Enhancing Response to Individuals with Mental Health Issues

Tonya Mann, LMFT, System Administrator – Crisis Services

Kern Behavioral Health & Recovery Services

Noah Reiter, SVP of Customer SuccessRave Mobile Safety

Agenda

• A Primer for Alternative Response

• Position & Policy Statements

• Kern County, CA’s Integrated Approach

• The Role of 9-1-1 & Incorporation of Technology

• Wrap-Up

Learning Objectives

• Discover initiatives that can be implemented to improve the outcomes of calls for service involving mental health

• Learn how some communities leverage technology for a more effective response

• Hear real-world examples of the effectiveness of these initiatives

A Primer for Alternative Response

•1 in 5 Americans live with a mental illness (NAMI)

•7% of police contacts involve an individual with mental illness1

• Almost 26% of individuals shot and killed by law enforcement in 2015 had signs of mental illness2

• Individuals with untreated mental illness are >16x more likelyto be shot and killed by police3

• For every $1 spent on a CIT, a jurisdiction may expect $1.42 in cost avoidance4

1Cordner G. “The Problem of People with Mental Illness.” Center for Problem-Oriented Policing. 2006. http://www.popcenter.org/problems/mental_illness/print/ (accessed Jan. 19, 2017).

2Lowery, Wesley, et al. “Distraught People, Deadly Results: Fatal Shootings by on-Duty Police Officers.” The Washington Post, WP Company, 30 June 2015, www.washingtonpost.com/sf/investigative/2015/06/30/distraught-people-deadly-results/.

3Fuller, Doris A., et al. “Overlooked in the Undercounted: The Role of Mental Illness in Fatal Law Enforcement Encounters.” Treatment Advocacy Center, Dec. 2015, www.treatmentadvocacycenter.org/overlooked-in-the-undercounted.

4El-Mallakh, Peggy & Kiran, Kranti & El-Mallakh, Rif. (2014). Costs and Savings Associated with Implementation of a Police Crisis Intervention Team. Southern medical journal. 107. 391-395.

Worst Case Outcomes

Support for a Collaborative Approach to Mental Health

National Alliance on Mental Illness (NAMI)

The lack of mental health crisis services across the U.S. has resulted in law enforcement officers serving as first responders to most crises. A Crisis Intervention Team (CIT) program is an innovative, community-based approach to improve the outcomes of these encounters…CIT programs create connections between law enforcement, mental health providers, hospital emergency services and individuals with mental illness and their families. Through collaborative community partnerships and intensive training, CIT improves communication, identifies mental health resources for those in crisis and ensures officer and community safety.

www.nami.org/cit

DOJ Bureau of Justice AssistancePolice-Mental Health Collaboration Initiative

Benefits of a PMHC include:

• Improved safety

• Increased access to behavioral healthcare

• Decreased repeat encounters with the criminal justice system

• Reduced costs, including• Fewer repeat calls to 9-1-1• Fewer SWAT callouts• Reduction in civil lawsuits• Reduction in time spent on mental health calls

• Improved community relations

https://bja.ojp.gov/program/pmhc

IACP Concepts & Issues Paper

In a number of jurisdictions, law enforcement agencies have partnered with justice system, mental health, and other community agencies to develop more compassionate and cost-effective approaches that emphasize providing community-based treatment instead of arrest and incarceration for both adult and juvenile PIC. Ideally, the only PIC who should come into contact with law enforcement are those who are victims of crimes, suspected of committing crimes, or who are a danger to themselves or others. Those who do not fall into the category of potentially dangerous behavior are more appropriately handled by mental health provider response and referral.

IACP Model Policy

• Recognition of atypical behavior

• Assessment of risk

• Response to person in crisis

• Request assistance from specialized units – CIT or otherwise

• Taking custody or making referrals to mental health professionals

Kern County, CA: An Integrated Approach

Mobile Evaluation Team

• 14-person unit

• 24/7/365

• Behavioral health staff

• Dispatched by law enforcement to behavioral health calls

• Communicates via radio/trained in 10-codes

Mobile Evaluation Team

• FY19/20 – responded to 4,039 calls

• Performs behavioral health evaluations (WIC 5150)• Crisis intervention

• WIC 5150 holds

• Transport (if appropriate)

• Community linkage

• Connection to services

Mobile Evaluation Team

Working Together for a Positive Outcome

In 2019, Dispatch received a call from a child indicating that an adult in the home was armed with a weapon and threatening to kill himself in

others, the child also shared that the adult was Spanish speaking.

MET was dispatched to the scene, with a Spanish speaking unit. Because of the developed relationship between law enforcement and

MET, MET was asked to engage and de-escalate the situation.

MET staff was able to engage and formulate a collaborative plan with the individual and law enforcement to safely disarm the weapon.

The individual was safely linked to the appropriate treatment.

Mobile Evaluation Team

• Virtual MET• 36 iPads deployed to rural

areas

• Officers request a V-MET session and are connected to a MET unit utilizing HIPAA compliant technology

• A WIC 5150 evaluation occurs, and determination is made

Mobile Evaluation Team

Mobile Evaluation Team

• Co-Response• Partnership with Kern

County Sheriff’s Office and Bakersfield Police Department

• 1 Officer/1 MET Unit

• Responds to:• High utilizers of 911

• Electronic Monitoring Program Caseload

• Field calls

Mobile Evaluation Team

SWAT Call Outs

• MET staff are an addition to the command post• Bakersfield Police Department and Kern County Sheriff’s Office

• Verbally engage with individuals upon request

• Provide recommendations as requested

Mobile Evaluation Team

“I was dispatched to a rural area for a subject threatening to shoot himself with his firearm. The individual was ex-military with a strong mistrust of law

enforcement. He was monitoring the exterior of his home with cameras and making threats. Since I wasn’t LE, he was willing to speak with me over

the phone for approximately 2.5 hours with his gun intermittently to his head. Several times he came close to pulling the trigger in the presence of a

family member. I was able to finally convince him to exit his home and safely surrender to deputies. It was comforting to work alongside Crisis

Negotiators and other deputies who ensured my safety and supported me as I led the negotiation. It was a prime example of meeting the client where he

was at and utilizing obvious less lethal outcome and crisis interventions.”

Crisis Intervention Team

CIT Steering Committee

• Community leaders with representatives from local law enforcement, Veterans, schools, homeless advocacy program, and other community stakeholder groups

• A community enhancement opportunity• Smart911, FOCUS (Focusing on Children Under Stress)

Crisis Intervention Team

• CIT Training• MET availability is limited

• Kern county is over 8,000 square miles

• Provides officers with similar interventions skills and resources to manage behavioral health calls

• What officers are saying• “I have a better

understanding of mental illness”

• “This helped me understand how to access referrals and resources.”

• “I feel like I can help now.”

So what?

• Homogeneous approach

• MET is less intimidating

• Relying on each others expertise

• Ability to share/compare history

• Better understanding of how each system works

• Frees up resources

• De-escalation and reducing need for hands-on intervention

• Ability to provide referrals and resources

Intersectionality

• MET is a part of the LE ecosystem – we walk right behind them

• Developing strong bonds and relationships with LE and Emergency personnel

• Combined Experience Trauma – Connection/Bond

• Layered Trust – Opinions, recommendations, exposure to personal life.

• High level of respect/competence – LE feel like they can walk away

• MET has a level of empathy for LE

Smart911

• The Identified Problem• Calls to 911 have the

potential to end adversely for persons experiencing a behavioral health emergency event

• The Need• The Kern Crisis Intervention

Team Stakeholders identified the need for a Special Needs Registry to:• Help keep everyone safe at the

scene of a behavioral health crisis; and

• Provide first responders with more information while in transit to the scene of the crisis.

• Both community members and first responders placed a high priority on a county-wide special needs registry

So what?

• Gives the RP control of what information first responders have when responding to a call

• Gives first responders a heads up on what type of situation they may be heading to

• Mindset preparation

9-1-1 as the Lynchpin

City of Houston Crisis Call Diversion (CCD) Program

• Collaboration among…• Houston Police Department• Houston Fire Department• Houston Emergency Center• Harris Center for Mental Health & IDD

• 37,032 calls for service coded as mental health-related in 2017• 7,264 HPD CIT calls handled by CCD tele-counselors;• 2,151 HPD CIT calls-for-service (CFS) diverted from patrol• 344 HFD CIT calls handled by CCD tele-counselors• 184 HFD CIT calls-for-service (CFS) diverted from response

• $860,218 in net cost avoidance annually

City of Houston: Suicide by Cop Averted

A caller contacted the Houston Emergency Center and requested police to the location. The caller expressed the desire to have police shoot him. The caller also disclosed having a machete to provoke responding officers. The caller was connected directly to a CCD Phone Counselor. The caller disclosed being homeless and having no support system. The caller disclosed a mental health diagnosis and did not have medication. The caller also expressed feeling as if society does not care about less fortunate individuals such as the caller and did not want to live in such a world. The CCD Phone Counselor was able to de-escalate the consumer and offer a safety plan with the caller which led to the caller separating from the machete by throwing it across the lawn. The caller agreed to accept transport from HPD to the NeuroPsychiatric Center without self-injuring or attempting to provoke the responding officers.

What Role Can 9-1-1 Play?

• 9-1-1 is a key driver to success

• Explore alternative dispatch and/or co-response options

• Evaluate technology that can support these initiatives

• Facilitate discussions and help champion change

Technology: Smart911

• Empower residents and caregivers to share information about themselves

• Automatic presentation with a 9-1-1 call

Technology: Text-from-911

3rd party report of a suicidal friend in the Grand Haven area who was near the drawbridge, had three prior suicide attempts and was making comments about jumping off the bridge. TCO initiated a CHAT session with the subject and was able to communicate and obtain a physical address he was at so an Officer and his parents could meet and see that he received the help he needed. The subject was located by the Grand Haven Department of Public Safety at the address the subject provided through the CHAT feature and the situation was resolved safely or all involved.

This is 911. We ‘ve received a call from a relative who is concerned for your well being. Are you able to speak?

I’m fine.

We’d like to send someone out to speak with you to be sure you are okay. Are you open to that?

Technology: Contextual Notes

• Highlight special response instructions

• Identify assigned counselors or caseworkers

• Capture emergency contacts or caregivers

Technology: Two-Way Video

• Telehealth / Virtual Consults

Closing Comments