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How Police-Mental Health Collaboration Learning Sites Are Helping Transform Crisis Care

Learning Sites Are Helping Transform Crisis Care

Across the nation, the Covid emergency and increasing dialogue on police reform and racial justice have converged to propel the reformation of crisis systems to better meet people’s needs. “That includes improving how our communities support people experiencing mental health, substance use, and suicide crises, but also “quality of life” concerns and homelessness, and particularly how we are supporting communities of color,” says Ayesha Delany-Brumsey, Ph.D., director of behavioral health at the Council of State Governments Justice Center. 

A large part of Dr. Delany-Brumsey’s job is finding ways to bring law enforcement to the table. “They’re critical partners,” she says, “whether a community wants to develop a specialized law enforcement response for mental health or houselessness or build an alternative response.” The Justice and Mental Health Collaboration Program is a linchpin to fostering collaboration between criminal justice and behavioral health systems. “It includes a significant focus at the intersection between policing and behavioral health,” she points out.

Integrated into the program are 14 learning sites that have demonstrated best practices when responding to behavioral health issues and homelessness. The sites serve as peer-to-peer resources for communities and law enforcement agencies throughout the United States. Sites range in size and include smaller jurisdictions with law enforcement personnel as few as 65 people to large agencies with more than 12,000. “The work they do also varies, spanning from crisis intervention teams to dispatcher training,” says Dr. Delany-Brumsey. Sites provide 1-on-1 technical assistance by sharing their policies and procedures, coaching, and hosting site visits. During the pandemic, meetings and visits have been virtual.

The Law Enforcement Mental Health Learning Sites Program was launched in 2010 by the Bureau of Justice Assistance with the idea that agencies learn best from one another. “We’ve placed a lot of focus on peer-to-peer engagement,” says Dr. Delany-Brumsey. Over the years, the program has identified law enforcement agencies with strong, ongoing collaborations with their mental health partners that could be examples for other communities. Initially, there were 6 learning sites. Today, there are 14 locations throughout the United States in Arizona, California, Florida, Kansas, Maine, Massachusetts, Tennessee, Texas, Utah, and Wisconsin. 

One of the learning sites is the Harris County Sheriff’s Department in Texas, which oversees the county jail—with roughly 9,000 people detained in the facility each day—and does patrol work. Together, that includes a multi-program behavioral health crisis intervention approach consisting of a mobile crisis team, a co-responder unit, and a homeless outreach team on the patrol side, and a mental health infirmary and step-down unit in the jail. The department publishes a dashboard that gives a snapshot of each inmate’s mental health. Ed Gonzalez, Harris County Sheriff, told the Texas Standard that the dashboard is a way to provide transparency and give the public and lawmakers information on trends in the county’s jail population. A quick glance at the dashboard on September 6 revealed that the jail population the previous day was disproportionately made up of Black people (51%) and those experiencing mental health challenges (77%). More than 85% of the inmates were in pretrial detention.

“Many times, people don’t understand what our population looks like, and they don’t understand that the vast majority are pretrial, meaning that they’ve yet to be convicted,” he told the publication. “We operate, in essence, the largest mental health facility in the state, and, in my opinion, jails are not the best place to be dealing with that type of medical issue. That should be treated as a public health issue, not as a criminal justice issue.” 

Before becoming the director of behavioral health at the Council of State Governments Justice Center, Dr. Delany-Brumsey was the director of behavioral health research and programming at the New York Mayor’s Office of Criminal Justice and the director of the Substance Use and Mental Health Program at the Vera Institute of Justice. What most attracted her to the justice center is the way the organization works with jurisdictions nationally. Over the past two and a half years alone, the learning sites program has supported over 600 law enforcement agencies. “It’s that kind of credibility and influence that allows us to build best practices and push for justice reform nationwide,” she says.

Pairing a community with one of the learning sites is a tailored process based on commonalities; the program might match a community with a site in the same state or one of a similar size. The learning site can help the jurisdiction determine its next steps. For example, a community may reach out to the collaboration program on how to embed a clinician into their police department or develop a co-response team. “Or they might have some programs in place and want to examine how they all fit together to level up and create a real systemic response,” says Dr. Delany-Brumsey.

However, to make a marked change, a jurisdiction can’t just implement one specific program. While it’s an excellent place to start, Dr. Delany-Brumsey notes that community leaders need to consider how these systems and programs intersect and communicate at each potential entry point, from early diversion to reentry into the community. “If communities truly want to change the way people with mental health conditions interact with the justice system and work to keep them out of the justice system entirely, they must think holistically,” she points out. 

Sometimes, the justice center will make a peer-to-peer connection straight away or ask the jurisdiction to reflect more about potential partners in their community for the program or programs they’re trying to scaffold. 

On the day I interviewed Dr. Delany-Brumsey, she had just received an email from a jurisdiction in Connecticut looking to build a co-responder team and community responders, behavioral health mobile crisis teams dispatched by 911 that don’t include law enforcement. When she meets with the jurisdiction in Connecticut, she will dive into what they think the co-responder team will look like. “Will there be a clinician?” she’ll ask. “If so, will the clinician be in the car or on a tablet?” The answers will help her get a sense of where they are in the planning process.

“If we’re connecting them with a learning site, we’ll look at the jurisdiction and the initiatives they want to build,” says Dr. Delany-Brumsey. “It wouldn’t make sense to pair an agency of 334 sworn officers with one of 20,000.” Similarly, she would examine geography, whether the jurisdiction is in the same state as a learning site and if it’s in a rural, suburban, or urban area. For example, a community in a rural area that wants to build out its mobile crisis services might be paired with the Yavapai County Sheriff’s Office in Arizona, which covers a population of 235,000 and 8,000 square miles. “They’ve been able to build mobile crisis teams through Spectrum Healthcare that assist officers within 30 minutes across the county,” says Dr. Delany-Brumsey. The teams are available 365 days a year.

Yavapai County also has a cross-system initiative called Reach Out that’s designed to divert people with mental health or substance use disorders from the justice system. The 911 public safety answering points in the county have access to the Reach Out database, where they can both enter and retrieve pre-arrest diversion information. The context helps officers who encounter someone listed in the database to have a fuller understanding of the person in crisis and their needs, thereby increasing the likelihood of diversion rather than arrest.

Dr. Delany-Brumsey says a confluence of factors—the pandemic, the increased lens on racial equity and social justice, and 988—has created a shift in what innovations jurisdictions have inquired about over the past 18 months. For example, she notes that communities focused on housing at the start of the pandemic. “They wanted to know how to transition people from living in encampments to hotels and unused dorm spaces,” she says. Now the program is getting questions on how to make temporary Covid innovations permanent.

Another frequent inquiry during the Covid emergency is on community reentry, specifically how to assist people released from jails who have behavioral health needs. “In 2020, it was harder to get appointments and see providers,” says Dr. Delany-Brumsey. She notes that some of these challenges have sustained or reemerged with the Delta variant; this has been particularly challenging for smaller jails that don’t have dedicated reentry personnel. So she and her staff partnered with the National Sheriffs’ Association to develop a short reentry Covid checklist. “The list allows jails to have a step-by-step guide at their fingertips,” she says.

After the murder of George Floyd by four Minneapolis police officers in May 2020, Dr. Delany-Brumsey says that law enforcement agencies have also increasingly reached out to the program to take a closer look at the calls they respond to. “Some in law enforcement were already wondering if it’s them who should be responding to calls about homelessness, neighbor disputes, noise complaints, or behavioral health concerns,” she says, “but the summer of 2020 catapulted the conversation.”

Despite the desire for crisis system redesign and diversion programs, concern about staffing is an ongoing issue in many communities, not just for behavioral health but also for law enforcement. Jurisdictions have also shared with Dr. Delany-Brumsey and her team that they’re worried fewer people are interested in entering law enforcement. “It’s unclear whether that’s related to the staffing shortage,” she says. She points out that even if communities have the funds to stand up specialized crisis response, they might not have the behavioral health or law enforcement personnel to do so without making a concerted financial effort to boost these numbers. 

With staff shortages continuing to be an ongoing challenge for law enforcement, it’s even more essential that jurisdictions have a robust crisis continuum and community partners to help alleviate the continued pressure on law enforcement to be the default mental health first responder. The national dialogue, says  Dr. Delany-Brumsey, is helping to increase the number of collaborative models. “We’re seeing far more jurisdictions think about how to build community responder programs as part of their crisis system,” she says, “instead of solely relying on law enforcement.”

The national dialogue has galvanized communities to reimagine systems that work for people who’ve been historically most disadvantaged or marginalized by those systems. Dr. Delany-Brumsey says this approach elevates access for all people. She points to the example of sidewalk ramps. Before the passage of the Americans with Disabilities Act, signed into law by President George H.W. Bush in 1990, people in wheelchairs faced chronic sidewalk inaccessibility. CW Tillman told #CrisisTalk in October that “without curb cuts, people in wheelchairs end up having to use the street, putting them at grave risk of injury or death.” 

Dr. Delany-Brumsey says that curb cuts also benefit bicyclists and pedestrians. “Communities built curb cuts for people who use wheelchairs, but they also help parents pushing strollers and older people tugging along groceries in carts,” she says. The same is true for health and wellness systems. “If we build them for our most marginalized populations—people facing serious mental illness, people experiencing houselessness, and communities of color—they work better for everyone.”

 

Learn more about JMHCP learning sites at Taking the Call, a virtual conference on October 20 and 21 that’s free and open to the public. It will cover how certain law enforcement jurisdictions serve as laboratories for innovation to ensure people facing behavioral health issues, quality of life challenges, and homelessness get the care and resources they need.