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Mental health crisis teams are no longer just for cities
Jeff White knows what can happen when 911 receives a call about someone feeling down or upset. He experienced it repeatedly: the emergency call center dispatched the police, who often took him to a hospital or prison. “They don’t know how to deal with people like me,” said White, who struggles with depression and schizophrenia. "They just don't do it. They just guess." In most of those cases, he said, he really needed someone to help him calm down and find aftercare. That's now an option, thanks to a crisis response team based in...
Mental health crisis teams are no longer just for cities
Jeff White knows what can happen when 911 receives a call about someone feeling down or upset.
He experienced it repeatedly: the emergency call center dispatched the police, who often took him to a hospital or prison. “They don’t know how to deal with people like me,” said White, who struggles with depression and schizophrenia. "They just don't do it. They just guess."
In most of those cases, he said, he really needed someone to help him calm down and find aftercare.
That's now an option, thanks to a crisis response team operating in his region. Instead of calling 911, he can contact a government hotline and request a visit from mental health professionals.
The teams are sent from a program that serves 18 predominantly rural counties in central and northern Iowa. White, 55, has received help from the crisis team several times in recent years, including after heart problems forced him to move to a nursing home. The service costs him nothing. The team's goal is to stabilize people at home, rather than admitting them to an overcrowded psychiatric ward or sending them to prison for behavior consistent with mental illness.
For years, many cities have sent social workers, medical professionals, trained social workers or mental health professionals to calls previously handled by police officers. And the approach gained traction due to concerns about cases of police violence. Advocates say such programs save money and lives.
But crisis response teams have been slower to catch on in rural areas, despite mental health concerns just as widespread There. That's partly because these areas are larger and have fewer mental health professionals than cities, he said Hannah Wesolowski Chief Advocacy Officer of the National Alliance on Mental Illness.
“It was certainly harder to climb the hill,” she said.
Melissa Reuland, a researcher at the University of Chicago Health Lab, who examines the intersection between law enforcement and mental health, said no solid statistics are available but that small police departments and sheriff's offices are increasingly open to finding alternatives to a standard law enforcement response. That could include training officers to better handle crises or seeking help from mental health professionals, she said.
The lack of mental health services will continue to be a hurdle in rural areas, she said: "If it was easy, people would have fixed it."
Nevertheless, the crisis response approach is making progress program by program.
White has spent most of his life in small Iowa towns surrounded by rural areas. He is pleased to see mental health care efforts strengthened beyond urban areas. “We’re being forgotten out here – and it’s out here that we need the most help,” he said.
Some crisis teams, like the one White is helping, can respond alone, while others work with police officers or sheriff's deputies. For example, a South Dakota program, Virtual Crisis Care, equips law enforcement officers with iPads. The tablets allow officers to set up video chats between people in crisis and counselors from a telehealth company. That's not ideal, Wesolowski said, but it's better than having police officers or sheriff's deputies try to handle such situations alone.
Counselors help people in mental health crises calm down and then discuss what they need. If it is safe for them to stay at home, the counselor will call a mental health facility, which will later contact people to see if they are interested in treatment.
But sometimes counselors conclude that people are a danger to themselves or others. If so, counselors recommend officers take them to an emergency room or jail for evaluation.
In the past, sheriff's deputies had to make this decision themselves. They tended to be cautious and temporarily remove people from their homes to ensure their safety, said Zach Angerhofer, a deputy in South Dakota's Roberts County, which has about 10,000 residents.
Detaining people can be traumatic for them and expensive for authorities.
Officers often have to spend hours filling out paperwork and ferrying people between emergency rooms, jails and psychiatric hospitals. This can be particularly stressful when there are few deputies on duty in a rural county.
The Virtual Crisis Care program helps avoid this situation. Almost 80% of people completing the video assessment are staying at home. according to a current state study.
Angerhofer said no one declined to use the telehealth program when he offered it. Unless he sees an immediate safety risk, he offers people privacy by leaving them home alone or letting them sit alone in his patrol car while they talk to a counselor. “From what I saw, they are a completely different person after using the tablet,” he said, noting that participants seemed relieved afterward.
The South Dakota Department of Social Services funds the Virtual Crisis Care program, which received startup funds and design assistance from the Leona M. and Harry B. Helmsley Charitable Trust. (The Helmsley Charitable Trust also donates to KHN.)
In Iowa, the program that helps White always has six pairs of mental health professionals on call, said Monica Van Horn, who runs the state-funded program through the mental health nonprofit Eyerly Ball. You will be directed via the national crisis line or the new national 988 mental health crisis hotline.
In most cases, Eyerly Ball crisis teams respond in their own cars, without police. The low-key approach can be beneficial for clients, especially if they live in small towns where everyone seems to know each other, Van Horn said. "You don't necessarily want everyone to know your business - and if a police car shows up at your house, everyone and their dog will know about it within an hour," she said.
Van Horn said the program averages between 90 and 100 calls per month. Callers' problems often include anxiety or depression, and sometimes they are suicidal. Others call because children or family members need help.
Alex Leffler is a mobile crisis responder in the Eyerly Ball program. She previously worked as a behavioral interventionist in schools, went back to college and is about to earn a master's degree in mental health counseling. She said that as a crisis responder, she has met people at home, at work and even at a grocery store. “We respond to almost every location,” she said. “You can just make a better connection in person.”
Thomas Dee, an economist and education professor at Stanford University, said such programs could draw support from across the political spectrum. “Whether someone opposes police funding or supports the blue, they can find something they like in first responder reforms like this,” he said.
Police critics have called for greater use of unarmed mental health experts to defuse tense situations before they become fatal, while law enforcement agencies that support such programs say they could give officers more time to respond to serious crimes. And government officials say the programs can reduce costly hospitalizations and prison stays.
Dee studied the Denver Support Team Assisted Response program allowing 911 dispatchers to dispatch medical and behavioral health experts instead of police on certain calls. He found that the program saved money, reduced minor crime and did not lead to more serious crimes.
DR. Margie Balfour is an associate professor of psychiatry at the University of Arizona and an administrator at Connections Health Solutions, an agency in Arizona that provides crisis services. She said now is a good time for rural areas to introduce or improve such services. The federal government has committed more money to the effort, including through pandemic response funds, she said. Recently, the emergency number 988 was also established, whose operators can help coordinate such services, she noted.
Balfour said the current national focus on the criminal justice system has brought more attention to how it responds to people with mental health needs. “There is still a lot of disagreement on police reform,” she said. “But one thing everyone agrees on is that law enforcement doesn’t have to be the default mental health first responder.”
Arizona has crisis response teams throughout the state, including in very rural areas, as the settlement a Class action lawsuit of the 1980s Better options are needed for people with mental illness, Balfour said.
Such programs could be implemented outside cities with creativity and flexibility, she said. Crisis response teams should be considered as important as emergency medical services, Balfour said, noting that no one expects police to intervene in other medical emergencies, such as when someone has a heart attack or stroke.
“People with mental health issues deserve a health response,” she said. “It’s worth figuring out how to bring this to the public.”
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