Dispatch Triage, Alternative Responders and Co-Response: Ending Police-Only Responses To Mental Health 911 Calls Communities United Against Police Brutality Dispatch Triage, Alternative Responders, and Co-Response: Ending Police-Only Responses to Mental Health 911 Calls Communities United Against Police Brutality Cover art, tables and graphics designed by Abigail Grewenow This white paper is dedicated to Archer Amorosi, Benjamin Evans, Kobe Heisler, Travis Jordan, Keaton Larson, Phil Quinn and others who lost their lives at the hands of law enforcement during a mental health crisis. With deep appreciation to the volunteers who spent many hours researching, writing, editing and reviewing this white paper. Our goal is to end the practice of police-only contacts for people in mental health crisis through presenting evidence and practical information to enable the necessary changes. We believe we have achieved this goal. --Volunteers with the Mental Health Working Group of Communities United Against Police Brutality August 2020 As someone who’s been a mental health practitioner for over 35 years, I cannot recommend this position paper strongly enough. Individuals and our society at large are still suffering from the broken promises of the mental health system’s de-institutionalization process that began in the 1980s and has flooded our streets, our prisons, and our homes with people who cannot access the mental health care they desperately need. Then, when these people with chronic mental health challenges are in their most desperate moments of crisis, their need is often met with a visit from the police, which further threatens their life and their well-being. We need a different strategy. This paper is a serious, well researched analysis of this problem that presents a vision of a better way: responding to mental health emergencies with mental health professionals. I encourage you to read it, and endorse these proposals. Rev. Daniel Wolpert, M.A., M.Div. Executive Director, Minnesota Institute of Contemplation and Healing i PREFACE Communities United Against Police Brutality (CUAPB) is a Minnesota all-volunteer grassroots organization that provides advocacy for survivors of police misconduct and the families of people killed by police. We work to address the underlying causes of unjust and harmful policing. Part of that work is research to help communities understand relevant problems and seek better solutions. This paper addresses field contact between police and people experiencing mental health issues. This is a narrow focus on a key crossroad in time. These contacts are the common points of divergent outcomes that lead to consequences for vulnerable persons, the criminal justice system, and the community. It is time to take a fresh look at how these contacts are handled, who handles them, and how to enable alternative responses when appropriate. This paper challenges the common reflex to simply provide more police training and casually accept the problems that arise thereafter. It is time to ask: Why are police officers responding? Why a police-only response? Why aren’t police collaborating on-scene with mental health professionals more often? These questions are at the heart of the crisis created by the ongoing surge in police contacts with persons who suffer from mental illness. In a September 22, 2017, PoliceOne.com article, Booker T. Hodges, a veteran Minnesota law enforcement officer, explored the relevant questions. His words are an apt starting point for this paper. I have been a Crisis Intervention Team (CIT) coach for over a decade and believe the current push for more mental health care training for police officers is a good thing in part. I say in part because after years of experience and research, I do not believe that law enforcement should be responsible for responding to non-violent mental health calls. As a profession, we are problem solvers. The public and elected officials know this, so they keep heaping societal problems on us with the expectation that we solve them. It is time we start saying no. There are two reasons why I believe society should stop having police officers respond to non-violent mental health calls: 1. Cops lack adequate mental health care response training The average psychologist has between 10-12 years of college education in addition to 3,000 hours of supervised training. A licensed mental health care professional has between 7-8 years of college education in addition to hundreds of hours of supervised training. By comparison, a police officer who attends a CIT course receives 40 hours of formalized training. Most police officers receive far less than 40 hours training afforded to those who attend CIT training. ii Yet despite this gap in training, society expects police officers to show up and handle mental health calls with the same precision and expertise of a mental health care professional. This is an unrealistic expectation. We are setting police officers up for failure by continuing to send them on calls that, in spite of our best efforts, we can never train them well enough to handle. 2. Law enforcement brings the tail of the criminal justice system There is a consensus within society that the criminal justice system is not the appropriate place to handle those who suffer from mental illness. In light of this, it makes no sense to send police officers—who bring the tail of the criminal justice system with them—on calls involving non-violent mentally ill individuals. The chance of a non-violent mentally ill person being interjected into the criminal justice system increases when they come into contact with police. Our jails are full of people suffering from mental illness who have no business being there, yet society keeps sending them because there is no other place for them to go.1 1 2 reasons cops should not respond to non-violent mental health calls. Hodges, Booker. Police1. Lexipol. September 22, 2017. https://www.policeone.com/patrol-issues/articles/421707006-2- reasons-cops-should-not-respond-to-non-violent-mental-health-cal iii TABLE OF CONTENTS Page Executive Summary vii I. Introduction 1 A) Law Enforcement Response to Mental Health Crises 3 B) Law Enforcement Officers as de facto Mobile Mental Health Crisis Workers 3 C) The Scope of the Problem 5 D) The Comparison That Matters: Police Officers vs. Mental Health Professionals 9 E) Our Scope: A Narrow Focus on the Point of Contact with Police 12 II. Key Principles 15 Principle 1: An on-scene mental health response is the proper response to a 15 mental health problem. Principle 2: Avoid police-only contacts with people in mental health crisis. 15 Principle 3: “The right service at the right place at the right time” creates 16 efficiencies and improves outcomes. Principle 4: Collaboration is key—“separate silos” is the problem. 16 III. The Police-Centered Status Quo—A Brief History 17 A) The Trap 17 B) Into The Soup 17 C) Laboratories of Democracy Stir 19 D) Growth Without Sunshine 20 IV. Foundations for Failure 23 A) Lack of Effective Dispatch Triage 23 1) The Police Obligation to Respond – Never Real and Being Withdrawn 2) Dispatch Triage at the Police Dispatcher Level (e.g. CAHOOTS) B) Stand-Alone CIT—Exaggerated Competencies and Separate Silos 26 1) CIT’s Core Elements Are Not Patient Centered 2) The Excuse To Avoid Co-Response or Alternative Response iv 3) Territorial Tendencies Result in More Investment in CIT 4) The CIT Paradox C) Refusal to Involve Alternative Responders 34 D) The Odd Effort to Misrepresent Follow-Up Services As Co-Response 34 E) Follow-Up Schemes Intended to Support Entrenched Police-Only Response 34 1) Rule Out Cost-Saving Deflections 2) Myth of a Clinician Labor Shortage 3) Betray Early Episode SMI Sufferers 4) Delay Care and Degrade Effectiveness 5) Are Risky 6) Business Model Told Them to Do It 7) Maintain a Failed Status Quo F) Dedicating Officers to Do Social Work Follow-Up Visits 39 G) LEAD Programs and Mental Illness 39 H) Telepsychology, Where Chosen for Convenience Only 44 I) Ambulances and EMTs Instead of Licensed Mobile Mental Health Crisis Workers 44 J) Using Under-Qualified Workers for Mobile Mental Health Crisis Response 44 1) CAHOOTS K) Promises to Collaborate Without Formal Policy and Mechanisms 45 V. Foundations for Success 47 A) General Concepts 47 1) Multi-Layered Response Schemes That Prioritize Collaboration at First Contact 2) Dispatch Triage 3) Alternative Responders—911 Mental Health First Responders 4) MN’s County Crisis Response Teams: Ideal Alternative and Co-Response Option 5) Co-Response and Mental Health Co-Responder Teams 6) Statutes, Medical Assistance, and Insurance Requirements B) Considerations for Rural Areas 62 1) Dispatch Triage and Alternative Response 2) Rural Co-Response 3) Co-Location v 4) Telepsychology for Rural Collaboration C) Start-Up Resources for Evidence Based Approaches 64 1) Advocates Inc. of Massachusetts - Technical Assistance Center 2) Law Enforcement Learning Sites VI. Specific Approaches for Success 67 A) Deflection and Prevention Before the Call to 911 67 B) Dispatch Triage—Examples 67 1) Ramsey County Deflection to County Crisis Response Team 2) Abilene (TX) Deflection to Crisis Response Team 3) Harris County 911 Crisis Call Diversion Program 4) Mental Health Nurses in U.K. Emergency Call Centers 5) Dallas Deflects at 911 to RIGHT Teams to Avoid Police Response 6) Other Examples of Dispatch Triage at 911 Emergency Call Centers C) Alternative Responders—911 Mental Health First Responders 69 1) Ramsey County Mental Crisis Response Teams 2) Psychiatric Emergency Response Team (PAM) – Stockholm 3) CAHOOTS Teams – Eugene, Oregon D) Post-Booking Diversion 81 E) Co-Location 81 F) Co-Response Options 81 1) New to the U.S.: Three-Person Officer/Clinician/EMT Co-Response Teams 2) LAPD and Houston: Very Large City Programs 3) St.