In Mental Health Crises, a 911 Call Now Brings a Mixed Team of Helpers — And Maybe No Cops

iStock.com/FatCamera

 

Connecting state and local government leaders

More communities are creating teams of health care providers to respond to mental health crises instead of cops, a shift propelled by nationwide demonstrations against police brutality. But the shapes of those mobile crisis response teams vary because the movement is still in an experimental stage.

By the time Kiki Radermacher, a mental health therapist, arrived at a Missoula, Montana, home on an emergency 911 call in late May, the man who had called for help was backed into a corner and yelling at police officers.

The home, which he was renting, was about to be sold. He had called 911 when his fear of becoming homeless turned to thoughts of killing himself.

“I asked him, ‘Will you sit with me?’” recalled Radermacher, a member of the city’s mobile crisis response team who answered the call with a medic and helped connect the man with support services. “We really want to empower people, to find solutions.”

Missoula began sending this special crew on emergency mental health calls in November as a pilot project, and next month the program will become permanent. It’s one of six mobile crisis response initiatives in Montana — up from one at the start of 2019. And four more local governments applied for state grants this year to form teams.

Nationwide, more communities are creating units in which mental health professionals are the main responders to psychiatric crises instead of cops, though no official count exists of the teams that are up and running.

More support is on the way. The covid relief package President Joe Biden signed in March offers states Medicaid funding to jump-start such services. By July 2022, a national 988 hotline, modeled on 911, is slated to launch for people to reach trained suicide prevention specialists and mental health counselors.

Protests against police brutality in the past year have helped propel the shift across the United States. While one rallying cry has been to “defund the police,” these crisis intervention programs — the sort that employ therapists like Radermacher — are often funded in addition to law enforcement departments, not drawing from existing policing budgets.

Studies suggest such services enable people in crisis to get help instead of being transported away in handcuffs. But the move away from policing mental health is still a national experiment, with ongoing debate about who should be part of the response, and limited research on which model is best. Even then, not all communities can afford and staff separate mental health teams.

“I don’t know that there’s a consensus of what the best approach is at this point,” said Amy Watson, a professor of social work at the University of Wisconsin-Milwaukee who has studied such crisis intervention. “We need to move towards figuring out what are the important elements of these models, where are the pieces of variation and where those variations make sense.”

The federal Substance Abuse and Mental Health Services Administration sets minimum expectations for teams, such as including a health care professional and connecting people to more services, if needed. Ideally, the guidelines suggest, the team should include a crisis response specialist who has personally experienced mental health challenges, and the team should respond to the calls without law enforcement.

Still, crisis response teams vary significantly in their makeup and approach. For more than 40 years, the Los Angeles Police Department has deployed teams in which police officers and mental health workers respond together. It boaststhe program is one of the nation’s earliest to do so. A program out of Eugene, Oregon, which has been copied across the U.S., teams a crisis intervention worker with a nurse, paramedic or emergency medical technician. In Georgia, 911 emergency dispatchers steer calls to a statewide crisis center that can deploy mobile units that include professionals with backgrounds in social work, counseling and nursing. In Montana, teams are based within law enforcement departments, medical facilities or crisis homes.

“Mobile crisis response, in whatever format it looks like, is becoming more and more the norm,” said Kari Auclair, an area director for Western Montana Mental Health Center, a nonprofit treatment program. “In some communities, it’s going to be the church group that’s going to be part of a crisis response, because that’s who people go to and that’s what they’ve got.”

Defenders of the various models tout reasons for their teams’ makeups and match-ups: Medics can recognize a diabetic blood sugar crash that might mimic substance misuse or a mental health crisis; police can watch for danger if tensions escalate; and crews tethered to hospitals’ behavioral health units have a team of doctors on standby they can consult.

Many crisis teams still work directly with law enforcement, sometimes responding together when called or staying on the scene after officers leave. In Montana, for example, 61% of the calls that crisis teams handled also involved law enforcement, according to state data.

Zoe Barnard, administrator for Montana’s addictive and mental disorders division, said her state is still establishing a baseline for what works well there. Even after they’ve worked out a standard, she added, local governments will continue to need flexibility in how they set up their programs.

“I’m a realist,” Barnard said. “There will be parts of the state that are going to have limitations related to workforce, and trying to put them into a cookie-cutter model might keep some from doing something that really does the job well.”

In some areas, recruiting mental health workers to such teams is nearly impossible. Federal data shows 125 million people live in areas with a shortage of mental health professionals, a problem exacerbated in rural America. That lack of expertise and support can fuel the crises that warrant emergency help.

In Helena, Montana’s capital, for example, a crisis crew that formed in November must still fill two positions before services can run round-the-clock. All across the U.S., with these sorts of high-stress jobs often paid through cobbled-together grants, retaining staff is a challenge.

Being flexible will be key for programs as they develop, said Jeffrey Coots, who directs an initiative at John Jay College of Criminal Justice in New York City to prevent unnecessary imprisonment.

“We’re trying to figure our way out of historical inequities in mental health care services,” Coots said. “The best thing to do is to run that demonstration project, and then adapt your team based on the data.”

And for the people in these crises who need help, having an alternative to a police officer can mean a big difference, said Tyler Steinebach, executive director of Hope Health Alliance Inc., which offers behavioral crisis training for medics across Montana. He knows firsthand because he has both bipolar and post-traumatic stress disorders and has had to call 911 when his own mental health has plummeted.

“You know cops are coming, almost certainly,” Steinebach said, from his personal experience. “You’re trying to figure out what to say to them because you’re trying to fight for yourself to get treatment or to get somewhere where you can talk to somebody — but you’re also trying to not get hauled off in handcuffs.”

Gallatin County Sheriff Dan Springer also noticed the benefits after two mental health professionals started to respond to 911 calls in Bozeman and the surrounding area in 2019. Although deputies in his department are trained in crisis intervention, he said that goes only so far.

“When I hear deputies say the mental health provider is a godsend, or they came in and were able to extend the capabilities of the response, that means something to me,” Springer said. “And I hear that routinely now.”

Erica Gotcher, a medic on the mental health response team in Missoula, recalled a day recently when her team was wrapping up a call and received three new alerts: A man was considering suicide, a teen was spiraling into crisis and someone else needed follow-up mental health services. They knew the suicide risk call would take time as responders talked to the person by phone to get more details, so they responded to the teen hitting walls first and saw all three people before their shift was done.

Gotcher said being busy is a good sign that her team — and teams like it — are becoming just one more form of first response.

“Sometimes we roll up on a scene and there are three cop cars, an ambulance and a firetruck for one person who is having a panic attack,” Gotcher said. “One of the best things that we can do is briefly assess the situation and cancel all those other resources. They can go fight fires; they can go fight crime. We are the ones that need to be here.”

But gaps still exist, such as not always having somewhere to take a patient who needs a stable place to recuperate or get more help. The team’s shift also ends at 8 p.m., meaning, come nighttime, it’s back to police officers responding alone.

Katheryn Houghton is a staff writer at Kaiser Health News

NEXT STORY: 22 States, Biden Administration Ask Supreme Court to Keep Eviction Ban in Place

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.