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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.