According to the Substance Abuse and Mental Health Services Administration (SAMSHA), between 5 and 15 percent of the approximately 240 million calls made to 911 across the country each year are related to mental health issues, and police are often the first entity available to offer assistance. This practice likely persists due to a combination of inadequately resourced mental health services and the historical criminalization of certain behaviors that are now recognized as health issues. But, there is movement toward change.
Although many law enforcement agencies face their own economic challenges and have innumerable other demands on their resources, as a society we continue to ask them to serve as first responders when a behavioral health crisis occurs. In most communities there simply are no other viable options and police are one of the few resources available around-the-clock. However in parallel circumstances, we would never expect EMTs to grab a hose and run towards a burning building to extinguish a fire, yet we persist in asking our law enforcement officers to effectively address mental health and substance use issues.
Although it has been brought to the fore over the last year, the question of the most appropriate response to behavioral health emergencies has, in fact, been receiving attention for some time. Crisis Intervention Teams, a model that formalizes partnerships between police and mental health professionals, were first developed in Memphis in 1988 and an international organization is dedicated to providing technical assistance to communities interested in implementing the model. In 1989, a widely-admired approach that most of us might recognize as a behavioral health paramedic unit (that does not rely on police in most circumstances) launched in Eugene, Oregon called CAHOOTS.
Howard Center’s own Street Outreach Team, which coordinates with local police, has been at work in Downtown Burlington for more than two decades, beginning as a proof-of-concept in 2000. Our Street Outreach model has been replicated in other U.S. cities and Canada, and a growing number of Chittenden County communities are coming under the umbrella of our Street Outreach-inspired Community Outreach Team, which now serves nine towns and cities. Winooski Police Lt. James Charkalis shared of his city’s partnership with Community Outreach, “The outreach team has allowed us to focus more on criminal activity, and in turn, they’re able to more professionally and effectively deal with the mental health populations,” he said. Police ensure the scene is safe while the specialists do their work. “Really, at that point, we take a back seat.”
The National Alliance on Mental Illness (NAMI), a leading advocacy group for mental health issues, supports the use of Crisis Intervention Teams, highlighting their focus on improving accessibility to mental health and substance use treatment and resources to those in need, and as an alternative to criminalization. Cost effectiveness is an added and not insignificant benefit of this model with some communities reporting up to a 30% savings when directing an individual to mental health treatment rather than incarceration.
Meanwhile, programs similar to the behavioral health paramedic model and other variations are being tested with cities like New York and Philadelphia implementing pilot programs in recent months. Our own Street Outreach Team provided technical consulting to New York City’s Times Square businesses a number of years ago and now in New York’s current pilot, a team of mental health and crisis professionals are the default responders to 911 calls involving mental health emergencies and have the option to call in police if necessary. In Philadelphia’s model, clinical staff work alongside 911 dispatchers to identify mental health crisis calls and determine the most appropriate response. Philadelphia Mayor Jim Kenney said, “The goal of the program is to safely deflect individuals with behavioral health needs away from the justice system and into more appropriate behavioral health care or social services in the community.”
As Vermonters we often learn from others and use that knowledge to develop local solutions. With effective partnerships and an excellent network of mental health and substance use care providers in place, I have no doubt that we can do the same in this case and provide a more comprehensive and effective response to those experiencing crisis, relieve police departments of some responsibilities, and save resources overall.
At Howard Center we already have some considerable capacity to respond to crisis situations in our First Call for Chittenden County crisis program and our Street and Community Outreach programs that coordinate closely with several local police departments. And, we have a full range of mental health and substance use supports at our fingertips including crisis beds for both children and adults and a team of staff with lived experiences to support adults experiencing a mental health crisis to remain in their home. With these resources as a starting point, we envision an expanded 24/7 response model based at Howard Center, an agency with the necessary clinical mission, which includes existing clinically focused supervisory structures and supports, technical skill sets, programmatic resources, and peer experienced teams that are vital to the provision of effective mental health interventions. If resources became available, such a program could be expanded to provide 24/7 capacity in short order.
SAMSHA, in a recent policy paper exploring collaborative approaches to behavioral health emergencies, noted, “communities must commit to investing in a coordinated system of care in which people get the help they need as early as possible, in the safest and least-restrictive setting as possible.” Howard Center is pleased to be part of conversations taking place in communities across the region and looks forward to helping to build structures that will improve health outcomes for our friends, neighbors and families experiencing crisis, improve public safety by preserving law enforcement resources, and reduce costs in the healthcare and criminal justice systems.
Bob Bick is CEO of Howard Center, Vermont’s largest designated agency, and lives in Shelburne.