During a mental health crisis, how the community responds to an individual can be paramount in how a situation is resolved, and what the outcome is for the person in crisis.

In Winona, police, emergency room personnel, and mental health professionals are often the front line for that response, but how a person interfaces with those resources can have a huge impact on the intervention they ultimately receive.

In his book Grounded by Bipolar Disorder, Brian Jost talks about repeated encounters with Twin Cities police or emergency room staff while in various states of mania. in some cases he was hospitalized. other times he was sent home.

According to John Rislove, director of Behavioral Health for Winona Health, either could happen in Winona?s emergency room based on the symptoms a person presents when they come in.

Jost admits on more than one occasion his delusions about hospital staff and paranoia about being admitted prompted him to hide the true scope of his mania from them.

But the candor of a patient in the emergency room, Rislove said, is critical to the assessment staff must make to determine their overall condition. Often, he said, especially in the case of a manic episode, a package of symptoms present themselves in such a way that doctors can easily diagnose the problem.

But a manic episode alone may not be enough to have a person admitted to the Behavioral Medicine Department, better known as the ?psych ward.?

The guidepost that typically must be met, said Rislove, is that a person must be considered a danger to himself or others to generate a diagnosis of a true medical emergency.

A physician making that determination can place someone on a 72-hour hold whether they want to be admitted or not. it is a recommendation police can ask for as well if they transport someone to the emergency room because of mental health-related behavior.

But barring that, a patient can?t be admitted against their will, and sometimes won?t be admitted if doctors don?t feel hospitalization is a medical necessity. ?The key that it comes down to is where is the right place for this person at this time,? he said.

For those who are admitted, the average stay is five days, though certain patients can qualify for up to 45 days if there is medical need and they are dually covered by Medicare and Medicaid. it is rare, Rislove said, to have someone in the unit for longer than 13 days, but sometimes more time is needed to find the right mix of medications to straighten out the brain chemicals of a patient.

And really, Rislove said, mental illness is all about brain chemicals and the fragile balance that must exist for ?normal? behavior.

The unique biology of individuals is largely a mystery to science, but medical professionals know that an imbalance is an imbalance, whether it is blood sugar or serotonin.

The difference, Rislove said, is that mental illness carries a stigma even today that the medical community has been trying to rid it of for decades. ?It?s certainly a lot better than it used to be, but that doesn?t mean there?s not room for improvement,? he said. ?It?s not a character weakness. It?s a biologically based condition. We don?t look at people with high blood pressure and think of them as weak.?

Treatment is important for people with mental health conditions. But sometimes denial or stigma keep a mental health secret for too long, until a person becomes so unstable they have a real crisis.

Fortunately for Winona, Wabasha, and Houston counties, there is 24-hour help for such a crisis, and it is truly only a phone call away.

Hiawatha Valley Mental Health Center has a number that can be called 24 hours a day, seven days a week to reach help.

On the other end are two resources, one a voice to talk to, and the other someone who will get in the car and come to your house.

Eric Sievers, director of outpatient and community-based services, said a caller may choose what type of help they receive through that call-in line, whether it?s crisis counseling over the phone or a physical assessment from someone on the Crisis Response Team.

If a person asks for it, a mental health practitioner will come to their home wherever it is within those three counties, whatever time of day or night it is. They will do an assessment and provide intervention and stabilization if the person wants it.

Sometimes, Sievers said, that intervention is seeing that the person gets to the hospital. other times it is helping them get connected to mental health services or practitioners they have used in the past to make medication changes or follow-up appointments.

Whatever that interface requires, the practitioner will help someone struggling with a mental health crisis to accomplish it, regardless of their ability to pay.

Those who have medical coverage are asked for insurance information, those who don?t are treated just the same.

The only situations in which a person might not be able to use the Crisis Response Team services is if they are highly intoxicated, Sievers said, or highly assaultive. neither has really impeded services in the past, Sievers said, as crisis workers would more likely call on the police for support rather than leave a person without help.

For people seen at the hospital who do not meet the criteria for admission, sometimes the Crisis Response Team will be asked by hospital staff to step in, Sievers said.

In addition to helping with intervention and stabilization efforts in a person?s home, there is a crisis bed available in Winona for people who could be better served outside of their home.

The bed is located at Hope Estates in Winona and there is only one, but crisis workers have it as a resource and will stay with a person there just as they would a person?s home.

The goal of the crisis call-in line and the Crisis Response Team, Sievers said, is to help people avert crisis and stay in their home rather than a hospital setting.

The types of mental health situations they see are as varied as the people who call, from deep depression to manic episodes and beyond, but there is no mental health condition that the crisis team will not intervene in if a person asks for help.

The counseling phone line and Crisis Response Team can be reached through the same number 24-hours a day at (507) 454-4341 or (800) 657-6777.