Crisis care beyond cops

Illinois envisions a new way of responding to those in mental distress

During a pandemic that led many to grapple with grief, distress and isolation – and civil rights uprising against police brutality and systemic racism – a lack of support for those suffering from mental health distress became increasingly evident. There is a growing movement to create a mental health crisis response that doesn't solely rely on police.

Sara Anderson, manager of community engagement and care coordination for Memorial Behavioral Health in Springfield, is on the forefront of that movement locally. She regularly teams up with Steve Termine, a Springfield neighborhood police officer, to respond to situations where a person with expertise in mental health is requested by the Springfield Police Department. Anderson, a licensed clinical social worker, and two more mental health professionals with Memorial are part of a co-responder program with Springfield police. The program connecting citizens interacting with police to mental health services started in 2018.

Earlier this year Anderson and Termine helped one family find long-term care for a relative who suffers from post-traumatic stress disorder (PTSD). The man served in the Army for about two decades and did three tours in Iraq. After coming home from the first tour, he was treated for mental illness. But the Army then approved his going back to war. His family said his issues compounded from there.

While in the Army he served as a sergeant, and was a role model to others. But in order to deal with the trauma of what he had witnessed, he turned to unhealthy coping mechanisms, like alcohol. About a decade ago, the veteran came to central Illinois to be with family after his service. Back home, he wasn't socializing. Family members couldn't relate to what he had been through in the Army – including witnessing the violent deaths of friends. He wasn't open about the trauma.

He hopped from various family houses, and entered a treatment program for a time, before moving to his mom's house in Springfield in 2015. The PTSD presented as extreme paranoia, which eventually made the home unlivable. For instance, he would stack furniture in strange ways and was hoarding. A pet was going to the bathroom indoors, and the man wasn't cleaning up after it. His symptoms soon spiraled into psychosis. In late 2020 his mother left the house due to concerns over her safety.

The family would call the police, and Termine would arrive to do wellness checks. Anderson said Memorial's complex care team also intervened. Anderson said about the man, "He was in that very paranoid and even delusional state." The pandemic made response more difficult due to COVID restrictions.

Until getting involved with the co-responder program, the family had struggled to find options to help the man. His sister and brother-in-law were particularly invested – they shared the man's story with Illinois Times but didn't want to use his name or theirs to protect his privacy. Termine and Memorial helped the family get the man medically assessed and eventually into a home for veterans.

"Our health system is not easy to navigate. For someone who's been doing it for 10 years, I struggle every day figuring out how we are going to make this work," said Anderson. "So to expect an individual who is sick, or a family that has no experience with this whatsoever – to expect them to be successful in getting help – it's not practical, it's not logical."

Anderson surmised that, were it not for the co-responder team, the man, now 51, would have been involuntarily hospitalized after police response, with no means of support once he left the hospital and returned home.

Termine said both those in law enforcement and the military are likely to suffer from mental illness resulting from their intense, often traumatic, work, where they must be hyper-alert. Asking for help has traditionally been hard for many who seek to maintain a sense of machismo and self-reliance. "It's not the old days where you just suck it up," said Termine. "You can't do that, because sooner or later, your glass is going to overflow and you're not going to be able to control things."

The veteran is now receptive to treatment, which gives the family hope for long-term positive change. They credit Anderson and Termine for helping identify the best path forward. And Termine and Anderson credit the family for regularly advocating for their relative's well-being.

Memorial Behavioral Health covers the $110,000 annual cost of the co-responder program, $100,000 for a full-time clinician and $10,000 to pay for some client needs, such as transportation, clothing and medication costs. It has expanded the team to add two more staff members since it started in 2018.

click to enlarge On May 15, people in Springfield gathered for a "Mental Health and Justice Awareness Rally." - PHOTO BY RACHEL OTWELL
Photo by Rachel Otwell
On May 15, people in Springfield gathered for a "Mental Health and Justice Awareness Rally."

A new path
The program is trying to address several problems. The erosion of mental health services over decades has left police as the go-to when people are in mental or behavioral health crises, often to their detriment. Police struggle with having few tools to resolve the crises, frequently relying on one of two options: arresting the person in crisis or bringing the person to a hospital emergency room.

This in part has led to an overrepresentation of people with mental illness in the criminal justice system, and over-reliance on hospital emergency rooms, which aren't best equipped to treat those in mental health crisis. And, all too often, police encounters can turn deadly. Analyses of police shootings from the Treatment Advocacy Center, a national group that advocates for better mental health care, and the Washington Post show one in four people killed by law enforcement had some form of severe mental illness.

Co-responder programs – like Memorial's, where a law enforcement officer, usually trained in crisis intervention, teams up with mental health professionals to respond to those in crisis – have emerged as one solution. Studies of these programs show a decrease in the number of unnecessary hospital admissions, and that the people served are more likely to continue their treatment after a police encounter when a clinician is on the scene with them, according to Dr. Amy Watson, a professor in the social work department at the University of Wisconsin-Milwaukee. For the past two decades she's studied police interactions with people with severe mental illness.

"My worry about this big push to expand co-responder (programs) is that we'll stop there," Watson said. "And so in order to get that mental health response, you'll have to have an officer there."

click to enlarge Sara Anderson and Steve Termine often work together to respond - to calls for help where people might be suffering from a mental health crisis. - PHOTO BY RACHEL OTWELL
Photo by Rachel Otwell
Sara Anderson and Steve Termine often work together to respondto calls for help where people might be suffering from a mental health crisis.

Police officers aren't needed in most mental or behavioral health crises, Watson said. They can increase stress and anxiety in these situations, for example, when a person is suicidal or having an episode of paranoia. Research by Watson and others shows Crisis Intervention Team (CIT) training for police can help. In the 40-hour training, often led by local mental health providers, officers learn about mental illness and treatment options in their community as well as advanced de-escalation techniques. Officers' attitudes about mental illness improve, and they're more likely to connect people in crisis with medical and other services after an emergency call. But whether there is also a reduction in arrests or use of force is difficult to measure, Watson said. The Springfield Police Department has been training officers in crisis intervention since 2003, and currently 93 of the department's 217 officers are CIT-certified, according to Deputy Chief Joshua Stuenkel.

Anderson, with Memorial Behavioral Health, agreed that police should not be the first-responders in all crises. "There's always going to be an appropriate time, but to just assume that police officers always need to be there is not the reality," Anderson said.

Watson serves as board president of CIT International, a nonprofit that offers crisis intervention training and advocates for partnerships between law enforcement, mental health professionals and people with mental illness. While the group promotes partnership with law enforcement, she said it also advocates for non-law enforcement alternatives for people in crisis. She said only promoting models that require police response "doesn't really change the fact that we're defining (mental illness) as a law enforcement, criminal justice issue. It's also very tone deaf to the communities that are saying, 'Stop sending police. We want something else.'"

9-8-8 number
The debate over the need for a different response system has taken on more urgency in the Springfield area after a police shooting this spring. In Chatham in March, a Black man was shot four times by police while in the midst of a mental health episode. On May 15, more than 100 people gathered in Springfield to raise awareness about mental health. The man's sister, Sunshine Clemons, co-founder of Black Lives Matter Springfield, was one of the first people to take the podium outside the Capitol.

"I know that my brother is not the only one who is facing a situation like this. He's not the only one who has had struggles and had negative interactions with those who are called to help," she told attendees.

Also at the rally was Diana Knaebe, president of Memorial Behavioral Health. She told the attendees that people in crisis deserve safe ways to be vulnerable and find help. "That's especially difficult for persons of color and marginalized individuals. It's important that we prioritize mental health and acknowledge that it is OK to not be OK," Knaebe said that day.

Knaebe also spoke about the Living Room in Springfield, which is an option for those experiencing non-emergency circumstances to seek resources and to speak with peer recovery specialists – people who have lived through their own addiction and mental health crises. "We have too many people that often are taken to the emergency room, or go to the emergency room, where they're not really equipped to handle mental health crises." Knaebe said the Living Room and similar efforts are hoping to solve this problem. The Illinois Department of Human Services (IDHS) funds the Living Room in Springfield and others around the state that offer the service to patients at no cost.

But places like the Living Room are only one piece of an effective crisis response system. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) published a report last August, Crisis Services: Meeting Needs, Saving Lives, outlining how states can build a system that responds to anyone in crisis, at any time, anywhere. It's a three-pillar system: crisis call centers staffed with trained professionals to assess the level of care needed; mobile crisis response teams that go out into the community; and crisis stabilization centers – facilities that provide an alternative to hospitalization.

IDHS cited the report in a recent call for proposals for grants to set up the mobile crisis teams around the state. According to the call, the agency has up to $35 million in state and federal money to fund the teams, though a spokesperson said the final spending would be determined when grants are awarded.

IDHS is also working with crisis call centers across Illinois in anticipation of the new, three-digit number for the National Suicide Prevention Line, 9-8-8, coming online in July 2022. The hotline promises to route calls to centers based on location throughout the country and serve anyone experiencing suicidal thoughts or going through a mental health crisis.

Meanwhile, during this past General Assembly session, state lawmakers approved the Community Emergency Services and Support Act, which mandates that 911 dispatchers, police and emergency medical responders coordinate with 9-8-8 and the new crisis system – referring calls back and forth, and setting up protocols for when law enforcement, ambulances or mobile crisis teams should respond.

Knaebe said plans are now underway for what the crisis call response center for the 9-8-8 number will look like in Springfield. Memorial could manage a crisis call center, as it has applied for the IDHS funds to help run the center and mobile response units. She said in states that already have a call center, about 70% of callers are able to find the resources they need over the phone, including planning follow-up appointments. For those who do need immediate assistance, part of the planning will be a process to decide who responds to calls, such as when law enforcement is involved.

Another key is having a safe place for people to go, like the Living Room, that is not an emergency room or a jail cell. Currently, the Living Room in Springfield is not available 24/7. Setting up a stabilization center, a goal of Memorial's, is part of the three-pronged approach promoted by federal guidelines.

Knaebe said Memorial also hopes to expand its co-responder program with the Springfield Police Department. "We have worked with the city and are looking at bringing on a person with lived experience as a part of that team to work especially with individuals who are homeless," she said. Beyond crisis response, a more preventative approach involves reaching out to grassroots organizations in marginalized communities to learn more about what resources would be helpful, said Knaebe.

Knaebe has been in the field of social work for more than 30 years. She said the pandemic and increased awareness of racial injustice have made the need for more robust mental health responses and resources more clear, and policymakers are acting. "I am very hopeful," she said.

Decriminalization and representation

click to enlarge Barra Madden, a student at SIU School of Medicine in Springfield, told - attendees at the May 15 mental health rally that there is a need to raise awareness and promote change regarding mental health services. - PHOTO BY RACHEL OTWELL
Photo By Rachel Otwell
Barra Madden, a student at SIU School of Medicine in Springfield, toldattendees at the May 15 mental health rally that there is a need to raise awareness and promote change regarding mental health services.

Advocates hope a comprehensive crisis response system that doesn't rely on law enforcement will mean fewer people with mental illness will become incarcerated, and instead will have access to the health care they need. Still, Watson said policymakers need to be careful not to perpetuate the same biases in these new systems that have criminalized communities of color. Addressing inequities in mental health care needs to be a part of the approach. "The mental health system has not been particularly responsive to communities of color, historically," Watson said.

At the Springfield mental health awareness rally in mid-May, Barra Madden, who studies at SIU School of Medicine in Springfield, addressed this problem as well. Madden told those in attendance that she was raised in an "urban, lower socio-economic status" in Rochester, New York, and experienced firsthand the ways people would dismiss mental health problems in communities of color.

"Mental health was a silent condition," Madden told the crowd. "I have too witnessed that even uttering the words, 'I am depressed, I am anxious, I am suicidal,' was responded to with a spiritual or biblical verse, or even worse, 'No, you're not, you'll get over it. It will pass.'"

"We owe it to our community to start the movement for de-stigmatizing mental health," she said. "There aren't many psychiatrists of color. My goal in becoming a female Black psychiatrist is to dismantle barriers and improve inequities in health." Madden said trust in medicine is a key to people getting help. Patients being able to see doctors who represent them is important. The face of medicine needs to change, as does policy, Madden said.

Mary Hansen is a reporter with NPR Illinois in Springfield. Contact her at mhans6@uis.edu. Rachel Otwell is associate editor for Illinois Times. Contact her at rotwell@illinoistimes.com.

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