Fam Proc 16:281-292, 1977

Emergency Psychology: A Mobile Service for Police Crisis CallsDIANA SULLIVAN EVERSTINE, Ph.D.a

ARTHUR M. BODIN, Ph.D.a

LOUIS EVERSTINE, Ph.D.b

aResearch Associate, Mental Research Institute, Palo Alto, California.bAffiliate, Mental Research Institute, Palo Alto California.

The Emergency Treatment Center, a new program of crisis intervention services, has been in operation sinceFebruary 1975. This seven-day-a-week, twenty-four-hour-a-day program backs up ten Northern California policedepartments to provide help to people who are experiencing psychological emergencies such as violent family fights,suicide attempts, and severe emotional disturbance; in addition, the Center responds to any kind of crisis call involvingadolescents. The population of the area served is approximately 750,000, of whom approximately 110,000 areadolescents between 10 and 17 years of age.

The Role of the Police as Mental Health Care ProvidersFamily crises do not wait upon the eight-to-five office hours that are preferred by mental health professionals. In nearly

every community, it is the police who currently provide the only free, mobile service that is available to the public on atwenty-four-hour, seven-day-a-week basis. The police are used, particularly by the poor, in the way that family physiciansand the clergy are used by the middle class; that is, "as the first port of call in time of trouble" (3, p. 285).

The police are called upon to fill the gap that has been left open by those helping professionals who once made routinehome visits. Such visits were once traditional for general practitioners and family physicians. The advent of laboratorymedicine and hospital-based practice ushered in an era in which the home visit became a rarity. Now, however, manymental health and other helping professionals are viewing the home visit with renewed concern. It is for such professionalsas psychologists, psychiatrists, social workers, and other family specialists that this paper is written.

Of the many helping professionals today, it is the police who must attempt to resolve the widest range of emergencysituations and who in the course of a day come into contact with the most people who are experiencing active crisis states.The psychosocial problems with which they must deal are usually intense, complex, and potentially dangerous. It is widelyestimated that approximately 85 per cent of all calls to urban police departments are calls for help in crisis situations (e.g.,family disturbances, rapes, adolescents beyond parental control, runaways, and persons dangerous to themselves or others).The police attempt to resolve the crisis with whatever training and skills they may have. They must try to prevent furtherescalation of the crisis into violence. The police, however, have many mandated responsibilities that require their uniqueexperience, and the many calls for crisis services are a drain upon police resources in terms of time, effort, andeffectiveness.

Need for the ServiceThere are both consumer and provider needs that are not being met by the present mental health system's general

inability to respond effectively to emergency calls, particularly those that occur late at night, early in the morning, and onweekends. When one considers the needs of the person who is in crisis, it will be clear that those needs are seldomsatisfactorily met when a crisis call is answered by the police, whose training, temperament, and motivation fall short ofequipping them to cope with emotionally charged and highly ambiguous psychological emergencies. Moreover, manypeople are afraid of dealing with the police because of presumptions of racial prejudice or fears that they may obtain orextend a record with the criminal justice system. Many hold a not completely unfounded skepticism about the ability ofpolice officers, considering the framework within which they operate, to cope with crimeless victims (i.e., people who havenot done anything culpable). Those who hold that view may perceive that the police approach is one that predisposes thepolice to assigning blame and to dealing with a "guilty party."1

From the provider's standpoint, the client's emotional status may be less vividly revealed by what is said in the officeabout it than by what is seen in the home; there, in so many instances, the problem that led to the crisis has originated and isbeing acted out. Also, what clinician has not heard a disgruntled wife say, "He's one way here in your office, Doc, but youshould see him at home!" A therapist's office is a public place in which guarded behaviors are generated; by contrast, thehome is a sanctuary in which people let their hair down (and with it, their defenses). The condition of the house, its layout,its furnishings, the way in which the life-space is used, the handling of pets, relationships with neighbors and other sources

_____________________________________________________________________________________________________________

1

of intrusion that can diffuse attention, all give clues to the family ecology that profoundly influences each family member'semotional well-being. Does the home meet the needs of individual family members to have some privacy and space of theirown: i.e., does the family live in physically crowded conditions, or is the family psychologically crowded, such as thesmothering family that does not allow its members enough psychological space to be individual persons? Are the childrenallowed a reasonable amount of freedom to play in the home, or is it obsessively clean with furniture covered by plastic dustcovers? Is the living room furnished with expensive designer furniture while the rest of the house, not usually seen byvisitors, is furnished with orange crates and mattresses on the floors? Furthermore, the helping professional who has notvisited the home of those whom he or she serves has not experienced the more intense rapport that it is possible to achievein that setting. And, although it is fashionable to sound tough instead of sounding tender, there are those among us who arecapable of feeling a special sense of satisfaction from responding to people who are in acute need, despite the considerableinconvenience. The old family physician would not have been ashamed to acknowledge such a sentimental satisfaction.

The ModelThe Emergency Treatment Center is a new model for working with, or in place of, other crisis intervention models (4).

There are some mobile emergency programs that, on the surface, appear to be conceptually similar to the EmergencyTreatment Center. Two examples of such programs are: (a) the Psychiatric Emergency Team in Los Angeles and (b) theMobile Emergency Services Unit of Santa Clara County. Both of these services (PET and MESU) perform, as their primaryfunction, emergency psychiatric evaluations to determine whether or not a person is in need of hospitalization. They attemptto cool down the crisis situation, decide whether the person should be hospitalized, and refer the client to the appropriatehelping agency. The staff members of these services do not provide ongoing treatment, referral coordination, or follow-uptherapy to their clients. The role of these services is evaluative, by contrast with one that begins family and/or individualtherapy in the home or at the scene of the emergency.

When a team from the Emergency Treatment Center makes an emergency home visit, the therapy begins at that moment,and any subsequent therapy that is necessary will be conducted by one or both members of the team. Every effort is made toensure the continuity of service to the family. Although the Emergency Treatment Center does not provide long-termtreatment, the Center staff generally sees clients for at least two, and as many as six, visits. It is the Center's policy that anyreferral made for special services or long-term therapy should be followed up by the Center staff until the referral isfunctioning.

The differences described above may appear subtle, but, in actuality, they are profound. It is basically the differencebetween therapy in the home and an evaluation that results in hospitalization or a referral slip. Some statistics on theseprojects will amplify this point of view. For example, MESU hospitalizes about 40 to 50 per cent of its cases, whereas ETChospitalizes less than 10 per cent of its cases. The critical factor that separates ETC from the mobile psychiatric evaluationunits such as PET and MESU, as well as from the police family crisis intervention units such as the Bard (2) or Schwartzand Liebman (6) models, is that the people who respond to the emergency calls are trained therapists who begin and, ifnecessary, continue the therapy in the home or other scene of the emergency until the crisis situation is resolved.

The Emergency Treatment Center model operates in the following manner: mobile teams, consisting of two persons (onemale and one female) are on call during the hours in which mental health facilities are ordinarily closed, includingweekends. During the week, one person is on call during the day from 8:00 A.M. to 4:30 P.M. Two teams are on call from4:30 P.M. until 8:00 A.M. On weekends, three shifts are employed: one team is on duty during the day from 8:00 A.M. to5:00 P.M.; one team takes an early evening shift from 5:00 P.M. to 10:30 P.M.; another team takes the late evening shiftfrom 10:30 P.M. until 8:00 A.M. In addition to the team members, one member of the supervisory staff is always available(by telephone or radio page) to the on-duty staff for special consultation or to take cases when the need arises. The staffmembers respond from the Center's office to calls received by telephone or to a radio pager when the staff is alreadyresponding to a call. Most ETC calls originate from police officers who are in the field. Depending upon the severity of thecrisis, the officers can do one of three things: (a) call ETC directly; (b) have their dispatcher call ETC; or, (c) ask the familyto initiate the call to ETC. The Emergency Treatment Center's offices are centrally located so that, in most instances, a teamcan reach the scene of an emergency within twenty minutes.

Another important aspect of the ETC model is that the Center's teams have more time flexibility than do the police.Generally, police officers can take twenty to thirty minutes off the street before their absence from regular patrol dutiesbegins to be felt by the other officers who are on patrol. The Center's staff members, by contrast, are not under this kind oftime pressure, so that they can remain on the scene until the immediate emergency has been resolved. The average initialETC visit lasts 2.3 hours, although some extremely unusual situations have required as many as eight hours to bring toresolution.

The methods used by the Center in crisis intervention and follow-up are, in general, eclectic and flexible. And, while themethods can be described as tough-minded and problem-specific, they are warm in orientation. The counseling provided byETC is active, and the follow-up is extensive. Usually the follow-up is initiated and maintained by at least one of the staffmembers who responded to the initial call. This provision maximizes continuity and takes advantage of the considerable

_____________________________________________________________________________________________________________

2

rapport that was developed when the team responded at the time of the emergency, when defenses were at a low ebb andthe need was most acute. It is the lack of such continuity that has accounted for the overwhelming majority of dropouts fromattempted referrals in previous crisis intervention programs. A study of the percentage of referrals that were followedthrough was made by a large Northern California police department. It was found that about 15 per cent of the referrals thathad been made by its Family Crisis Unit were, in fact, completed by the family. By contrast, the Center has found thatapproximately 90 per cent of its clients who are offered follow-up visits actually accept the offer. Because they were theones who reached out to help during the emergency, the ETC staff members enjoy special advantages in terms of obtainingthe cooperation for follow-up of persons who might otherwise be extremely resistant to help by professionals from themental health, probation, or social service fields. In summary, the special relationship that is initiated by the promptresponse of the Center provides a foundation from which affirmative follow-up measures can be implemented, in that waycapitalizing upon the momentum already gained.

The rationale and purpose of this model are in accord with recommendations contained in a recent report of the NationalInstitute of Mental Health. This report emphasized the "increased need for community-based emergency services." Thereport took note of the Emergency Medical Services Systems Act of 1973 (P.L. 93-154), according to which funding is tobe provided for "emergency medical services programs throughout the country." (7, p. 1) The Act

...makes deliberate reference to the inclusion of both physical and psychological emergencies. Specific mentalhealth emergencies such as suicide, alcohol abuse, drug addiction, child abuse, rape, and acute psychiatric episodes(e.g., psychosis) have been considered in the operating plan. [7, p. 1]

Others have reached the same conclusion about the need for emergency mental health services, from differing premises. K.D. Gaver (5) speculated on possible new approaches to the provision of mental health care, as follows:

...it is not only the total amount of treatment resources applied but also, and even more important, the when,where, how and by whom those resources are applied. [5, p. 5; Gaver's italics]

And, Gaver added, the

emergency points are in the community, and there are many of them. A mental health care system must, therefore,be community-based, structured to deliver services at emergence points, and programmed to respond promptly andfiexibly. [5, p. 6]

In addition, the American Public Health Association, in a proposed policy statement issued in 1974, recommended thatmental health systems should include

...twenty-four hour emergency services to provide mental health services for persons who require them on anemergency basis and day care and night care services at the time the patient needs them, while still permitting himto stay at home. [1, p. 4]

Clearly, the kind of program typified by the Emergency Treatment Center embodies an idea whose time has come.

Methods of Initial ContactTo facilitate understanding of the actual operations of the ETC program, the flow of communication and activities in the

course of handling a typical crisis call will be described. Initially someone calls the police for help. Usually this is amember of the client's family. Rarely are the police, themselves, witnesses to the emergency that prompts the call. In a fewinstances, the caller is a neighbor or passerby, a bartender, or a motel manager. The police officer, after responding to thescene, sizes up the situation and decides whether or not the help of Emergency Treatment Center would be useful. Inmaking this decision, the officer reviews guidelines that were presented to him by ETC staff members at a prior trainingsession. If the police officer decides that help from ETC would be useful, he gives the family some information about theCenter and asks the persons involved whether they will consent to the Center being called. Thus, the ETC staff respondsonly when the police believe that it may be useful and when the persons involved give their consent. Having obtainedconsent, the police officer will either call ETC directly or call the police dispatcher, who, in turn, will call the on-duty staffmembers. The response time of the staff usually depends upon the intensity of the emergency situation and ranges from fiveminutes to forty-five minutes.

When an initial call comes, for example, from Police Dispatch, the staff members usually get only the name of the officerwho called in and the telephone number at which the officer can be reached. A staff member then calls the officer at thatnumber and gets a description of the situation and the officer's assessment of it. In this description, the police officer tells

_____________________________________________________________________________________________________________

3

the staff whether it would be wise for the officer to remain at the scene until the team arrives, whether the officer will leaveimmediately while the team is enroute, or whether the officer wishes to wait a little while after the team has arrived in orderto see if the crisis situation can be sufficiently contained. It is often useful at that point for the staff member to talk on thephone with one or more of the persons who is involved in the crisis before the team leaves for the home. Sometimes, butnot often, this initial conversation results in the team's deciding upon a response other than going to the scene.Hospitalization by ambulance, scheduling an office appointment during the daytime hours, or meeting on some neutralground such as a community center or a neighbor's house are examples of such alternatives.2

In responding to the scene of a call, the staff members usually find confirmation of their map-reading efforts when apolice car is spotted at the address indicated. Usually, the police officer who is awaiting their arrival greets the team outsidethe house or at the door and gives them a few minutes' briefing. In some instances, the police have already left, having sizedup the situation as likely to remain calm until the team's arrival. In a small number of instances, the staff members and thepolice officer have agreed that the officer should stay on for a little while to ensure that the situation remains calm enough toconduct a useful intervention without physical force.

Upon entering the home, the staff members talk in turn with each of the persons involved, with the intention of gettingeach person's story without having to worry about the telling of it contributing to further escalation of the interpersonalconflict. While a thorough account of the range of methods that are used subsequently would be beyond the scope of thispaper, it is worth emphasizing that the team's methods are concrete and problem-oriented, tailored to the particularsituation at hand and to the persons involved. The procedure usually begins by asking each person to describe what he orshe sees as the main problem or problems. The response to that question may be clear or vague, and it may be interruptedby one of the other persons. When a response is interrupted, the staff members firmly introduce, if need be, the rule thatonly one person may speak at a time. Then they may seek clarification of initially vague problem descriptions by asking forspecifics or illustrations or for an account of what it is that the person would like to do that he or she can't do because of hisor her difficulty; and/or, what it is that he or she would like to stop doing, were it not that the difficulty prevents him or herfrom stopping. (It is not just the young who tend to couch their initial complaints in vague language. It is essential torecognize and not to accept such vagueness without further clarification; it must be converted into concrete terms before thecomplaints behind it can be dealt with.)

Since it is normal to have difficulties in life and since it is the mismanagement of these difficulties that converts them intoproblems with a capital "P," we inquire routinely about attempts to manage the difficulties at hand. Thus, we ask a questionsuch as, "What have you been trying to do about this so far?" In the answer to this question, we often obtain informationabout previous attempts at therapy and what the person felt was useful or not useful about those attempts. That kind ofinformation is important, not only because it may be useful for the staff to contact previous therapists (having obtainedappropriate consent), but also because it may save us from wasting our time with interventions that have already been triedbut have failed (either because they were unsuitable from the start or because they were not tried in a manner that wasacceptable or useful to the people involved). In the initial interview, staff members also attempt to find out what the peopleinvolved would like to achieve as a result of their talking with us. When they reply that they want simply to "feel better" orthat they "want to feel less depressed," we ask for further information along the lines of what they would then be able to dothat they cannot do now or what they would be able to stop doing that they can't help doing now.

A further step in the first interview is to get some idea of what notions the persons involved may have about how theachievement of their goals can be reached. It is useful to inquire about that for several reasons: (a) it encourages familymembers to think positively; (b) the process itself stimulates hope; and (c) their replies may provide vital cues to the staffabout how to follow the course of least resistance in obtaining desired changes by pursuing them in ways that are consonantwith the expectations of the persons involved.

An additional step in the initial interview is to attempt to make a summary of what has occurred and to request somefeedback from the client or family members about their reactions to this initial contact. Finally, the staff members introducea discussion about further steps. We may suggest another session in the home or invite the family members to come for afollow-up session at our offices; or we may make an appointment with some other agency, either at that time or in atelephone call scheduled for a later time.

To illustrate how the Emergency Treatment Center model works, two cases will be described, from the first call for helpto the resolution of the emergency. (The names, of course, have been changed.)

The Case of Mr. and Mrs. Campbell

How and Why the Emergency Treatment Center Was CalledThe Emergency Treatment Center was called by a police officer who responded to a family disturbance. The officer

asked ETC to respond immediately because the couple was still actively combative. The officer met the responding staffmember in front of the Campbell home with the news that the situation inside the house was still very "hot": the husband

_____________________________________________________________________________________________________________

4

had tried to stab his wife earlier, but a friend had stopped him. The officer added that the husband was sitting in a corner,swearing and mumbling about flowers.

How the Problem Presented ItselfWhen the ETC staff member entered the Campbells' dimly lit, lower middle-class home, furniture had been thrown about

and there were empty bottles and beer cans on the floor. Mr. Campbell was sitting in a far corner of the living room; Mrs.Campbell was in the next room with a second police officer. The officers had found that the couple would not stay apartwithout supervision. At this point, it was decided that only one officer would remain on the scene.

The staff member decided to interview the husband first because he was by far the angrier of the two and the one morelikely to explode violently. After Mr. Campbell had settled down a bit, the staff member asked him what the problem was.He answered that he could not stand the sight of his wife. When asked how long he had not been able to stand the sight ofhis wife, Campbell replied that, for the past three years, she would not let him "live down" his drinking. He said that he wascurrently unemployed but that he was looking for work. The staff member talked for a while with Mr. Campbell, but it wasobvious that he was too intoxicated to be interviewed effectively that night. The staff member also decided that Mr.Campbell should, if at all possible, go to an inpatient facility for detoxification that night, since he had been drinkingheavily for a long period of time. When the idea was proposed, Campbell agreed to go to the alcoholism treatment facility.

Next, the staff member talked with Mrs. Campbell, in order to learn her view of the problem. She said that when Mr.Campbell got drunk he became irrational. She said that he was too proud and that he was too blind to see the impact thathis drinking had had upon his family and his work. She added that he had been laid off from a foreman's job, which he hadheld for eleven years, because of his drinking. She said that she was fed up with him and had already seen an attorney abouta divorce. The staff member discussed with the wife the idea of hospitalizing Mr. Campbell, and she agreed that it would bea good idea, considering the length of time that Mr. Campbell had been drinking heavily.

Next, the staff member called a local detoxification facility to reserve a bed and asked the workers at the facility to send acar to pick up Mr. Campbell. He was quite cooperative at first. When the car arrived, however, he refused to leave andbecame belligerent again. Finally, the police officer had to step in, informing Mr. Campbell that if he did not go willingly hewould be hospitalized involuntarily because of his earlier attempted assault on his wife with a knife. After Mr. Campbellhad been taken to the detoxification facility, the ETC staff member stayed to talk with Mrs. Campbell, the teenage children,and the friend of Campbell who had taken the knife away from him. The friend said that he was an ex-alcoholic who hadbeen "dry" for six years. He said that Mr. Campbell suffered from the "nice-guy syndrome," because he was nice to hisenemies and to strangers but was nasty to his friends and to his family. The friend said that Mr. Campbell had bullied hiswife and children mercilessly. He said that Campbell picked on the children incessantly but that he bragged about theiraccomplishments to his friends when the children weren't around.

After some summarizing discussion, the staff member made a follow-up office appointment with Mrs. Campbell for twodays later. He also suggested that Mrs. Campbell call her lawyer the next day about a restraining order and about her wishto begin divorce proceedings. The staff member also offered to talk with her lawyer about the writing of a special type ofrestraining order; it would contain a specific order from the judge to the police, directing them to enforce the order on thespot rather than inform the woman that the problem was a civil matter and that she should go to court. The staff memberalso reminded Mrs. Campbell that the police thought she should change the locks on the house in case Mr. Campbelldecided to come back for revenge.

Resolution and Follow-UpIn the first follow-up interview Mrs. Campbell said that, during his first day in detoxification, her husband had called her

and had been talking in a suicidal manner. She said that he had asked her how much life insurance he had and whether thepolicy would be paid if he committed suicide. She said that he was being transferred that same afternoon to a privateresidential clinic for alcoholics. She added that the clinic had an intensive, three-month program.

The ETC staff member asked Mrs. Campbell how long Mr. Campbell had had a drinking problem and also if she couldthink of anything in particular that she could associate with the onset of his drinking. Mrs. Campbell answered that herhusband had been drinking for twelve years. She also replied that four things had happened at about the same time that hehad started drinking heavily: (a) their son was born; (b) Mr. Campbell's mother died; (c) they bought a house; and (d) she(the wife) had started a new job. She went on to say that Mr. Campbell deeply regretted not having shown more affection tohis mother before her death. Mrs. Campbell added that her husband was very fearful of growing old and that he dyed hishair.

Mrs. Campbell told the staff member that she had had an abortion two years before and that her husband had been angryat her for doing that. She also said that Mr. Campbell frequently referred to her as a "bastard" because he thought that shehad been an illegitimate child.

_____________________________________________________________________________________________________________

5

Although she was still quite angry about her marriage, Mrs. Campbell began to look at and deal with some of theproblems in the marriage that had led up to the crisis. The staff member pointed out to her that she had repeatedly rescuedand forgiven her husband and that by doing so she had, in some respects, hindered him from stopping his drinking. Thestaff member made another appointment for Mrs. Campbell in about a week.

At the next appointment, Mrs. Campbell told the staff member that she wanted to try to save her marriage. She said thather husband was making amazing progress and that his progress was forcing her to look at herself. She said that she had tolearn how to relate to a man who was not completely dependent upon her and who was not always making empty promises.She said that Campbell now realized how childish he had been and that he had become more understanding with thechildren.

The staff member who made the emergency home visit continued to see Mrs. Campbell (and, on two occasions, thechildren) periodically for about three months. Occasionally Mr. Campbell came in for individual sessions while still aresident of the alcoholism facility. When Campbell was released from the residential program, he returned to his family. Todate, the Campbells have had only a few minor difficulties. On one occasion, Mr. Campbell became angry at his eldestdaughter for disobeying him. His son became afraid and called the police. When the police arrived, Mr. Campbellexplained what had happened, and the police told the boy that his father had a right to discipline his children so long as hewas not cruel or abusive, which, in that instance, he had not been. Except for that minor incident, the Campbells havebecome a successfully integrated family, and there have been no subsequent calls to the police.

The Case of Jerry Berkshire

How and Why the Emergency Treatment Center Was CalledThe Center was called by a police officer who had arrested Jerry Berkshire, age 16, for breaking into and robbing a local

furniture and appliance store. The officer asked the staff members if they would be willing to meet with him at the boy'shome when he brought the boy back there later that evening. The officer said that he had already spoken with the boy'smother by telephone and that she was willing to see us. The officer was quite concerned because he thought that the boydidn't look or sound like a real delinquent. The officer thought that there might have been some other reason, possibly afamily problem, that was the cause of the boy's apparently delinquent behavior.

The ETC staff arrived at the Berkshire home around midnight, when the officer who had called the team brought Jerryhome. The Berkshires lived in a modern, upper middle-class home, and there were two expensive, "flashy" cars parked inthe driveway.

How the Problem Presented ItselfAfter introductions and general discussion, the staff members decided to interview each member of the family

individually at first so that they could learn each person's independent view of the problem. (Jerry's sister, Julie, was not athome at the time.) The staff members first talked with Jerry's mother, Carolyn Berkshire. Mrs. Berkshire, a good-lookingwoman in her late forties, was self-employed as an insurance broker. She voiced concern that her work was probablykeeping her away from home too much. She said that she often had to entertain clients with her common-law husband,Arnold Snow (also an insurance broker), until after eleven or twelve at night. Mrs. Berkshire said that she had been marriedtwice before she met Mr. Snow and went on to explain that they did not intend to get married, although they consideredtheir relationship to be a permanent one. She said that she really did not know why Jerry was behaving like that but thoughtthat she might not have been strong enough to handle him because she had experienced trouble before in disciplining himeffectively. She said that she had seen a social worker in Los Angeles two years before, when Jerry's grades had firstdropped. That was about the time she had married her second husband. Carolyn said she had not gotten along with thatsocial worker and that she had not liked the way he had "handled" Jerry. Subsequently, she had seen a psychiatrist who wasa friend of hers, and the psychiatrist had helped her quite a bit.

A staff member sensed that, for some reason, Mrs. Berkshire was reluctant to set limits for her son. When asked if theboy was holding some secret over her head, Mrs. Berkshire revealed that, about a year before, Jerry had turned her in to thepolice for smoking marijuana. She said that Jerry had done so after she had tried, unsuccessfully, to discipline him. She saidthat, even though she hadn't had to go to court, it had placed her in a very awkward and embarrassing situation. Now, shesaid, she is always fearful when she tries to be firm with Jerry.

The staff members felt that Mrs. Berkshire's inability to discipline Jerry effectively was centered around two problems:first, Mrs. Berkshire was afraid of losing Jerry's love and, second, she was afraid that Jerry might get her into anotherdifficult legal situation. She also was unsure of herself because Arnold Snow did not support her in her attempts todiscipline Jerry. She said that Mr. Snow would not accept any responsibility for the disciplining of her children. Because hewould not help her, she felt that she had no one to turn to for support or relief when Jerry would start acting-out. In facing

_____________________________________________________________________________________________________________

6

that situation, she usually gave in to Jerry's demands and rarely attempted to discipline him.After the staff members had talked with Mrs. Berkshire for about twenty minutes, they talked with Mr. Snow. An

insurance salesman in his late fifties, he had obviously been drinking but was not too drunk to talk coherently. Mr. Snowhad also been married twice and had three grown-up children. He said that he had been through the raising and supportingof his own three children and that he had no intention of raising anyone else's children. He said that he consideredeverything relating to Mrs. Berkshire's children to be her problem exclusively. He also said that he was having financialdifficulties, and, for that reason, he couldn't do anything about Mrs. Berkshire's children even if he wanted to. The staffmembers made several attempts to convince him that Mrs. Berkshire needed his help with Jerry and that Jerry needed astrong, male, role model. Nonetheless, Mr. Snow consistently refused to accept any responsibility, even though he claimedto like Jerry very much and to know how to "handle" a boy like Jerry.

Next, the staff members talked with Jerry. Jerry was a good-looking, soft-spoken boy of 16, who looked a bit young forhis age. Jerry appeared to be extremely sad and sorry about his recent robbery attempt. He seemed to be a little immature,and he was not able to verbalize any reasons for his recent behavior. A staff member asked Jerry whether he was angry orupset with his mother. Jerry said no, he wasn't angry with her, but he was very sad because he knew that his mother worriedabout him all the time. The staff inquired into Jerry's financial situation, and whether he had some way of earning money.Jerry said that when he needed money he would ask his mother and she would give it to him. Next, a staff member askedJerry if he had any chores to do and whether there was a specific hour when he had to be home at night. He replied that hedid not have any chores but that he was supposed to be home by eleven.

The staff noted that, while talking with Jerry, both Mrs. Berkshire and Mr. Snow kept coming into the room for onereason or another: to get matches, cigarettes, a pillow, a book, an ash tray, etc. It was obvious that they were nervous aboutletting Jerry talk with the staff members alone. That "hovering" type of behavior was quite disconcerting, and Jerryappeared to resent it. If that kind of behavior happened all the time, it could provide a form of pressure from which Jerrywould naturally attempt to escape.

Finally, a staff member asked Jerry if he would be willing to work for his spending money. He said that he would like towork for money and that he would also like to earn more free time. The staff told him that they would like to design someguidelines for chores, as well as for specific behaviors by which Jerry could earn extra time and money. That idea seemedto appeal to Jerry, and he said that he would like to try it.

Resolution and Follow-UpThe staff members called Mrs. Berkshire and Mr. Snow into the living room, and asked Mrs. Berkshire whether Jerry

had an allowance. She replied that he did not have an allowance but, if he needed money, he would just ask her for it. Whena staff member explained to her that that arrangement had often been demeaning to Jerry and could easily have led to ablackmail type of behavior on his part, Mrs. Berkshire said that the idea had not occurred to her. The team memberssuggested a small basic allowance just for Jerry's keeping his room clean and that he should be permitted to earn a specificadditional amount each week for doing specific jobs. A staff member asked Mrs. Berkshire what the maximum amount ofmoney would be that she could afford to give Jerry if he did some work for her. She said that the most she could afford wasseven dollars a week. Then the staff member asked what the minimum would be that Jerry could receive for doing no morethan one established chore, such as cleaning his room, and Mrs. Berkshire replied that Jerry could have a dollar a week ifhe only cleaned his room. Jerry was agreeable to that and, in fact, was surprised at how high the minimum amount was. Thestaff went on to outline and to obtain agreement about jobs that Jerry would do on specific days, for specified amounts ofmoney. Jerry would have to complete those jobs by the end of a mutually agreed-upon time, without having to be reminded.Also, Jerry would have to complete each of the chores in order to earn the seven dollars, so that there would be a bigreward for finishing all of his chores. The details were worked out between Mrs. Berkshire and Jerry that evening in such away that there would be no confusion or misunderstandings later.

The staff members made an appointment for a follow-up visit later in that week. When they next talked with Mrs.Berkshire, the arrangements seemed to be going well and she was gaining some confidence in herself as a capable mother.The family was seen for a total of three follow-up visits. When a staff member called back a month later, Jerry was stilldoing fine.

Summary of the Center's AchievementsIn its first full year of existence (February 1975 through January 1976), the Emergency Treatment Center provided

services to 340 families in its ten-city area of responsibility. Of those families, 129 were headed by a single parent; in 69other families, the natural parents had been divorced and the parent who held custody had remarried.

In a year's time, the Center intervened in eight cases that involved threatened or attempted homicide, 38 cases ofattempted suicide by adolescents, and 23 cases involving rape, assault, incest, or molestation. To date, there have been nocompleted suicides or homicides in any of the cases that were provided counseling by ETC.

_____________________________________________________________________________________________________________

7

The service provided to the 340 families can be described separately according to initial and follow-up visits. Initialvisits:

1. were almost exclusively conducted in the homes of the clients; 2. lasted, on the average, 2.3 hours per home visit; 3. were conducted by an average of 1.8 staff members; i.e., a majority of visits were conducted by two-person teams.

Follow-up visits: 1. were, in a majority of instances, conducted in the homes of the clients; 2. lasted, on the average, 1.5 hours per visit; 3. were conducted by an average of 1.5 staff members; i.e., half of the visits were conducted by two-person teams.

In the course of its first year of operation, the efficiency of the Center's services increased markedly. Consequently, itscosts significantly declined from month to month, culminating in a cost of $24.14 for each visit during January, the lastmonth which is reported in this review. That cost is well below the prevailing cost for an outpatient visit in the surroundingCounty's Community Mental Health program.

In general, the work of the Center has provided a much-needed service to a wide range of extremely volatile andcomplex emergency cases. It is a highly efficient program, considering the immense logistical and staffing problemsinherent in the operation of a seven-day, twenty-four hour emergency service.

REFERENCES

1. American Public Health Association, Proposed Policy Statement, The Nation's Health, October, 1974, 4. 2. Bard, M., "Family Intervention Police Teams as a Community Mental Health Resource," J. Crim. Law, Criminol.,

Police Sci., 60, 247-250, 1960. 3. Cumming, E., Cumming, I. and Edell, L., "Policeman as Philosopher, Guide, and Friend," Soc. Prob., 17,

276-286, 1965. 4. Everstine, D. S., "The Mobile Emergency Team: A Model for Psychological Intervention in Police Crisis Cases"

Ph.D. Dissertation, California School of Professional Psychology, San Francisco, July, 1974. 5. Gaver, K. D., "Modules for a Better World," MH (Mental Hygiene), 60, 3, 5-8, 1976. 6. Schwartz, J. A. and Liebman, D., "Mental Health Consultation in Law Enforcement, in H. Snibbe, and J. Snibbe,

(Eds.) The Urban Policeman in Transition, Charles C Thomas, Springfield, Illinois, 1972. 7. Witkin, M. J., "Emergency Services in Psychiatric Facilities, Mental Health Statistical Note No. 128, U. S.

Department of Health, Education and Welfare, Public Health Service, Alcohol, Drug Abuse and Mental HealthAdministration, DHEW Publication No. (ADM) 76-158, 1976.

Reprint requests should be addressed to Diana Sullivan Everstine, Ph.D., Mental Research Institute, 555 MiddlefieldRoad, Palo Alto, California 94301.

1The concept of the crimeless victim signifies two contradictory elements in the experience of the person who calls the police atthe moment when a family dispute or other emotionally charged crisis is taking place, namely: (a) there is, without a doubt, at leastone person who represents a "victim" in the situation, or it may be that both partners in a couple are "victims," and in somesituations an entire family can be thought of as "the victim"; also, (b) in most domestic crisis situations, no identifiable "crime" hastaken place. It is the latter state of affairs that creates the maximum conceivable irony for a family when one of its members hascalled the police and the police have responded: i.e., the police represent the only institution that can be expected to respond to thecall, yet the police officer can supply only the least appropriate kinds of solutions to the problem. In the case of the crimeless victim,the police are often the first helping agency to arrive on the scene and the last whose efforts can be appreciated. The crimelessvictim becomes a victim of the System, and the police officer becomes a victim of a role that the System, mistakenly, expects him orher to perform.

2ETC staff members have met their clients in settings such as the lobby of a hotel, the waiting room of a community mentalhealth center, the lounge of an airport, a doughnut shop, and a public phone booth in the parking lot of a shopping center.

_____________________________________________________________________________________________________________

8