Historically, a person experiencing a behavioral health crisis may find themselves first encountering a law enforcement officer, which often results in the person ending up in a hospital’s emergency department or jail.
Today, however, some communities are changing how they respond to 911 calls involving people with behavioral health conditions. Some police departments are pairing officers with behavioral health clinicians to respond to mental health emergencies and get people the help they need.
One of those behavioral health clinicians is Stephanie Williams, a licensed professional counselor and licensed addiction counselor, in Fort Collins, Colorado.
“We respond to a variety of calls,” said Williams, a 2012 graduate of the Adler University Master of Arts in Forensic Mental Health Leadership program, who currently serves as a co-responder program supervisor with UCHealth. “It can be suicide attempts or threats. It can be a traffic stop or maybe someone’s having a panic attack. It can be a domestic violence incident where someone on scene, typically the victim, is having a difficult time emotionally regulating and understanding what’s going on.”
Although relatively new, co-responder programs in Colorado are already demonstrating positive outcomes for law enforcement and people with behavioral health conditions, according to “Responding to Behavioral Health Needs,” a June 2020 report by the Colorado Office of Behavioral Health Department of Human Services.
From August 2018 to August 2019, co-responder teams in Colorado responded to 4,357 calls. The report found that the co-responder teams were more likely to report success in diverting Coloradoans from formal actions, such as arrests, mental health holds, and emergency department transports. Instead, the teams were more likely to connect residents with much-needed support, and the program improved interactions between law enforcement and community members.
Williams shares some insight on the impact of co-responder programs on the community and criminal justice system, how Adler shaped her career, and why she sees co-responder programs as the future for law enforcement across the country.
In its most distilled form, what is a co-responder program?
A co-responder program is pairing a behavioral health provider with a law enforcement officer to respond to in-progress 911 calls that have some type of a confirmed or suspected behavioral nexus. In Fort Collins, our team operates in a primary response model in which the clinician and officer ride together and respond to calls at the same time. The goal of our co-response program is for us to divert people, when appropriate and possible, from unnecessary emergency department visits, tickets, and/or arrest. We help put people on a trajectory of care instead of incarceration.
Why is it important to divert people experiencing a behavioral health crisis from arrests, mental health holds, or emergency department transports?
What we’ve identified is that, as many of us know, our justice systems are becoming more of a holding place for individuals struggling with any kind of a behavioral health issue. Additionally, we are finding 911 calls are a common way for community members to access health care with support from a provider who knows how to navigate the health care system and can help them ensure they get connected to the right care, at the right time, in the right place.
When I graduated from Adler, I worked with community members recently released from prison, often after lengthy sentences. A common theme amongst their stories were myriad factors related to poverty, lack of (access to) resources, lack of support, trauma, and more. In those moments, I realized that if a clinician had been with officers at the time of the initial 911 call, some, if not many, could have been diverted from the long-term ripple effect of justice involvement.
According to the Colorado Office of Behavioral Health report, 35% of the inmate population in Colorado has a mental health need, and 74% has a substance use disorder.
This is the result of legislation and laws over the past decade that were well-intended but had unintended effects. Those effects include the fact that we see a disproportionate number of people in the criminal justice system who have a behavioral health issue that might be undermanaged.
In your experience, how has the co-responder program evolved over the years?
I began working in co-response in 2018 when it was still a very new idea here in northern Colorado. Over time, we’ve utilized mixed methods research and action-based research to finetune the design and delivery of our program. In the last five years, we’ve experienced four iterations of our program, each driven by data and community input, and with each iteration, we’ve provided a better product to our community. A big learning for us is that these programs have to pivot in real-time with the needs of the community they serve to be most effective.
In addition, we found these scenes are dynamic, even if initially stabilized. You’re dealing with someone in the middle of a crisis that has, sometimes completely, changed their plans and ideas of what their future would look like. Things often have been building to a crisis, then the crisis occurs and is often coupled with some form of substance use, social factors, and/or medication non-compliance. All of these factors, and more, create an unpredictable situation that can stabilize and rapidly de-stabilize, too. An example of this is when I was early on in my work as a co-responder, I was on a scene that quickly changed, and I thought I was going to be shot. From that point forward, I advocated for a co-response model in which the officer remains on scene with the clinician and ballistic vests. Although I’m here to help, I’m not willing to lose my life in the process if I can help it.
Do you see these types of co-responder models expanding around the country?
Absolutely. Co-response has been around since the late ‘80s, early ‘90s. It just wasn’t talked about very much. From my knowledge, Los Angeles, as well as departments in Oregon, helped developed these programs. In addition to co-response, other models of innovative responses are cropping up, like mobile integrated care (MIH), in which a nurse or paramedic might go out with a clinician and/or officer to respond to calls with a focus on a more holistic approach covering the legal, medical, and behavioral health needs of community members.
Here in Colorado, these programs are rapidly starting and growing, not because officers aren’t good people or they don’t know what they’re doing, but because officers are dealing with individuals who are experiencing very complex issues that would be a challenge for some experienced clinicians.
I have so much more appreciation for what an officer goes through every day now that I work alongside one and see what it’s actually like responding to calls. For example, as my officer partner and I respond to calls, he takes on a variety of roles from officer to brother to father to mentor and more. These models of response are an excellent intervention, but the solution lies in funding and updated legislation to remedy the core problem leading to community members with significant behavioral health needs interfacing with public safety at elevated rates.
From your perspective, what are other solutions or ideas that could help divert people experiencing a behavioral health crisis from the criminal justice system?
I’ve learned Crisis Intervention Training (CIT) courses are a great option to help officers bolster their knowledge and skills when working with a community member in crisis, however, it’s unfair to expect an officer with 40 hours of crisis training to have the same skill, knowledge, and insight that a seasoned, licensed clinician has. Many of the calls we go on, experienced therapists would struggle with – that’s the level of illness we are seeing. The great thing about models such as co-response and MIH is we are providing a wider range of response models and tools for our public safety partners to utilize to provide a high level of service. Models such as these also lead to public safety partners having more knowledge and skill as a result of working alongside a health care professional who specializes in this work, so when we aren’t on shift, the officers have more training and experience than they would if we weren’t part of the team.
Again, and as we often see, a tertiary response to a primary problem isn’t congruent or as effective as a primary response to a primary level problem. We need to focus on the root cause – antiquated legislation and lack of federal funding – if we don’t want public safety, emergency departments, and jails to be community members primary method of accessing appropriate, meaningful care.
Do you think this model might open the door for increased resources in regard to mental health, specifically in training and resources for officers?
That’s a great question and as I’ve alluded to, I don’t necessarily think that’s THE answer, but a step in the right direction. In this way, I see co-response and mobile integrated health care as the future of law enforcement in some regards in which maybe there is a clinician and/or paramedic or nurse on every shift to fill that need as opposed to expecting officers to wear yet another hat.
Lastly, how did your time at Adler prepare you for your role as a co-responder?
I cannot tell you how impactful going to Adler has been for my career. It has given me such a lens and edge that I don’t think I would have gotten from any other program, especially given that social justice perspective. Adler was the option for me because the University’s mission aligned with who I am. Even as I progress in my career, I’m seeing more and more the edge Adler has given me, and how that lens of social justice has affected every aspect of my work.