Mental health experts join in police response

By Lisa Brody

Birmingham Police Chief Mark Clemence was more troubled about the situation in his community than in all of his 37 years in law enforcement – and as he spoke to his fellow law enforcement leaders in neighboring communities, he knew they were experiencing similar problems, where too many police calls were those involving mental health issues. Many of the calls for help were from the same people, at the same addresses – “frequent flyers,” in their parlance. Rather than assisting, Clemence and many local officers felt helpless at their inability to provide relief and support to those in need.

“In my 37 years as a police officer, I've never seen the number and type of mental health issues we're seeing,” Clemence said. “About 50 percent of the mental health calls we're going on are people under the age of 30. Twenty-four percent are under 17, and 26 percent are between 17 and 30 years of age. There's a huge substance abuse issue. COVID-19 is an X factor – we haven't had normal socialization, and people have been cooped up.

“Further, I firmly believe social media has helped create anxiety and feelings of lacking self-worth,” he continued. “It's purely speculation, but I see it a lot.”

Within the law enforcement tool box, officers usually have had one of two choices in dealing with individuals in crisis, if they were not a violent threat to the themselves or others in the community – they could drop them off at a local hospital, without any follow-up, or at the county jail if they were violent and had committed a crime in their delusional state. Clemence and other chiefs knew that neither was an adequate solution.

In an era when the mantras of “Defund the police,” “Black Lives Matter,” and other potentially adversarial catchphrases have entered the mainstream, and we have all witnessed unfortunate interactions between some officers and members of the public, especially people of color, there has been a movement within some law enforcement agencies across the country to address some of the problems they see by integrating mental health workers, usually a social worker, into a law enforcement unit. Some are called co-response teams, others crisis intervention team programs.

The National Alliance on Mental Illness (NAMI) said, “The lack of mental health crisis services across the U.S. has resulted in law enforcement officers serving as first responders to most crises. A Crisis Intervention Team (CIT) program is an innovative, community-based approach to improve the outcomes of these encounters. In over 2,700 communities nationwide, CIT programs create connections between law enforcement, mental health providers, hospital emergency services and individuals with mental illness and their families. Through collaborative community partnerships and intensive training, CIT improves communication, identifies mental health resources for those in crisis and ensures officer and community safety.”

NAMI noted that CIT programs often can bring community leaders together, offer police officers more tools in order to do their jobs safely and effectively because they are trained in both attitude and knowledge about mental illness. It can also reduce the number of arrests for people with mental illness while simultaneously helping them receive mental health care and follow up services.

Clemence felt a co-response team would be an ideal tool for his force – and likely some of the neighboring local departments as well. As they already share resources for things like HAZMAT and major crime investigations among other mutual aid services, Clemence reached out to Bloomfield Township Police Chief Phil Langmeyer and Auburn Hills Police Chief Ryan Gagnon to get their takes.

“The three chiefs had gotten together and chatted and talked about the number of mental health and the increase of issues because of COVID,” Langmeyer said. “We were going to the same places, many times over and over. We just didn't have the ability to help them, especially with HIPAA. We could refer them to Oakland Community Health Network. Thirty years ago when I started, we had options, there were mental health hospitals. They weren't perfect, but still. Now, we could only drop them off at hospitals, and we didn't know what would happen.”

Langmeyer said Oakland County has a plethora of resources, but police departments don't know how to take advantage of all those assets and opportunities.

Clemence's idea to share a dedicated social worker struck them all as a great idea.

“I don't have enough work to have one dedicated social worker full time – but three departments splitting someone – we're partners in lots of other programs,” Langmeyer noted.

“Clemence was certainly the visionary for this program, and gave me the latitude to go and explore it,” Gagnon said.

“Having us come to your home every other weekend does not help the underlying issue, and it is a drain on our resources,” Langmeyer noted. He added that “getting all our officers CIT trained, which is the highest level we can get, is a huge benefit.”

Birmingham, Bloomfield Township and Auburn Hills police departments studied crisis intervention teams and its benefits for law enforcement, and recognized the best benefit for them would be to develop a co-response team, ideally with an embedded social worker who would learn their departments from the inside out, and work with them to help their community members. Clemence said that Gagnon teaches mental health responders, and he suggested reaching out to and partnering with Oakland Community Health Network, a provider service network that assists approximately 23,000 Oakland County citizens at more than 300 service sites across the county. That, in turn, helped them find and hire Hillary Nusbaum, a social worker who, since August, works full-time with the three departments Co-Response (CoRE) Crisis Outreach Program, taking a 10-hour shift once a week with each, and is available at any time any department has a crisis call.

“I work with people who have suicidal ideations, delusion, psychosis, family trouble – where there are verbal altercations and they're getting destructive with threats of harm to themselves or family members, or with custody issues,” Nusbaum explained, as well as with domestic problems, where she said is often where physical issues come in.

Nusbaum said she is seeing suicidal ideations in all ages.

“Anxiety has heightened since COVID,” she said, “along with isolation, concerns about wages and employment, the housing crisis has changed.”

Prior to working on the CoRE Crisis Outreach Program, Nusbaum worked in three different school districts working with kids in crisis, and had been in private practice specializing in trauma, informed care, anxiety, depression, LGBTQ+ issues, among others. But law enforcement is in her blood – her father was the police chief in Coldwater, Michigan, and she said she always had an interest in policing – so much so that she had just finished a course in certified first responder counseling when the opportunity to apply for this job through Oakland Community Health Network came about.

All three chiefs rave about the work Nusbaum is doing – and the impact she has had already on their officers.

“She's been a welcome addition, and she's doing a wonderful job,” Clemence said. “She's adding a very needed service. With Hillary, before she ever took a call, we had her take as many rides with officers as possible so she understood how they thought, how they worked. In addition, we wanted the officer to get to know her and understand her role and how she thinks.”

“Our officers are responding very, very well. She's phenomenal,” Langmeyer said. “She fits right in. Her personality and outlook makes the difference. She's very comfortable and makes all the difference. She rides with the officers, spends time with the officers, to get comfortable with them so they feel they can talk to her about their wellness, too. She's become a resource for us here in the department – it's someone for us to go talk to. The job puts a lot of stress on our officers and this is one option to help them with their wellness.”

Gagnon agrees. “It's been really positive. It was really important to hire the right person because law enforcement and social work can have different objectives,” he pointed out. “Having her go on ride alongs and getting to know the staff was really important. When she shows up on scene when someone's in crisis, they know she knows what she's doing can help solve the problem for someone in crisis.

“She's the resource at the scene – before it was after the fact,” he noted.

Gagnon, like Clemence and Langmeyer, said the response from their officers has been extremely positive.

“Before we even introduced her, I got all four platoon commanders on board,” Clemence continued. “I made sure I explained the program, had them ask questions, understood their needs and concerns – what is her role, when we go on a call, who will be in charge? There is some stigma between social workers and police, and we're trying to get rid of that stigma.”

There has long been a disconnect between law enforcement and mental health professionals, with law enforcement toughing it out and those in the mental health world often viewing them as adversaries. That has been changing as there is a greater understanding of the disorders that affect mood, thinking and behavior, with society as a whole recognizing them as diseases rather than poorly informed choices.

Leah Jacobs, MSW PhD, University of Pittsburgh School of Social Work, said that researchers continue to fall along a spectrum when examining the criminal justice system and people with mental health disorders.

“Across the board, there is a recognition and agreement that law enforcement is being asked to do too much,” Jacobs said. “What to do about it is where they disagree. Those who are pro-law enforcement believe we must strengthen the police by training more effectively, using the CIT model, integrate social workers into departments so they have specially trained people who can respond to those with mental health problems.

“Even farther along the spectrum is the collaborative response which is a more distinct response,” she explained. That is where there is a call upon the community mental health and substance abuse based cooperatives to help provide assistance.

“Then even farther along the spectrum is 'Defund the police,'” Jacobs said. “It's 'why would we even strengthen law enforcement – why wouldn't we strengthen community mental health providers and behavioral health professionals?' Some people want to take current investments in law enforcement and shift them to social services and community-based organizations that are trying to promote collective efficacies and social cohesions, so communities can provide safety for one another. There are studies where communities are cohesive, this is an efficacious approach.”

Ultimately, Jacobs said the empirical question is – do you need a balance between law enforcement and a collaborative approach. She said that has not been answered by any randomized samples.

“They're really hard things to test for, for good reason,” she said. “But we need to be aware of the effectiveness or ineffectiveness of any of the programs. It's the broader implications I'm concerned about – why are we so inclined to invest in law enforcement, and not in community mental health. We now have a highly fragmented and inaccessible community mental health system and welfare state retrenchment, and now we're having huge issues. We're setting up people to have these problems. I'm very leery about spending more on law enforcement when we're the number one country in the world with incarcerated individuals.”

That concern jibes with Clemence, Langmeyer and Gagnon's concerns, as well.

“It's another layer of resources and services we didn't have before,” Clemence said, noting that Nusbaum has access and understanding of the resources Oakland Community Health Network has to offer. “We didn't bring in someone from the outside, but someone inside who knows all the programs of Oakland Community Health Network. When we co-respond, Hillary can stay there with the family and provide them with the resources. Our population is getting much older, and more services are needed. We don't want to embarrass them, but they have needs but don't want to be recognized as being needy. We want to be of service in a respectful manner that otherwise would not be addressed, in addition to the more serious mental health issues we face.”

“In Oakland County, there's a jail diversion program instead of just sending someone to jail,” Gagnon said, for individuals who have been arrested for disorderly conduct, trespassing, and “low level misdemeanors committed by people mentally ill at the time, they can be temporarily diverted to Common Ground voluntarily, and if they agree, then they will not be charged. This way, they can get the help they need and hopefully won't repeat the crimes in the future. Hillary has helped us with it, and helped us with with repeat offenders we've been going to. She can go to probate court and request hospitalization.”

“So far, we haven't seen any downside – it's all positive,” said Langmeyer. “We're really able to address the mental health issues we're seeing. All three chiefs, Hillary, Oakland Community Health Network, we meet monthly and coordinate so we address any issues that come up, because things are going to pop up. They're just minor procedural things, and they're addressed right there.

“The three departments work really well together and we've got a shared history,” he said. “That's the great thing about being close neighbors. A few positives came out of COVID, and this is one of them. It showed we needed to address mental health.”

“People with anxiety, depression, bipolar and more severe mental illness, react negatively with the police, and historically the police have not known how to address it (mental illness),” said Carrie Krawiec, LFMT, Birmingham Maple Clinic. “That leads to where people are hesitant to reach out to law enforcement. Even if it's only their perception, it's a negative reaction. A social worker can help walk you through the situation, make you feel more comfortable with the process. A trained social worker or trained officers can really help because it can influence how they see the situation, conceptualize what issues or triggers are playing out, and help the families as well to be supported.”

Krawiec noted that “no one wants to call the police out on their kids, but this can be a way where people can find find a way to get a loved one help without getting them in trouble.”

“I am very glad there are attempts to train the police. They are witnessing things everyday that are unimaginable for ordinary people,” said Alireza Amirsadri M.D., associate chairman of clinical services, Wayne State University School of Medicine who has been in crisis work, including with frontline workers, for over 30 years. He currently has a $1 million grant from the state of Michigan studying the traumas of first responders who have PTSD, and they are educating them on how to best recover.

Amirsadri noted that more than 80 percent of violent behavior is because of someone else – “a reactionary aggression to something or someone else,” which he explained is evolutionary for humans unless they are trained to not react. “With bias' on both sides, it is destined to be a fire that is not going to be extinguished. Police need to be trained in a supportive manner rather than a challenging way, because it puts others on the defensive – it puts you in an evolutionary challenge. It is a 'bullying' or judging attitude, and if they have a weapon, that can reduce many incidents to violence.

“What we are trying to do right now through our grant with the state is train first responders to be more oriented to this and help them when they encounter people as they are under stress or distress, as are their families,” he said.

It is a ripple effect. The officers then bring it home, Amirsadri explained, and that is why they often have difficult partnerships. They are transferring their own distress and stresses to their partners and children, “and then the children endure the impact, and their longevity, health and welfare.”

By adding in a mental health wellness component to the culture of policing, both within the department and in their law enforcement work, it is working to remove the concept of “other,” he said.

“The culture of 'other' is very pervasive in policing,” which Amirsadri said is an evolutionary phenomenon. “By telling them you're working here, you don't think of them as 'other' – you are part of the community and one with them.”

The UC Center for Police Research and Policy, University of Cincinnati, supported by a grant from the Department of Justice, assessed the impact of co-responder team programs and their best practices. “The co-responder team model for behavioral health crisis response is a police-based intervention that pairs trained police officers with mental health professionals to respond to incidents involving individuals experiencing behavioral health crises. This collaborative crisis response model aims to improve the experiences and outcomes of persons in crisis by providing effective crisis de-escalation, diversion from the criminal justice system, and connection to appropriate behavioral health services. Supporters of the co-responder team model highlight the cost-effectiveness of this response, suggesting its capacity to alleviate pressure on the criminal justice and health care systems. Although not without limitations, the available research examining the processes and impact of co-responder team programs suggest this model may have value for crisis response.

“This research provides preliminary evidence of the promising effects of this response model in (1) enhancing crisis de-escalation, (2) increasing individuals’ connection to services, (3) reducing pressure on the criminal justice system by reducing arrests, police detentions, and time spent by officers in responding to calls for service, (4) reducing pressure on the health care system by reducing emergency department visits and psychiatric hospitalizations, and (5) promoting cost-effectiveness… The co-responder team model has been implemented across many communities hoping that joint police-mental health response to behavioral health crises will facilitate crisis de-escalation, reducing the frequency and severity of officer use of force and the risk of civilian and officer injury during these interactions. Few evaluations have assessed the impact of co-responder team programs on crisis de-escalation. The limited evidence suggests co-responder teams may be effective in de-escalating crises… Supporters of the co-responder team model for crisis response suggest using co-responder teams in the community can alleviate pressure on the criminal justice system by diverting individuals in crisis away from the system.”

The conclusion of the UC Center for Police Research and Policy study concurs with University of Pittsburgh's Leah Jacobs that more research must be conducted on the co-responder model between law enforcement and social workers because “The use of the co-responder team model across communities has resulted in substantial variation in the definition and delivery of co-responder team programs. In many cases, this variation is a product of efforts to tailor co-response to the specific needs of communities.” It also criticizes the lack of consistency in methodology of research.

“It's a great idea, but the distinction of the calls that are mental health-based versus a violent crime is an issue,” said Barry Goetz, PhD, professor of sociology, program in Criminal Justice, Western Michigan University. “One of the struggles they are having to determine is when is it a true threat versus a mental health issue.

“It's all great – as long as they can sustain it, because 10 percent of all (police) calls involve mental health issues,” Goetz noted. “Most police calls are not for serious issues. For a lot of rank and file officers, they're willing to do it up to a point, but not to the point where they have to redefine what their jobs are. If police officers say, I'm a crimefighter, I don't want to deal with these social issues, what then?”

Goetz worries about the sustainability of the programs once grants run out.

“Instead of relying on a grant to fund these programs, incorporate it (the social work and CIT training) into police academies so they can learn it” from the beginning, he said. “You're going to need a bigger boat. One or two social workers aren't going to do it. Police officers want to fight crime.”

Birmingham Chief Mark Clemence fervently disagrees.

“I truly believe this model we're working on has the potential to change how law enforcement and mental health professionals can work together because what this program does is put us on the same team,” he said. “Some programs just want social workers, but that scares me to death. You don't know what you're walking into – we're trained in how to de-escalate a violent person, and social workers aren't, physically.

“This program shows how a police officer can co-respond with social workers, because both know their role,” Clemence explained. “A social worker can talk to a person, and a police officer is there if the situation turns physical or violent. The key is you have to have buy-in from both sides. No one is trying to protect their turf. For the first time, we're working together.”

He said the difference between the CoRE Crisis Outreach Program and other crisis intervention training programs is not only they are working together, but they have very strict set of rules on both sides; they meet monthly to review issues, see how to improve, and connect people with resources; and “because we're working so well together, we’ve removed barriers that were impediments to success between law enforcement and social work.”

The three local municipal governments approved the inter-local co-response team, with start up costs at approximately $45,000 per agency. But first, it needed to be funded. A proposal in spring 2021 from the three chiefs garnered a $75,000 grant from the Community Foundation of Southeast Michigan to help it launch in September. That was followed up in July 2021 by an announcement from Congresswoman Haley Stevens (D-Birmingham, Auburn Hills) that she had secured $260,000 in federal funding for the co-response program.

“This federal funding will facilitate the hiring of two mental health clinicians who will be contracted by the three participating agencies from OCHN,” Stevens' spokesperson Larkin Parker said. “It will also provide a vehicle and communication equipment for the clinician so that they can have flexibility to move about freely among the three communities, to respond to crisis situations and follow-up with families, the hospitals, and courts. Funding will also provide much needed Crisis Intervention Team training and Mental Health First Aid training to 100 percent of all sworn police officers in all three agencies (150 police officers).”

Nusbaum's salary is split by the three communities, and with the federal grant secured by Stevens, Birmingham, Bloomfield Township and Auburn Hills will be able to hire a second social worker as well as to train 100 percent of the officers from all three departments in CIT.

“We're certainly excited about that because it will give us more coverage,” Auburn Hills' Gagnon said. “Hillary is only one person.”

For example, between October 1 and December 31, 2021, Nusbaum worked with 132 referrals from all three police agencies; there were 47 referrals just from Bloomfield Township police. Referrals have come from police dispatch or from officers answering calls for which Nusbaum was not immediately called.

Several other police agencies are now requesting to participate in the CoRE Crisis Outreach Program, recognizing their success and looking to incorporate it into their department, including the Oakland County Sheriff's Department and Troy Police Department.

Oakland County Sheriff Michael Bouchard has seen the need for mental health care since he was a street officer, he recalled.

“When I became sheriff (1999), about eight percent of the population was on meds,” he said. “Now, pre-COVID, 43 percent of the population is on psychotropic medications. Now if you look at the jail populations, the largest mental health provider in America are the county jails. It's not the best place for the person with mental health challenges or for the facility.”

Many years ago, he said, with that in mind, he launched an initiative to divert an individual in mental crisis to treatment at Common Ground, which has relocated to the Oakland County campus. He also has a full-time PTSD expert on reserve with his SWAT team.

“Having him as part of our agency has informed our training process for officers to identify PTSD, chemical dependency and acute mental illness. He has also gotten called out for barricaded gunmen,” Bouchard said.

Adding a full time clinician as a co-response person can inform their calls, help with their techniques and procedures, “and keep people safe and informed on mental health,” he said. “We have a lot of layers working on this. Our folks are great about this. If we can diffuse a situation, all the better. So many calls have a mental health component or a chemical component.

“We have a proactive mentality,” Bouchard said. “You don't need to defund the police to fund mental health. 'Defund' is a false concept. If you take money out of police services and give it to just to mental health, you create a whole new set of problems. It's give more funding.

“Fund mental health – but give more money for better training for best practices. You've got to come at it from a lot of different angles. You try to do the best you can in any situation, and the more training and equipment and tools you have, the better it turns out.”