Calling for backup
Mental health clinicians work with police officers in Framingham to make referrals instead of arrests
the framingham police officer called for a different sort of backup. He was at a department store in a local mall where a woman suspected of shoplifting was acting strangely. She was visibly upset and didn’t seem to be a sophisticated criminal, so the officer called in the department’s mental health clinician.
By the time the clinician arrived, the woman was in the mall’s parking lot, surrounded by the responding officer and mall security. She was screaming and crying, alternately shoving stolen shoes under parked cars and searching frantically for an escape route. Eventually she was ushered back into the store, where the mental health clinician was able to calm her down. The woman claimed to suffer from anxiety and depression and the clinician took note of her incoherent speech patterns and unstable mood; a security tape revealed that she had been sporadically pulling items from the shelves for more than three hours.
The clinician recommended treatment instead of arrest. The store manager and the policeman agreed, and the woman was directed to a mental health treatment program. She received the care she needed and taxpayers avoided the cost of an arrest and court proceedings that would have benefited no one.
Craig Davis, Framingham’s deputy chief of police, says he recognized the need to change how his police department dealt with the mentally ill a decade ago. “We were handling these folks in the wrong manner. We were arresting them continually for minor offenses. We weren’t providing any service to them, or the community,” he says. “It was a cost to the police department and it was also a cost to the local emergency room where we were taking these folks when we weren’t arresting them.”
In 2011, Ride-Along teams in Framingham responded to 683 calls involving a mentally ill person and made decisions that saved an estimated $544,000 in booking, jail, or emergency room costs, far exceeding the program’s annual operating budget of $120,000.
Records indicate 150 of the 683 calls involved the commission of a crime, of which 124 were nonviolent, such as trespassing or disturbing the peace, and 26 were violent. The 26 individuals who allegedly committed violent crimes were arrested, but the 124 nonviolent offenders were referred to treatment instead of jail. The other 533 incidents didn’t involve a crime, and the individual was typically referred to treatment. In 58 of those cases, the clinician’s onsite assessment saved a needless trip to the emergency room, according to Framingham officials.
Officials at the Department of Mental Health say that, in the short term, a Ride-Along program diverts costs that would normally be incurred by the criminal justice system on to the mental health system. Over the long run, they say, money will be saved as the conditions of the mentally ill are stabilized and their contacts with the justice system dissipate.
The 10-year-old Framingham program is the outgrowth of a growing recognition that people with mental illness all too often become entangled with law enforcement and the justice system in ways that could be avoided. A majority of the crimes committed by those with a mental illness in Massachusetts are nonviolent. But oftentimes their first arrest is the beginning of a self-destructive odyssey that sees them cycling between the courts, prisons, and probation system. Rather than receiving the psychiatric treatment they need to take control of their disorder, they are punished in a manner that only serves to perpetuate their situation.
Framingham’s Ride-Along program isn’t the only working model for diverting the mentally ill from the criminal justice system. Communities in Tennessee, Florida, and Ohio rely on crisis intervention teams consisting of volunteers from local police departments who undergo an intensive, 40-hour course on handling situations with the mentally ill. (Police academies typically offer only four hours of training.)
In Taunton, a variation of this program has been operating for more than 10 years. Some courts in Massachusetts also set up special sessions to steer offenders with mental health issues to treatment programs, much as they do for offenders with drug problems.
Vic DiGravio, president and CEO of the Association for Behavioral Healthcare in Massachusetts, a nonprofit advocating for community-based mental health services, says, “There is no ‘best’ program or practice” and communities need to decide what works for them.
“Our officers are dealing with people in all walks of life,” Davis says, “from kids who are out of control in school to elderly people who live alone hearing voices and everything in between. We don’t have the resources or training to deal with it, which is why the embedded clinician has been so successful. These habitual contacts with profound mental illness will now shift over to the mental health system, and sometimes we never see them again, which is exactly what we want.”
Framingham’s Ride-Along clinicians come from Advocates Inc., a nonprofit agency based in Framingham that provides services for people with intellectual, developmental, and mental health needs.
Sarah Abbott, an Advocates employee who coordinates the Ride-Along program, says clinicians have a number of options when dealing with the mentally ill. “Some people just need de-escalation and stabilization in the moment. Some need more,” she says. “It can be outpatient treatment, say, meeting with a therapist once a week, all the way up to hospitalization, with a number of options in between.”
With near-universal healthcare coverage in Massachusetts, Abbott says diversion teams rarely encounter a person who is unable to afford some level of treatment. But for the few who are uninsured, there are organizations that will provide basic mental health services free of charge.
Abbott says the program works because police officers have a lot of discretion in responding to criminal behavior. In an email, she says, “There are a few circumstances under which a police officer has to make an arrest (e.g. felony or domestic violence), but for these low-level offenses, where there is typically no victim, they can choose to divert to a more appropriate treatment outcome.”
She says the police come into contact with people on a daily basis who mental health organizations would never see ordinarily, even though they are often the people who most need their help. “It’s a great way to get them into the mental health system and out of the criminal justice system,” she says.
Davis and Abbot say their program has helped build a stronger relationship between police officers and mental health workers.
“When a clinician isn’t available, we contact Advocates’ psychiatric emergency service, which is a 24-hour information network,” says Davis. “It’s just second nature for us to reach out to them. Whereas before, it was a distrustful, cold relationship. We would only call them when we really had to. But when we got the program running, we realized we were dealing with the same folks and we have more in common than we thought.”
“We need a more professional and appropriate response and we need to be willing to spend some additional dollars,” says O’Day, who worked as a social worker for 24 years before taking office.