Bill Shaner helps mental health patients in the emergency room of Mercy General Hospital every day. He’s not a doctor or a nurse. He doesn’t prescribe medicine. He just talks to people and listens carefully.
Shaner works as a triage navigator, helping those in mental health crises who end up waiting in the emergency room for help. Mental health-related emergency department visits have swelled in Sacramento County in recent years. The navigator program was started three years ago and refers mental health patients in jails, emergency rooms and Loaves and Fishes to services and facilities where they can get treatment.
Shaner walks the halls of the emergency department visiting people the hospital staff have determined might need more than clinical care.
“Bill is well-suited for this job because he brings lived experience to it,” said Erin Johansen, executive director of TLCS, a housing and mental health services provider hired by the county to run the navigator program. “This guy has it. He can connect with people.”
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Shaner was diagnosed with schizophrenia in 2002 after decades of coping with it on his own. He has been homeless and suicidal and said he’s using his experience to connect with those who have similar problems.
“It puts me on a level with them,” he said. “I’ve been through it and they’re going through it. I can say, ‘You can change if you want to.’ I can give them hope and that’s the goal, to give them hope and get them into services.”
According to TLCS, navigators like Shaner were able to divert 89 percent of the 414 mental health patients discharged from area emergency rooms from April to June 2017 to outpatient services, preventing inpatient psychiatric hospitalizations. Navigators refer patients to other facilities for mental health services the emergency rooms don’t provide.
TLCS runs its own crisis respite center, where people experiencing a mental health crisis can stay for 23 hours and get help rather than wait in the emergency room. Navigators in Mercy hospitals, Sutter Medical Center, UC Davis Medical Center and Kaiser South also divert mental health patients to resources for substance abuse, residential psychiatric care and housing.
At Mercy San Juan, Mercy General and Methodist Hospital, 317 patients have been treated through the navigator program so far in 2017, said Melissa Jue, spokeswoman for Dignity Health, which runs the hospitals. During the same period, return mental health visits to the emergency departments have dropped by 62 percent.
Shaner said his own rough experience with drug addiction and mental illness helps him understand what others are going through.
He said he started abusing drugs when he was just 9 years old but his psychosis really began when he shot up methamphetamine for the first time when he was 39.
“And that was it, I was gone. I paid someone else to do my work and I didn’t work again,” Shaner said. “I thought everyone was chasing me. I became paranoid.”
It got so bad that his wife and daughter asked him to leave home. He spent months living in motels and his truck in Riverside, doing a lot of drugs, until one night he held a knife to his throat.
“I got a room at the Motel 6 and so I had a knife and I put it to my throat,” Shaner said. “I said, ‘You know, I think I’ll end it right now’ and this small voice said to me, ‘I’m not done with you yet.’ It was a dynamic experience, it was something out of the ordinary.”
Shaner checked himself into Charter Oaks Hospital in Corona, where he spent 53 days sorting through “a lot of junk” to get to the bottom of his addiction. Meanwhile, his wife divorced him, leaving him homeless. When he was released, Shaner lived in his car and went to Alcoholics Anonymous meetings four times a day, drinking lots of coffee. Eventually he moved to Yakima, Washington, to live with his sister and her husband, who was a church administrator. There, Shaner started his long road to recovery.
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“I switched over from AA to church. They’re open seven days a week and you can go any time,” Shaner said, laughing. He worked with prostitutes and drug addicts on the streets of Yakima, holding a Bible study in a slum hotel and church services in a bar on Sundays. On the weekends, he worked as a janitor and did accounting work for a logging company, where the numbers helped him get his mind straight.
“I was not able to function in a real good manner for like three years, because what happened with my brain is that it was just like soup and I had to rebuild it,” Shaner said. “And people said, ‘Oh, you can’t rebuild brain cells’ and I said, ‘Yes you can. I’m going to do it.’ You have to get control sometime, and I needed control of my mind.”
It took three years to get his life back together, he said. He came to Sacramento and met his current wife through a church group. They started a Bible study in their home.
But in 2002, he experienced an episode. He was plagued by racing thoughts, voices and a paranoid feeling that people were scheming against him, he said. He made an appointment with a psychiatrist. When he finally was diagnosed with paranoid schizophrenia, it shocked him and his family.
He left the company where he was working and got a job with a mental health agency. He started working on managing his schizophrenia by learning from his clients, he said. He didn’t tell his employers about his illness.
In 2012, he had another episode and he got a poor employee evaluation for the first time in his life, setting him off and making it worse, he said. “I was really embarrassed. I was hurt,” he said.
Shaner took the next few years learning ways to handle and cope with his illness. He said he spent hours on the computer reading about schizophrenia and ways to treat it. He used some of the methods he learned while working at the mental health agency, like standing in front of a TV and telling it the voices aren’t real, and standing in front of a mirror and saying “I’m a good person” over and over again.
“I could tell that when I was visualizing things, bad things, I could say ‘This is not real. This is not real.’ I had to get into reality,” Shaner said.
When Shaner interviewed to be a triage navigator with TLCS, he just clicked there. He was assigned to the emergency room at Mercy General.
“He’s really been able to bridge community mental health and hospital social work, which is hard to do,” Johansen said. “He doesn’t have the usual medical education and he’s able to perform the job in a way the (hospital staff) can respect. The hospital can be such a triggering place for him, but he excels there.”
Shaner is included in the clinical staff meetings where they decide who might need Shaner’s help. He then goes to those patients and talks to them about what they’re experiencing and services they might need. He learns about their family, their living conditions and their illness. He then tries to connect them with help.
“I really don’t have a lot of sympathy, but I have compassion,” Shaner said. “I don’t go in there with the mindset that they’re sick. I go in with the mindset that they can be healed, they can be better. I don’t treat them like they’re a mental health patient. They’re humans.”