Problem

Problematic Behavior or Activity

Numerous factors contribute to the outsized presence of persons with mental illness or in crisis who are involved in the criminal justice system. Given the prevalence of mental illness in the United States, people who have these conditions often have some contact with law enforcement and risk being incarcerated. The Portland Police Bureau’s approach to crisis-intervention has undergone many changes over the years—often precipitated by tragic incidents. Like many law enforcement agencies, the PPB sought a way to actively improve police interactions with people who have mental health issues or are in a behavioral health crisis.

Impact on the Community

As first responders to behavioral health crises, law enforcement officers are asked to acquire and implement new skills to resolve these situations and provide those in need with prevention and intervention resources.

Solution

Program Description

The PPB’s Behavioral Health Unit (BHU) coordinates the response of law enforcement and the behavioral health system to aid people in behavioral crisis stemming from known or suspected mental illness and/or substance use. The BHU works directly with a mental health specialist from the bureau’s Training Division to develop PPB crisis intervention training in support of the crisis response model. The model includes crisis intervention training as a core competency, development of a crisis response team, and a follow-up prevention-focused capability.

• All patrol officers are required to have a core competency in crisis intervention. As primary responders to crisis calls, all PPB officers receive 40 hours of basic crisis-intervention training, as well as annual crisis-response refresher training.
• The Enhanced Crisis Intervention Team (ECIT) is a group of volunteer and vetted officers from a variety of patrol assignments who have an additional 40 hours of crisis-intervention training that focuses on responding to more complex crisis calls. These officers are the first responders 911 dispatches to behavioral health crisis calls, as set forth by established dispatch criteria.
• The Behavioral Health Response Team (BHRT) pairs a patrol officer and a licensed mental health professional from Cascadia Behavioral Healthcare’s Project Respond. The Portland Police Bureau has three BHRT cars. The officers and mental health professionals work actively with individuals who have mental health issues and are identified as having had multiple or high-risk contacts with police. The BHRT personnel work to connect individuals to appropriate community resources. Referrals to the BHRT cars are made by patrol officers.
• The Service Coordination Team (SCT) is a program that offers treatment to the city’s most frequent drug and property-crime offenders to address their substance use, mental health treatment, and criminality. In 2015 the SCT expanded by implementing the Supportive Transitions & Stabilization (STS) program, run by Central City Concern’s Housing Rapid Response collaboration. The six-bed program allows the BHU to assertively address the needs of those facing mental illness and co-occurring disorders by creating a direct housing resource for the BHRTs. Individuals referred to the SCT and BHRTs often experience periods of unstable housing and come into contact with the police during times of crisis; providing safe, service-connected housing can significantly change the outcomes of these interactions. STS provides 24-hour staffing, including case management and peer supportive services. Program participants will have the opportunity to address basic needs, connect with health care providers and treatment, engage in community support systems, and, ideally, have an uninterrupted transition to appropriate services. Access to stabilization beds is an invaluable tool for intervening with and engaging this population.

Funding

The Behavioral Health Unit was formed in FY 2012-13 and has received City of Portland General Fund dollars as part of its funding. The Project Respond mental health clinicians are supported by PPB contract dollars. For the SCT program, PPB contract dollars go to programming at a social service agency. Also, in 2006 PPB hired a mental health training specialist to help develop, organize, and assess mental health training needs.

Outcome

Program Impact

Behavioral Health Response Teams PPB currently has one BHRT assigned to each precinct. The average caseload of each BHRT is 12-15 people at any given time. In 2015 there were 985 referrals to the Behavioral Health Unit, a number that includes individuals who had multiple referrals. Of those referrals, 584 (60 percent) were assigned to the BHRT caseload. The 985 referrals represented 777 individuals, of whom 432 (56 percent) were assigned to the BHRT caseload. In 2015 the BHRTs received 683 new referrals (individuals who previously had not been referred to the Behavioral Health Unit). 

Among those people, 355 (52 percent) were assigned to a BHRT and received follow-up services. All referrals are not assigned, given that some will not meet established program criteria. The BHU’s average weekly caseload of assigned cases was 35.5 people in 2015. The unit made 551 referrals in 2015, with the most prevalent being Coordinated Services (40.3 percent), which means that a person was connected or reconnected to mental health services or other community resources. Finally, of the individuals who transitioned to inactive status, 14 percent had previously been on a BHRT caseload.

An Enhanced Crisis Intervention Team (ECIT) template was introduced and adopted in February 2015. The templates help to evaluate the ECIT Program, not of every crisis call. Every time ECIT officers respond and uses their crisis skills, they must complete the template. They do this if they use ECIT skills on a mental health crisis call, whether it is in their district, or they are dispatched to assist elsewhere. The 2015 data from the templates indicate that ECIT officers applied their advanced training skills to 714 calls (that is, for crisis events). An ECIT officer was the primary officer on the scene in 49 percent of those calls, an officer indicated that a team member used de-escalation in 30 percent of the calls, and a mental health professional responded to the scene in 22.3 percent of calls. The subject was armed in 18 percent of the calls and force was indicated as having been used in 2 percent of the calls.

Service Coordination Team A recent study conducted by Portland State University concluded that every dollar spent on the SCT program saves the community and the criminal justice system $10. In 2015, 538 individuals were referred to the program, accounting for 583 total referrals. The SCT program accepted 60 percent of these referrals.

Critical Success Factors

The Behavioral Health Unit provides layers of service on the behavioral health spectrum through patrol officers with crisis intervention training, the Enhanced Crisis Intervention Team, the Behavioral Health Response Teams, and the Service Coordination Team. This multilayered approach allows for both a reactive and proactive model, with the goals of resolving behavioral crises, connecting people to resources, and reducing the frequency of police contact. The BHU also has a robust internal and external collaborative process, to meet the needs and expectations of the community, service providers, consumers, and officers.

The unit has also developed the innovative BHU Electronic Referral System (BERS), which allows any member of the bureau to make mental health referrals to the BHU. The system captures the number of referrals the Behavioral Health Response Teams’ cars follow up on, as well as the resolution of their efforts. BHU personnel evaluate all referrals for appropriateness prior to entry in BERS. The only referrals accepted are those that contain information indicating that an individual has a known or suspected mental illness. This electronic referral process allows officers to send immediate information to the BHU. The system also allows the unit to be notified if someone is having repeated contact with police or if police have contacted someone the BHU is currently working with.

Lessons Learned

In providing a layered approach to behavioral health crises, BHU personnel have learned that the unit needs to have a certain level of adaptability. Personnel are always looking for ways to become a better resource for patrol officers and community members. BHU personnel have also learned that a collaborative process is key to achieving the unit’s mission. Partnerships with traditional and nontraditional stakeholders allow for mutual trust and understanding among law enforcement, mental health providers, consumers, and advocates.