First, take a deep breath. Then I get in my car and drive the half-hour it takes me to get to work. Most of the time I don't think about what awaits me until I am about ten minutes away. Before that I listen to the radio or a CD and try to wake up.

When I approach the city where I work, I start thinking about what is waiting. If I am working a day shift, I worry that I am going to walk in to find work waiting. We call each case where someone is seen in person an assessment or an evaluation. So I wonder how many assessments will be waiting for me when I walk in. A lot of times someone will be intoxicated or unconscious or otherwise unable to participate in an evaluation or eval, and we would send someone after the hospital makes sure the person can "walk and talk,". which is our local jargon for someone who is conscious. I say only conscious because some psychiatric conditions can render a person unable to communicate or respond to us. The key is for the hospital to have ruled out any medical condition that might compromise a person's ability to participate in the interview.

When I walk into the office at the beginning of a day shift, the overnight people will tell me if anything is waiting. If there is a case waiting then I would gather information about the person including demographics such as name and address, age, insurance, etc. Then I would get a report on why the person needed an evaluation. I would generate the paperwork needed to complete the assessment, and then I would go out to see the person. Cases that are waiting in the morning usually involve going mobile - meaning that I would go to where the person is - usually a hospital emergency department. In this city the ERs have us do the assessments - few of them have their own crisis teams, and those that do usually only see people with private insurance. The reason for this is that our state funded health insurance has designated my agency as the gatekeeper for clients with that insurance, meaning they will pay for services rendered or recommended by our agency. But that's another story.

If there are no client's waiting to be seen, I will sit down at my desk and begin answering phone calls. The phone rings twenty four hours a day with almost any request you could think of - some people don't realize that we only do mental health so they call for all sorts of things. More than once I have taken a call from someone wanting to know the time! I have also taken calls from people asking what to do with unruly children or animals, and once took a call from a woman who discovered she had a bat in her house!

Workers arrive at different times; when most of us are there the supervisor will do what we call a passalong - a summary of what happened on the previous shift, including work that is pending or needs to be completed. Various tasks, such as verifying insurance or finding placements, will be assigned.  Then we all go back to our desks to make or take phone calls until we get assigned to an evaluation. 

The day usually doesn't go by without my doing a crisis assessment, and that means completing paperwork including a crisis assessment. If the person has to be placed or admitted to the hospital or a crisis stabilization unit, i may need to make calls to hospitals or CSUs to see if they will admit the person. This depends on what the person needs and sometimes on what insurance will pay for. After I find a placement for the person, I would call the insurance company and get approval for the placement. Meanwhile I would be typing up the eval and making a file or adding to one that already existed. The paperwork takes a while, as does the search for a placement (we call that a bed search) and the insurance approval. The average crisis clinician can do about three assessments in a shift - as long as they are not complicated. Sometimes a complicated case will take a whole shift (8 hours) or more to complete!

At the end of the shift I report to the supervisor and tell him or her if there is anything i need to pass on to another worker. I make sure I have completed all the paperwork I needed to do and then I walk out the door and leave it all behind. This is important to be able to do in crisis work, or I would quickly get overwhelmed and burn out. I have been doing crisis work for 15 years and have not burned out yet.

Finally, I am in my car, headed home, listening to music. I tend to stop thinking about work within the first few minutes of getting into my car. I think about what I will be having for dinner, talking to my friends, and upcoming events. I won't think about crisis again until the next time I get in my car and head for work at the crisis service.