Sherri Witwer
Appearances
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
But for the general population, I think we've made some big improvements in that way.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
Yeah, I think we do need to be focusing, first of all, on access for everyone. How can people get timely access when someone decides, yes, I need help? How do we help them get help quicker and in a way that works for them? So there's that. But if we look at this population with serious mental illness, we need to be focused on how can we provide better services for them.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
This is a population that cycles through different systems, our criminal justice system, the ERs, hospitals, and too often the care we provide is facility-based and so focused on, okay, now they're in this facility, now they're in this facility, but we're not talking about how do we help people get from point A to point B. And that really is care coordination.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
And that needs to happen on a high administrative level where you have partnerships in place between agencies and departments where there are points of contact that the buck stops with this person in helping to address. people with mental illness.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
Thank you. Thank you for the opportunity.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
Because people with mental illness will show up in various different systems, there has to be a point of contact within the mental health system that the other systems can go to for assistance. And that means wherever a person with mental illness appears, the mental health system needs to be there and be there also to help that person be diverted and navigated to the services they need.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
So on an administrative level, that needs to happen. But also on a boots on the ground level, we just need more peers. We need more case management. One of the most cost-effective interventions and one of the most effective interventions
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
When we can have people who can help people with serious mental illness just get from point A to point B. When someone is very ill, to tell them, okay, you have an appointment downtown at 10 o'clock on a Tuesday, that can be very difficult for them to navigate. And there are a lot of barriers to them just with transportation and being able to know how to find this location and get there.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
So to have case management assigned that can help, to have peers that can help talk about their experience, who know here on a granular level how we can help walk this person through and help them feel hope and help them look at building a life.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
I will say when I started in this work, I had legislators tell me that no one funds mental health because it's like putting money into a black hole and no one ever gets better. And I think we've made great strides in at least recognizing that People can do well if they can get treatment and get the services they need. But there are people who need more than just basic outpatient treatment.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
Yeah. I guess as a matter of introduction, I'm a longtime mental health advocate. I've worked in various capacities in our mental health system. primarily in public policy advocacy. I'm a family member of someone with a serious mental illness, and that's what has driven my work and my interest in the mental health system.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
They need that intensive case management within the system to help them get from place to place. It's a simple intervention, but we really don't do it very well as far as coordinating care for that person. The other big challenge that we have had, and you see this nationwide, is the lack of housing for people.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
And we need deeply affordable housing, but we also need permanent supportive housing, which is providing
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
on-site supports and services for people with serious mental illness or just people who have had a lot of experience being unhoused or being in the criminal justice system, that they need more intensive support on-site to help them get from, again, point A to point B and have a safe place to live so they can even focus on getting and building a life.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
A key component of that is to be able to show outcomes. And I can only speak for the system I know. We're not great at showing outcomes and showing what interventions work. I think the mental health system has to be able to make that case and be able to show, here are our outcomes. How do people lose 10 years of productivity?
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
And in that time, the damage that has done to that person's life, their family, their their employment, their life situation, and involvement in utilizing resources in typically multiple systems.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
It is a cost savings mechanism for everyone to be able to have an effective, accountable mental health system to make sure it's properly funded, but also that it's targeting interventions that we know work and we do know what works.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
And using best practices and evidence-based practices and really being able to identify these issues earlier on and really wrapping services around people who need them. Not make people have to fail several times and cycle through.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
Too often what happens is we blame the person, and the person blames themselves, and that compounds their feelings of worthlessness and difficulty, when really we are asking people to navigate systems that are incredibly broken, fragmented, siloed. And so then the thinking is, oh, we really need to just use a hammer. And then people tend to spend more time in the criminal justice system
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
There's a lot of discussion, there has been for decades now, about how jails and prisons have become the new mental health providers, and that does not work. Jails and prisons cause trauma. They compound the problem again. It is far more cost effective to have interventions that are community-based, that have people living in the community with wraparound services. We know it's more effective.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
As part of my work, I have been and am working with other families and people with lived experience with mental illness. I have been an advocate for crisis intervention team training. That is training for law enforcement, behavioral health providers, and families and people with lived experience.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
We know it's cost effective. We know people can do well. I guess my answer, twofold, being more accountable in the services that are provided, and two, really focusing on, again, point A to point B. So we have this great program, and once the person is released from that program, then what? And I think that's the question we should continually ask. Then what?
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
Okay, the person's released from jail, then what? Discharged from an inpatient facility, then what? How do we get them from that to a home in the community where they can live and engage and live a life? And we know that people can do well if they can get access to those services.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
Yeah, so I come to this work as a family member, and I think we really need to hear more from families, from people with lived experience about what works and what works on, again, that very granular level.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
I think too often we have people building programs and systems and service delivery models that when you talk to the person with lived experience or their families, they don't know how to access or they say, that won't work.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
and so rather than continuing to build things that people don't want or won't use we really need to have more voices in that space and if we could get our systems to be curious to show some curiosity around why do we continue to have these issues and these problems and not be so protective of the status quo, but be willing to hear fresh voices, hear from people who are living it.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
They could get the most important data of all, and that will help them determine how to build effective systems.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
Yeah, thank you. Appreciate it.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
They come together to provide training for law enforcement and, more importantly, to have an effective crisis response when someone is in crisis. that law enforcement has the training and the support of the mental health system to help them respond effectively and get the person to the treatment that they need.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
Now, really positive development is that with our crisis response systems, we have developed mobile crisis outreach teams that are driven by behavioral health providers with peers, people with lived experience who can respond to the overwhelming majority of those calls. And that really provides better outcomes and helps us to treat mental health as a mental health condition.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
However, there are times when law enforcement needs to be involved or behavioral health team is uncertain in their response. And so they can co-respond or have law enforcement take the lead in that response. But having that training and that understanding is critical to having better outcomes for everyone involved.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
Right. There's a 988 number now that's been developed that people can call and get that behavioral health response. And that has been a huge, significant improvement in crisis response. So CIT is still an important piece, and I don't want that to be overlooked in our crisis response systems because there just are times when law enforcement needs to be involved.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
They are called out and to recognize, oh, this is a mental health crisis, and we need to get our CIT team to be able to respond differently to that situation.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
Yeah, I think, first of all, when you talk to law enforcement, they are inundated with mental health calls, and they really would rather not be responding to those calls. So they welcome mobile crisis outreach teams in some of these areas. responses with really takes the burden off of law enforcement and having to make all of those decisions.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
Still, there are times when they need to, and that's where having best practice CIT program is involved. And that means having everyone have all law enforcement get basic mental health training and build those relationships, know who the partners in the community are that they can call in crisis response. It also is in having a specialized CIT team that responds, have them follow best practices.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
And that means that they self-select, that there are people who say, yeah, I would like to work with this population and build these relationships and know the system and know the civil commitment process and take their education and their tools and training down that path.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
When you are talking to law enforcement about this, they get it, that having that support in response and having the best tools and training for their officers is a win-win for everyone. A good CIT program has oversight that involves people with lived experience and family members who can help inform that crisis response as well.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
It's just a very unique partnership when done correctly, and it can make a huge difference in how things are addressed.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
They definitely will encounter people who are using substances, as you point out, but this is part of the CIT training. They do this very thing where they have different scenarios, scenario-based trainings, and they help to create some time and some distance from what's happening to be able to make those calls. And there's no question, they often don't have a lot of time.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
But that's where having officers who have had some time on the street, first of all, before they become CIT officers, so that only time and experience can really help them differentiate between What are we dealing with here? And then having that training and ongoing recertification for officers, because there are always new things that come out that they need to be aware of.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
And I just think that kind of training is so critical. And CIT is critical in helping to divert people. So rather than taking people to jail,
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
If there are receiving centers, which is another thing that has been developed and is starting to get traction, where rather than taking people to jail or even an ER, they go to a receiving center, which can do an initial assessment and decide what level of care the person may need, and it helps law enforcement in being able to take the person to a safe place.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
That's a real tool as well that has been very important in crisis response. We need more of those in assisting law enforcement and behavioral health in crisis response. Again, helping to take all of the decision-making off from law enforcement and have them get behavioral support, behavioral health support in that response, just makes a big difference for everyone.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
So 40-hour training for CIT in Utah, and I can just speak to how it is. It's a 40-hour training in order to get that certification. And they bring in experts who can talk about, here's what mental illness is. Here are the different medications. Here are the different ways it can present. Here is how someone who is in psychosis can can present.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
I'm talking about a condition called anosognosia where the person does not have insight to their illness or that they're ill. And it's not just denial or being difficult or belligerent. They truly do not believe they have a mental illness.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
and helping law enforcement to identify that and bringing in speakers who have expertise in civil commitment law, who are family members, who are people with lived experience. Having them spend time at different locations with people who are in recovery is really important. So it's just giving an overview of the system.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
The big part of CIT is helping to build those partnerships so law enforcement knows who to call, who are the contacts, where are the resources in our community. that they can lean on. And really, it's creating relationships.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
So much of CIT, and frankly, with the whole mental health system, so much of providing an effective mental health system is building those partnerships and relationships and points of contact so that people know who to call and how to have an effective response. And that's what the training is.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
That is a big question, and that's constantly being discussed. How do we help law enforcement get as much information about what's taking place as possible? Part of this is we encourage families to be able to talk to law enforcement and give them information and give them some history and background.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
Having the behavioral health contact in that crisis response, a lot of times the behavioral health system will know the person and will be able to enlighten law enforcement in what's taking place and be able to have an effective response that way. And so it's about helping law enforcement to get as much information as possible.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
This means also there needs to be effective training for call takers, dispatchers, and help them to get that information as well.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
That's right. And it's not always possible in every area, depending on the size of the police department. But ideally, there's time to say we need a CIT team to respond to this. And that's ideal where we have these trained teams that respond and are able to use their skills in that response.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
I would say overall, we really need to provide more avenues for families to be able to give information and explain what is happening and provide background and history to the situation as well.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
Yeah, so they're going to sort things out there. They're 23-hour stays. And so it gives them time to sort things out, to decide what level of care the person needs, and then let the legal system, and that's got to work its way through as well. But
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
Again, understanding that behavior is driven by a serious mental illness or psychosis or anosognosia is important information in knowing how to help the person from there and with the legal system, how to manage the court system with that person as well.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
Well, I think we've been talking about one area, which is crisis response. I think that has been a big improvement. I think having a number that people can call 988 to be able to get assistance and just help to sort things out on their end. A person with lived experience or family experience. to have that resource.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
So I think the establishment of mobile crisis outreach teams that use behavioral health providers and peers is very significant, very important. Receiving centers are very important as well. So I think those are big areas. I think in some ways, at least for general mental health and wellness, we're talking more about that. I think we're focusing more.
Tony Mantor: Why Not Me the World
Sherri Witwer: Rethinking How We help People in Mental Health Crisis
We understand that mental health is something we need to address and try to intervene early, focusing on mental wellness. I think that has been significant. For the most part, I think we've addressed stigma in a significant way, although for people with very serious mental illness, in some ways, it may be rougher for them where there's less tolerance and patience around that.