Joliet mental health program removes barriers to care

Joliet Mayor Terry D’Arcy attended the Joliet Fire Department’s Crisis First Aid for Paramedics refresher course Wednesday morning and praised the department’s mental health response program.

“It’s really going to improve the lives of so many people,” D’Arcy said. “Our first responders do all they can with mental health and behavioral health and now it partners with someone who can do an immediate service to those folks who need help.”

D’Arcy is referring to the city of Joliet’s partnership with Thriveworks, which provides Joliet residents with mental health professionals available when they need them, even if they can’t afford to pay for them.

“I’m on the board of Silver Cross Hospital and 30% of our emergency room needs right now are being filled with mental health and behavioral health,” D’Arcy said. “And what this Thriveworks partnership with the city is doing is eliminating the need to move so many people to the ER that have those issues, not physical issues.”

Joliet Fire Department Deputy Chief John Stachelski said that, before the fire department started its mental health program, 10% to 15% of emergency medical services were mental health-based – and that percentage increased when substance abuse-related calls were added.

“They were calling 911 and going to the ER because they had nowhere else to go,” Stachelski said.

Many Joliet residents couldn’t access care because they were uninsured, underinsured or on Medicaid, he said. If they did have access, it took about six weeks to get a first appointment with a psychologist and three months for a psychiatrist, Stachelski said.

On top of that, the drive to the provider might be an hour away, he said, and too often people didn’t show up for appointments.

“They just kept calling us over and over,” Stachelski said.

Making mental health care more accessible

The Thriveworks facility opened in July 2022 at the Silver Cross Professional Building, 1051 Essington Road in Joliet, in space Silver Cross Hospital provided.

Since the partnership with Thriveworks, a national network with more than 4,000 providers, people get care within 24 to 48 hours regardless of their ability to pay, Stachelski said.

We often say you can have an appointment today if the patient is ready for an appointment that quickly.”

—  Stephen van der Watt, Thriveworks representative

“And the hospital can enroll them in the program, so we don’t lose them,” Stachelski said.

Once people are in the program, they remain in the program. Consequently, the amount of care they need often decreases, too, Stachelski said.

Joliet residents can use their insurance or Medicaid to pay for mental health care. The city pays for any uncovered care or for residents without insurance, Stachelski said. The fire department had asked the city of Joliet for the funds and the City Council approved $400,000. The funds were not in the budget and required a budget amendment, as reported in 2022.

Most people opt for telehealth, but in-person visits are available, too, and clients see the provider of their choice, Stachelski said.

The program is available for children or adults, although children younger than 18 need parental consent, Thriveworks representative Stephen van der Watt said.

“We often say you can have an appointment today if the patient is ready for an appointment that quickly,” he said.

All of this has drastically reduced the mental health 911 calls, Stachelski said, but the partnership has other benefits, too.

Helping people in crisis

Many 911 calls for physical reasons may have a mental health component to them, van der Watt said. For example, a child receiving chemotherapy for cancer and the family isn’t coping well, he said. Families might have relationship problems or kids might be getting bullied or struggling with negative effects of social media, he said.

The fire department then developed a seven-step Crisis First Aid for Paramedics program. When people experience traumatic events, such as a house fire or witnessing an accident or shooting, paramedics can talk with them on the scene “to make sure they’re OK,” Stachelski said.

“We know at the time they’re not listening to us because they just suffered a terrible loss,” Stachelski said. “So in two or three days, John Koch (battalion chief of community risk reduction ) checks in with them.”

People can receive a referral if they need one to prevent a problem becoming a crisis, Stachelski said.

Let’s say paramedics receive a call to help someone who’s fallen, Koch said. Once paramedics arrive, they might see the person also needs a walker or home health care.

“We make those arrangements to get them the assistance they need,” Koch said.

People who are homeless can receive care, which can lead to that population getting jobs and homes, he said. The program has helped kids as young as 3 and in foster care.

“I realize I’m paying close attention more than ever,” Koch said. “I’m looking at them and listening to what’s not being said. I’m paying attention to the circumstances and taking into account all the things I didn’t think of before.”

Joliet Fire Battalion Chief Aaron Kozlowski compared paramedics providing crisis first aid to helping someone having a heart attack. In the latter, paramedics can provide emergency treatment en route to the hospital, but they can’t insert a stent.

Similarly, paramedics get people emergency help for a mental health crisis, especially when there’s a risk of self-harm or harm to others, Koslowski said. But the emergency room can’t properly treat chronic depression, he said.

“So we get them to the health provider who can actually help them in the long-term,” Koslowski said.

The hidden benefits of mental health care

Stachelski said providing “timely definitive care” also frees up emergency room resources. Suicides in the area this program covers are also down by half, although it’s premature to give all the credit to Thriveworks, Joliet Fire Department mental health coordinator John Lukancic said.

Joliet Fire Chief Jeff Carey said mental health professionals and other fire departments in the U.S. are recognizing this program, which he believes is the first of its kind in the country.

“The work that this group is doing is unprecedented,” Carey said.

Sister Mary Frances Seeley, a suicidologist and founder of multiple Will County crisis hotlines, said the fire department’s mental health program “is a dream come true for someone working in suicidology” and she praised the fire department’s efforts.

“I have never seen such a dedicated group doing good for the community,” Seeley said.

Stachelski said the program initially served 20 to 30 people a month and now serves about 600.

“People who came into the program with no insurance are now moving over to insurance,” Stachelski said. “Now that they’re mentally stable, they’re getting jobs and paying back into the system.”

Ultimately when people receive care and when couples receive counseling, communities become healthier, van der Watt said.

The program is currently available for Joliet residents. But the Joliet Fire Department is working with neighboring towns to offer a similar program, Stachelski said.

For information and to determine whether a person is a Joliet resident, call 815-724-3500.

The seven steps of the Joliet Fire Department’s First Aid for Paramedics:

Rapport: Building an empathetic bond with the person (acceptance, genuineness, empathy)

Reflect: Open-ended questions and nonjudgmental, reflective listening

Reassure: Providing encouragement, affirmation, and normalizing

Resilience: Discussing coping and social support solutions

Resources: Providing resources for clinical care, crisis lines, and support groups

Revisit: Re-contacting the person in 48 to 72 hours to check on their condition

Retrain: Help develop risk reduction and further coping strategies

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Joliet Fire Department Mental Health Coordinator John Lukancic leads a Crisis First Aid refresher course for the Joliet Fire Department Station One crew on Wednesday, July 12th, 2023 in Joliet. (Gary Middendorf – gmiddendorf@shawmedia/Gary Middendorf)