Photo by Christopher Dacanay A Short Creek Joint Fire District ambulance sits at Trinity Medical Center West’s emergency department drop-off zone.

WINTERSVILLE — Challenges to a person’s mental health, potentially with copious variables at play and nuances that demand sensitivity, can be a complex issue to handle.

As defined by the Centers for Disease Control, mental health is “the component of behavioral health that includes our emotional, psychological and social well-being. (It) is a state of well-being that enables us to cope with the stresses of life, realize our abilities, learn well and work well, and contribute to our community.”

Without professional assistance, symptoms of mental health disorders can impede a person’s ability to perform everyday tasks, manage relationships or control stress. Disorders, as well as trauma or other life difficulties, can compound and lead to personal mental health crises, which may put a person at risk of hurting themself or others.

A person experiencing a mental health crisis might feel overwhelmed and be unsure of where to turn for help.

Recognizing the importance of a collaborative, interdisciplinary approach, multiple organizations in Jefferson County — from first responders to behavioral health service providers — are working together to help those experiencing mental health issues get the treatment they need.

In a dire situation, many people are inclined to call upon emergency services by dialing 911. That places local dispatch centers at the front line of mental health response, necessitating a highly trained staff and an effective plan of action.

Rob Herrington has served as director of the Jefferson County 911 Center since its facility was built 32 years ago. He’s also the fire chief and a paramedic at Wintersville Fire and Rescue, meaning he’s served on both sides of 911 operations, he said.

Fundamentally, the dispatch center’s role is to receive emergency calls, assess callers’ needs and coordinate the appropriate response. Jefferson County 911 functions as the dispatch center for 54 agencies in the county.

The center operates 24 hours a day and has 23 employees. Staffing varies depending on the time of day, Herrington said, with between two and four people typically answering calls at a time, though busier periods are more highly staffed.

Mental health-related calls — whether they’re self-reports or originate from a person’s family member or friend — account for only 1 percent or 2 percent of the center’s call volume, Herrington estimated. Law enforcement, fire or EMS incidents occupy the bulk of that volume, he said, but mental health calls “all have the potential to be very serious, so there’s a lot of attention placed on handling those.”

Herrington said all employees are trained at the EMT or paramedic level, with training also imparted for “pre-arrival” software. The center’s information-gathering system receives keywords and provides relevant questions for dispatchers to ask the caller — “attempted suicide” might prompt dispatchers to ask about the presence of a weapon, for example.

Dispatchers undergo intensive training and recertify their skills every year in accordance with state law, Herrington said. Also, the center will review calls with more factors at play, including mental health calls, which tend to be more complex and can involve multiple agencies and response strategies.

“When we have these calls, we review them to see that we followed the protocol, if there’s anything we can do better,” Herrington said. “The agencies we work with, we’re constantly reaching out to them if the system doesn’t work. … A lot of what we do here is kind of (based) on the idea of the implementation cycle: We study something, we implement a program, then we evaluate and change it.”

Herrington said the 911 center’s initial job is to determine a call’s “chief complaint” — what’s wrong and who’s involved. Once the basic information has been obtained, the center will decide internally what outside resources are necessary. That may include EMS or law enforcement if there’s an immediate threat to the subject or others.

If an individual is suffering from mental health issues and simply wants to speak with someone, the 911 center would turn to one of its partners, Trinity Health System or Coleman Health Services.

Trinity is the center’s go-to for cold calls, where the subject has no history of interaction with a mental health service provider, Herrington said. Coleman is normally sought if the subject is an existing patient of the agency.

Trinity and Coleman have 24/7 over-the-phone crisis intervention capabilities, Herrington said. For either agency, dispatchers can bring an intervention specialist into the call to speak with the subject. Depending on the time of day, there may be a brief wait for a specialist, but dispatchers remain on the line until the call comes through.

“We’re trying to help the person get through that moment of crisis,” Herrington said. “What we don’t want to do is have a person who’s depressed get off the phone with us and then sit there and wait for (another agency) to call. And even though it might be a minute or two, it’s still the idea that we don’t allow any dead space.”

Dispatchers will remain on call in the event that the agency requests ambulance service to bring the subject to Trinity Medical Center West for evaluation. Not all subjects require an emergency room visit, Herrington said. For some, a regular appointment may be scheduled for treatment, but every case is different.

A few different services may loop the Jefferson County 911 Center in with their calls to help resolve a situation or send for emergency response. Ohio, for example, operates the call/text 988 suicide and crisis intervention lifeline, as well as the 247 behavioral health call service CareLine.

National lines may also loop in the center for calls about someone in Jefferson County from a third party in another jurisdiction, in order to facilitate localized response.

In the most urgent situations where a person is seriously contemplating suicide, the pre-arrival software becomes a great asset, Herrington said. Even though members of the staff are highly trained, the software provides critical assistance through recommended prompts, in order to keep the subject safe until help arrives.

“We are all that person has until someone pulls in front of their house,” Herrington said.

The 911 center, which handles about 38,000 calls a year, is in a pretty stable position when it comes to response efficiency, Herrington said. Gaps in service have only appeared when agencies are changing staffing or capabilities, he added, but the center has some “pretty good resources” at its disposal.

Herrington reflected on the foundation behind dispatchers’ approach to every call: Getting the information and helping to close the loop between the subject and whatever help they need, whether it’s physical or over the phone.

“By classification of calls, we have several hundred. The only commonality in that is trying to … get a solution to the problem. Mental health is no different in that.”

Wednesday’s story will look at the Jefferson County Prevention and Recovery Board and its role as a funder and regulator of local mental health and substance use prevention services.