NEWTON, Iowa — Jeff White knows what can happen when 911 dispatchers get a call about someone feeling down or agitated.
He experienced it repeatedly: 911 operators dispatched the police, who often took him to a hospital or jail. “They don’t know how to handle people like me,” said White, who battles depression and schizophrenia. “They just don’t. They’re just guessing.”
In most of those cases, he said, what he really needed was someone to help him calm down and find follow-up care.
That’s an option now, thanks to a crisis response team serving your area. Instead of calling 911, you can contact a state hotline and request a visit from mental health professionals.
The teams are sent by a program that serves 18 mostly rural counties in central and northern Iowa. White, 55, has received assistance from the crisis team several times in recent years, including after heart problems forced him to move to a nursing home. The service costs you nothing. The team’s goal is to stabilize people at home, rather than admit them to a crowded psychiatric unit or incarcerate them for behavior stemming from mental illness.
For years, many cities have sent social workers, doctors, trained community workers or mental health professionals to calls that were previously answered by police officers. And the approach gained traction amid concerns about cases of police brutality. Advocates say such programs save money and lives.
But crisis response teams have been slower to catch up in rural areas even though mental illness is just as valuable there. That’s in part because those areas are larger and have fewer mental health professionals than cities, he said. Hannah WesolowskiAdvocacy director for the National Alliance on Mental Illness.
“It’s certainly been a harder hill to climb,” he said.
Melissa Reuland, a researcher at the University of Chicago Health Laboratory who studies the intersection of law enforcement and mental healthHe said no hard statistics are available, but small police departments and sheriff’s offices seem increasingly open to finding alternatives to a standard law enforcement response. Those may include training officers to better handle crises or seeking help from mental health professionals, she said.
A shortage of mental health services will continue to be a hurdle in rural areas, he said: “If it was easy, people would have worked it out.”
Still, the crisis response approach is making progress, program by program.
White has lived most of his life in small Iowa towns surrounded by rural areas. He is pleased to see mental health care efforts strengthening beyond urban areas. “This is where we forget, and this is where we need help the most,” he said.
Some crisis teams, like the one helping White, may respond on their own, while others are paired with police or sheriff’s deputies. For example, a South Dakota program, Virtual Crisis Care, equips law enforcement officers with iPads. Officers can use the tablets 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 trying to handle such situations on their own.
Counselors help people in mental health crises calm down and then discuss what they need. If it is safe for them to stay home, the counselor calls a mental health center, which then contacts people to see if they are interested in treatment.
But sometimes counselors determine that people are a danger to themselves or to others. If so, counselors recommend that officers take them to an emergency room or jail for evaluation.
In the past, sheriff’s deputies had to make that decision on their own. They used to be cautious, temporarily moving people out of their homes to make sure they were safe, said Zach Angerhofer, a constable for Roberts County in South Dakota, which has about 10,000 residents.
The detention of people can be traumatic for them and costly for the authorities.
Agents often must spend hours completing paperwork and moving people between the emergency room, jail and psychiatric hospitals. That can be particularly burdensome during hours when a rural county has few deputies on duty.
Angerhofer said that no one has refused to use the telehealth program when he has offered it. Unless he sees an immediate security problem, he offers people privacy by leaving them alone in his house or allowing them to sit alone in his squad car while they speak with a counselor. “From what I’ve seen, they’re a totally different person after the tablet is implemented,” he said, noting that the participants seem relieved afterward.
The South Dakota Department of Social Services funds the Virtual Crisis Care program, which received seed money and design help from the Leona M. and Harry B. 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 available, said Monica Van Horn, who helps run the state-funded program through the mental health nonprofit Eyerly Ball. They are sent through the state crisis line or the new national mental health crisis line 988.
In most cases, Eyerly Ball’s crisis teams respond in their own cars, without police. The low-key approach can benefit customers, 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 about your business, and if a police car shows up in front of your house, everyone and their dog will know within the hour,” he said.
Van Horn said the program averages 90 to 100 calls a month. Callers’ problems often include anxiety or depression, and sometimes they are suicidal. Other people call because children or family members need help.
Alex Leffler is a mobile crisis responder on the Eyerly Ball show. He previously worked as a “behavioral interventionist” in schools, went back to college and is about to get a master’s degree in mental health counseling. He said that as a crisis responder, he has met people in homes, workplaces and even a grocery store. “We respond to just about anywhere,” he said. “You can just make a better connection in person.”
Thomas Dee, an economist and professor of education at Stanford University, said such programs can garner support from across the political spectrum. “Whether someone is ‘defunding the police’ or ‘taking back the blue,’ you can find something you like in these kinds of first-response reforms,” he said.
Critics of the police have called for more use of unarmed mental health experts to defuse tense situations. before they turn deadly, while law enforcement leaders who support such programs say they can give officers more time to respond to serious crimes. And government officials say the programs can reduce costly hospitalizations and jail stays.
Dee studied the Denver Support Team Assisted Response program, which allows 911 dispatchers to send doctors and behavioral health experts instead of police officers 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 administrator of Connections Health Solutions, an Arizona agency that provides crisis services. She said now is a good time for rural areas to start or improve such services. The federal government has been offering more money for the efforts, including through pandemic response funds, she said. She also recently released the crisis of 988 line, whose operators can help coordinate such services, he said.
Balfour said the current national focus on the criminal justice system has drawn more attention to how it responds to people with mental health needs. “There are still a lot of things that we don’t agree with on police reform,” he said. “But one thing everyone agrees on is that law enforcement doesn’t need to be the default first responder for mental health.”
Arizona has a response to the crisis equipment available throughout the state, even in very rural regions, because the settlement of a 1980s class action lawsuit it required better options for people with mental illness, Balfour said.
Such programs can be done outside cities with creativity and flexibility, he said. Crisis response teams should be considered as vital as ambulance services, Balfour said, noting that no one expects the police to respond in other medical emergencies, such as when someone has a heart attack or stroke.
“People with mental health problems deserve a health response,” he said. “It’s worth trying to figure out how to get that out to the population.”
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