NEWTON, Iowa — Jeff White knows what can happen when a 911 dispatcher receives a call about someone feeling depressed or agitated.
He experienced this time and time again: 911 operators dispatched the police, who often took him to the hospital or jail. “They don’t know how to handle people like me,” White said. “They don’t fix it. They are just guessing.”
Mostly, she said, all she really needed was to help her get sober and find follow-up care.
That’s now an option, thanks to a crisis response team serving his area. Instead of calling 911, he can contact a state-run hotline and request a visit from a mental health professional.
Teams are sent by a program that serves 18 mostly rural counties in central and northern Iowa. White, 55, has received help from the crisis team several times in recent years, even after heart problems forced him into a nursing home. There is no price for the service. The group’s goal is to stabilize people at home rather than admit them to overcrowded psychiatric units or send them to prison for behavior stemming from mental illness.
Over the years, many cities have sent social workers, physicians, trained outreach workers, or mental health professionals to calls that were previously handled by police officers. And the approach gained traction amid concerns over cases of police brutality. Supporters say such programs save money and lives.
But crisis response teams have been slow to catch on in rural areas even though mental illness is just as prevalent there. That’s partly because these areas are larger and have fewer mental health professionals than cities, said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness.
“It’s definitely been a tough hill to climb,” he said.
Melissa Reuland, a University of Chicago Health Lab researcher who studies the intersection of law enforcement and mental health, said hard statistics aren’t available but small police departments and sheriff’s offices seem increasingly open to finding alternatives to a standard law enforcement response. That could include training officers or seeking help from mental health professionals to better handle crises, she said.
Lack of mental health services will continue to be a barrier in rural areas, he said: “If it was easy, people would fix it.”
Still, the crisis response approach is entering program by program.
White spent most of his life in small Iowa towns surrounded by countryside. He is pleased to see that mental health care efforts outside urban areas have been strengthened. “We’ve been forgotten here – and this is where we need the most help,” he said.
Some crisis teams, like the one helping White, can respond on their own, while others are paired with police officers or sheriffs’ deputies. For example, a South Dakota program, Virtual Crisis Care, equips law enforcement officers with iPads. Officials can use the tablets to set up video chats between people in crisis and counselors from telehealth companies. That’s not ideal, Wesolowski said, but it’s better than having police officers or sheriff’s deputies try to handle such situations themselves.
Counselors help people in mental health crises calm down and then discuss what they need. If it’s safe for them to stay at home, the counselor calls a mental health center, which then contacts people to see if they’re interested in treatment.
But sometimes counselors determine that people are a danger to themselves or others. If so, counselors recommend that officers take them to the emergency room or jail for evaluation.
In the past, sheriff’s deputies had to make that decision themselves. Deputy Jack Angerhofer of Roberts County, South Dakota, with about 10,000 residents, said they tended to be cautious, temporarily evacuating people from their homes to make sure they were safe.
Detaining people can be painful for them and expensive for authorities.
Deputies often have to spend hours filling out paperwork and shuttling people between ERs, jails and mental hospitals. This can be especially difficult when few deputies serve in a rural county.
Virtual crisis care programs help avoid that situation. About 80% of people who complete of According to a recent state study, video assessments stop at home.
Angerhofer said no one refused to use the telehealth program when he offered it. Unless he sees an immediate safety concern, he offers privacy by leaving people alone in their homes or letting them sit in their own squad cars while he talks to a counselor. “From what I’ve seen, they’re completely different people after the tablet is deployed,” he said, noting that participants feel relieved afterward.
The South Dakota Department of Social Services funds the Virtual Crisis Care Program, which Leona M. and Harry B. The startup received funding and design support from the Helmsley Charitable Trust (The Helmsley Charitable Trust also contributes to KHN.)
In Iowa, the program that helps White always has six pairs of mental health workers, said Monica Van Horn, who helps run the state-funded program through the Yearly Ball mental health nonprofit. They are referred through the statewide crisis line or the new national 988 mental health crisis line.
In most cases, Yearly Ball crisis teams respond in their own vehicles without the police. A low-key approach can benefit 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 in front of your house, everyone and their dog will know about it within an hour,” he said.
Van Horn said the program averages 90 to 100 calls per month. Callers’ problems often include anxiety or depression, and they are sometimes suicidal. Other people call because children or family members need help.
Alex Leffler is a mobile crisis responder with the Yearly Ball program. She previously worked as a “behavior interventionist” in schools, went back to college and is close to earning 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 anywhere,” he said. “You can connect better in person.”
Such a program could garner support across the political spectrum, said Thomas Dee, an economist and education professor at Stanford University. “Whether one ‘defends the police’ or ‘blues back,’ they can find something to like in these kinds of first-responder reforms,” he said.
Police critics have called for more use of unarmed mental health specialists to defuse tense situations before they turn deadly, while law enforcement leaders who support such programs say it 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, which allows 911 dispatchers to send doctors and behavioral health specialists instead of police to certain calls. He found that the program saved money, reduced low-level crime and did not lead to more serious crime.
Dr. Margie Balfour is an associate professor of psychiatry at the University of Arizona and an administrator at Connect Health Solutions, an Arizona organization that provides crisis services. He said now is the right time to start or improve such services in rural areas. He said the federal government is providing more money for the effort, including the Pandemic Response Fund. It launched recently 988 crisis Line, whose operators can help coordinate such services, he noted.
Balfour said the current national focus on the criminal justice system has put more attention on how it responds to people with mental health needs. “There’s still a lot to disagree with on police reform,” he said. “But one thing everyone agrees on is that law enforcement doesn’t have to be the default first responder to mental health.”
Arizona has crisis response team Available across the state, including in very rural areas, because class-action lawsuit settlements in the 1980s required better options for people with mental illness, Balfour said.
With creativity and flexibility, such events can be done outside the city, he said. Crisis response teams should be considered as vital as ambulance services, Balfour said, adding that no one expects police to respond to other medical emergencies, such as someone having a heart attack or stroke.
“People with mental health concerns deserve a health response,” she said. “It’s worth trying to figure out how to get that to the population.”
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