will because they are committed to the process and the clients we serve.”

The Northern Idaho Crisis Center

Open since 2015, the Northern Idaho Crisis Center in Coeur d’Alene sees upward of 300 voluntary transports from law enforcement each year into their 20-client-capacity center on the Kootenai Health campus. With their location in the Idaho panhandle, they regularly see people from nearby Spokane and people who are travelling through the area, in addition to Idahoans. They also see many homeless clients with untreated or undertreated mental illness.

“We fill a huge gap,” Manager Don Robinson said. “It’s a huge win because before these people would just be adrift in our community.”

The Northern Idaho Crisis Center benefits significantly from nearby hospital services at Kootenai Health, such as inpatient psychiatric staff, emergency departments, chemical dependency treatment, and other clinics. If visitors are medically safe to stay at the center, they see a crisis intervention specialist and begin on their safety and treatment plan.

“It’s an ongoing process. Our biggest therapeutic intervention is the passage of time. It’s easy to underestimate the amount of courage it takes people to come to our door,” Robinson said. “They trust us and sometimes they just need time to decompress.”

Thanks to community partnerships, Robinson is happy to say many times people are able to leave and have an appointment with a provider within the next couple of days. Community partners have also donated clothing, tents, ponchos, jackets, single-use toiletries, and more.

While no one case is the same and some may need more time than others, Robinson is proud the majority of clients are able to discharge back home.

Nowhere else to go

Like other crisis centers, the Northern Idaho Crisis Center conducts exit surveys that ask, in part, where clients would have gone if the center wasn’t available. Robinson says it breaks cleanly into thirds for him – a third say jail, a third say the hospital, and the final third say they don’t know.

“That statement of ‘I don’t know’ really tells me how many people are suffering in silence and not seeking help,” he said.

In Boise, Pathways Community Crisis Center of Southwest Idaho Program Manager Bert Schweickart saves all of the surveys he receives, the vast majority of which have positive feedback. He and Chris Christopher think that they save even more lives than they know about from the surveys. They applaud the work their staff does every day to make the impact that the crisis center has possible.

Bert also saves the postcards the center gets from clients, the pictures they send the employees with their dogs, the notes they send him saying, “I wouldn’t be here without the center and its staff.”

“We’re fortunate to be able to provide this service,” he said.

Story and photos by Jon Meyer, Division of Behavioral Health