Problematic Behavior Or Activity
Law enforcement officers routinely interact with people with mental health issues. A number of the problems caused by or associated with people who have these issues often become law enforcement concerns. These include crimes, suicides, disorderly conduct, and a variety of calls for service. Although Washington County had a number of initiatives in place, there was no strategic plan or vision for serving this population. Two key events solidified our need to systematically evaluate our system and existing response team: (1) U.S. Department of Justice reports in Portland and Seattle highlighting use of force issues with mentally ill individuals; and (2) the shooting death of a young suicidal man by Washington County deputies.
Law enforcement was having frequent contact with the same individuals without their primary care providers’ awareness. Many mentally ill people were not getting connected to treatment due to lack of law enforcement knowledge and mental health providers being unaware of police contacts. There was a lot of frustration among first responders such as law enforcement and emergency medical services. A number of mentally ill individuals were committing crimes, but the charges were often dropped with few consequences.
Washington County’s Mental Health Response Team (MHRT) is a crisis response team that pairs one specially selected and trained deputy from the Sheriff’s Office with a master’s level clinician funded by Washington County Mental Health Services. The purpose of MHRT is to get clients/subjects into services without hospitalization or incarceration. MHRT offers resources to people and even attempts to contact their provider for follow-up appointments and services. MHRT focuses on providing support and intervention to individuals experiencing acute symptoms or emotional distress related to their mental health. MHRT will respond anywhere in Washington County to requests from any agency requesting service for those persons in crisis or needing
immediate mental health services or intervention.
Once on the scene and after the risk level is deemed low or the deputy has mitigated risk factors, the clinician assesses the mental health needs and provides a crisis intervention. The MHRT clinician conducts a crisis risk assessment. The clinician and law enforcement partner collaborate on decisions about whether a plan can be developed so that the individual can safely remain in the community or if the individual needs to go to a hospital. Safety planning can entail involving members of an individual’s natural support system, MHRT making phone or welfare checks, contacting current mental health providers, and/or making referrals to additional resources. MHRT does not use a standard assessment. The clinician often plans follow-up with a client.
MHRT started as a pilot project in February 2011. Staffing started as one patrol corporal paired with a master’s degree–level mental health professional. In September 2012 the program evolved into two teams, working from 11:30 a.m. until 11:00 p.m., seven days a week.
MHRT intercepts chronic users of emergency services, frees up officers to handle other calls, and reduces continuous calls from certain clients/subjects.
Based On Research
MHRT is based on the “Memphis Model,” an innovative first-responder model of police-based crisis intervention with community, health care, and advocacy partnerships.
Shifts are primarily filled with 4.0 FTE of law enforcement staff employed by the Washington County Sheriff’s office and 4.0 FTE of master’s level mental health clinicians trained to provide crisis intervention and clinical assessment of mental health conditions. The clinicians are employed by Lifeworks Northwest, which is contracted by the behavioral health program of Washington County’s Department of Health and Human Services to provide mental health crisis intervention services for county residents.
MHRT responded to 5,399 total calls in 2015.
Mental health services were received in 1,658 calls. If mental health services were not received, it could mean that the client was not located, refused services, or the follow-up did not involve client contact.
2,691 of the calls had a criminal aspect (charged or not).
Only 26 calls required a use of force.
Critical Success Factors
The relationship between Washington County Mental Health Services and the Washington County Sheriff’s Office was the most crucial element of success. The two organizations had the same goals, but just didn’t realize it: Keep mentally ill folks out of jail; keep everyone safe; and help people get the resources and treatment they need.
Timing was critical to launching the MHRT: There was not only new progressive command staff at the Sheriff’s Office, but also pressure for that office to take action before another organization dictated changes.
MHRT is not a silver bullet: It is one of many strategies, including expanding crisis intervention training, creating a dispatch triage protocol, and implementing a jail diversion project.
Successful engagement with other system partners has been key, including fire/rescue, hospitals, other police departments, mental health treatment providers, and others.
Improved communication among law enforcement and system partners has also been extremely important, including the development of guidelines for communication and a release-of-information form for all stakeholders.
Leaders and staff working with each key stakeholder—law enforcement, mental health services, and hospitals—must keep their judgments at bay and dispel misperceptions about one another.
Find leadership within key organizations to drive the process, share successes, and act as role models.
Start small and build on successes: Even a small win can go a long way. For instance, deputies need to see how it helps them do their job better to start believing in this effort; leadership needed to see positive outcomes before they could embrace the initiatives.