Cop or counselor? Wilmington Police Department's evolving relationship with mental health workers
One part of the debate over police reform is the use of mental health professionals on calls for service. The Wilmington Police Department has worked with a mobile crisis unit for over five years. So what’s this relationship like -- and how could it evolve in the future?
Police respond to a wide range of calls, but there's always a chance a situation will involve someone experiencing a mental health crisis.
Wilmington Police Department Lieutenant Leslie Irving gave an example of one of these scenarios. She said recently they were called to respond to an elderly woman having hallucinations. When they arrived on the scene, Irving said she wouldn’t open the door.
“But what we’re not going to do is force a confrontation, because how is that going to end, you know? So we end up calling the mobile crisis to come out and talk to her, to try and encourage her to seek medical attention,” said Irving.
WPD has a partnership with RHA Health Services. If police determine they need their expertise, they’ll dispatch a mobile crisis team to the scene.
Tom Pittman is a clinical mental health counselor. He was most recently the lead for one of RHA’s community support teams: “Wherever the situation is, the police determine the safety of the situation, make sure that the person has no firearms or any kind of weapons, and then let the licensed clinical person do their job. And I mean, there have been times when I told the police, ‘I think we can handle it from here.’ There's been times when it's kind of like, maybe y'all need to hang around. I've not personally experienced a situation where I had to ask the police to stay.”
Both Pittman and Irving agree: that even on mental health calls, they said, one can never know if the situation could turn violent. But behavioral health researchers said that this is not often the case.
Dr. Allison Gilbert, who is an associate professor in Psychiatry and Behavioral Sciences at Duke University School of Medicine, said, “people with severe mental illness are far more likely to be victims of violence than to be perpetrators of violence. I think there can be a lot of misunderstanding about somebody who is in an acute mental health crisis, and levels of dangerousness around that.”
Gilbert is currently in the midst of a three-year study of the Law Enforcement Assisted Diversion (LEAD) program in North Carolina. She said the idea of the program is to, "use their discretion to be able to refer people [for treatment] who use drugs in the community, instead of arresting them for low-level offending where there are no crime victims, things like shoplifting, prostitution, or petty theft. [If there is no diversion program], they will often end up in a revolving door situation with being arrested and incarcerated repeatedly. What this program does allow officers to refer somebody that is in that set of circumstances to harm reduction or treatment services instead of arresting them."
The Wilmington Police Department is a part of this LEAD program, but Gilbert did not disclose the participating departments in her study of the program's effectiveness.
Dr. Marvin Swartz is a professor in the Department of Psychiatry and Behavioral Sciences at Duke University and is a member of the Wilson Center for Science and Justice at Duke Law School.
Swartz said there are mainly three ways of thinking around the relationship between law enforcement and mental health professionals. One is the traditional way, in which law enforcement responds first, then determines if a counselor is needed. The second is where there's a co-response with police and the health professional, and the new way of thinking, he said, is to have a mental health professional respond first, then call law enforcement if needed.
Balancing law enforcement and mental health workers
Swartz said there have been some nationwide efforts, like the Crisis Assistance Helping out on the Streets (CAHOOTS) program in Eugene, Oregon, where they dispatch a mental health professional before the police are called.
“This is all part of trying to lighten the load on police officers who are called on for too broad of a set of responsibility. And so trying to sort of divert the behavioral health one to a standalone [service], I think is the way a lot of people are trying to go. [...] In part because if police are the first responders, then you're getting a law enforcement response, as opposed to a behavioral health response. We're trying to flip the relationship so that the law enforcement response is the last resort,” said Swartz.
With the mental health professional responding first, Swartz said that it takes a knowledgeable dispatcher to “sort out situations in which someone is potentially violent in need of police presence, but from what I understand that’s actually a fair minority of the calls for [mental health crises].”
Lieutenant Irving said for mental health calls, she can see a future where there’s an immediate co-response -- police and counselor. Because right now, she said it can take up to 60-90 minutes for the mobile crisis unit to arrive.
“I’m up for hiring counselors to work with us. And if we can have counselors on every shift; I’m really good with that, too. So if we get a call that we think requires a counselor to go with us, I’m not opposed to that. Because instead of having a 30-minute response, an hour response, the counselor is right there," she said.
Irving said, as of now, there really isn’t a good way to track how many times the crisis unit has responded to a call for service. They are sometimes noted in the officer’s narrative of the call, but she said she’s looking into ways that they can easily check a box if they’re called to the scene. “Both mobile crisis units and CIT [crisis intervention team] officers need to be utilized more [when there are calls for mental crises],” said Irving.
According to Wilmington Police Chief Donny Williams, over half of his staff are certified as part of a crisis intervention team, or they’re known as CIT officers. He said his goal is to have all of his officers go through this training, which teaches them to divert people with a mental illness away from jail and into treatment services.
Swartz explained some of the week-long, 40-hour program:
“The core of it is teaching officers approaches to people who are suspicious or inebriated, how to engage them rather than confront them, how to work with people in crisis, as opposed to coming at them with a law enforcement response. How do you engage and talk to people? How do you de-escalate a situation in which there may be hostility?”
Irving said CIT training gives the officers a chance to recognize:
“Somebody who’s in crisis, someone who's in a manic state; when it’s a drug overdose versus someone who’s off their medication. You need to recognize these differences. I mean, it’s able to recognize someone who’s having a bad day versus someone who is schizophrenic and hasn’t taken their medication in a couple of months because they couldn’t afford it.”
Swartz said if appropriate, the CIT-trained officer would transfer the person to a mental health professional, so they could determine the next steps for support.
The need for more resources
Both Swartz and Gilbert said CIT is a good program, but that it probably doesn’t go deep enough to give police all the tools they need to address mental health emergencies. Gilbert, in particular, said it’s also important for any officer to ‘buy in’ into the certification process so that it’s effective.
Even though the Wilmington Police Department has these CIT officers, Lieutenant Irving said during these mental health crises, officers are put in a tough situation: “We can’t be medical professionals; we’re caught between a rock and a hard place because we know this person needs professional help, medical help, not jail.”
But according to Swartz, one thing that’s getting in the way of this paradigm shift is a shrinking pot of money for these resources: “The legislature has reduced the funding for uninsured people, and because we haven’t expanded Medicaid there’s many more uninsured in the state.”
And while a crisis counselor can show up regardless of a person’s insurance status, follow-up care can be affected. Swartz said funding cuts can also translate into a lack of local infrastructure:
“Because we have a shortage of beds, a shortage of community resources, emergency rooms are getting clogged up with people with mental illness and are overwhelmed by it. Then that means that other people with medical needs can’t be addressed as quickly, so the idea is to try to divert people from emergency rooms to freestanding crisis centers," he said.
But these crisis centers are hard to come by -- Tom Pittman, who saw the issue up close with RHA, said it’s usually a trip to New Hanover Regional Medical Center if the person is in dire need.
Swartz said a good example of a comprehensive crisis center is UNC Health Care Crisis and Assessment Services at WakeBrook in Raleigh, North Carolina. But these aren’t necessarily part of the landscape in the Cape Fear region.
While the Healing Place of New Hanover County, which will have 200 beds, is set to open in May 2022, it’s mainly a drug and alcohol detoxification facility.
There is, according to Gilbert, an intersection of mental health and substance use disorders: “Among people with mental illness, when they do have co-occurring substance abuse, that puts them at a much higher risk for criminal justice involvement. And so an interaction with a police officer, it really depends on what resources are available to police to potentially divert the person away from continuing in a criminal justice pathway, but instead diverting them to a range of crisis services.”
According to the county’s website on the Healing Place, it lists that it costs $35 per day to operate, “which is much lower than the cost of an emergency room visit or incarceration.”
Potentially, for those who suffer from mental illness while also having substance use disorder, both RHA and WPD will be able to use the resources of the Healing Place.
In essence, Gilbert said, “a running theme is that for any program, or collaboration between law enforcement and human service providers or social service providers to succeed is that there needs to be capacity and availability of those kinds of services and resources for that to work.”