By Nick Greco

Editor’s note: Last week, CIT Coordinator and law enforcement mental health expert Nick Greco discussed the frustrating issues cops face while responding to calls involving people in mental crisis. Lack of funding for treatment, mental health system follow-through and institutional capacity to handle an influx of mentally ill individuals results in a  seemingly endless cycle of repeat responses that taxes law enforcement personnel and resources.

In this second installment looks at ideas—both good and ill conceived—that may help reduce the burden on officers and agencies and break the cycle of repeated calls to respond to the same issues with the same people.

Here are Nick’s thoughts on possible solutions:

One poorly thought-out idea is to take funding from other areas such as public safety and reallocate that money to social service programs. While that sounds as great on paper as did deinstitutionalization and makes for a great sound bite for a politician, it is merely a reactionary measure to the continued poor decision making and lack of funding for the mentally ill which has been going on since the 1960s. It is simply robbing Peter to pay Paul with no real plan in place when the money runs out. Mental health programs need to have a structure and a plan in place. It is not so simple to take money from one entity and give it to another, especially when underfunding has been the norm. Reactionary measures such as these often fail.

As a CIT trainer and coordinator, I am a strong proponent of CIT, and its value is immeasurable to the officer on the street. Sadly, I know it is merely a band aid for a much larger problem as CIT only deals with the crisis now, not the need for resources once brought to the hospital and the necessary aftercare. Hence the vicious cycle of officers being called to the same home numerous times and bringing people to the hospital just as often only to be discharged a short time later continues.

The idea that reallocating funding from the police is somehow going to help those with mental illness is shortsighted. Why? Because police agencies need money for training, like CIT training, and to cover the overtime while officers are in that 40-hour CIT course and someone else is covering their shift. Not to mention the numerous other training courses, oftentimes unfunded mandates required by cities and states.

Let’s look at some realistic solutions.

The first obvious solution is to separately fund mental health care, more so than has been done in this country. This is not going to be accomplished by taking money from other agencies only to detrimentally impact those existing services, like our needed police forces. Earmarking specific funding for mental health would allow for community mental health centers along with crisis centers that could be an option from going to the ER. Crisis Triage Stabilization Centers offer such an option. These centers offer 23-hour observation and stabilization to assist those struggling with a mental health crisis. They also allow for officers to drop off individuals that would have normally been brought to the ER or the jail. In 2021, the Department of Justice approved a $750,000 grant in Lake County, Illinois for this program. This type of program has been successful at helping to divert persons with mental illness out of the criminal justice system and towards actual help that they need. Crisis stabilization programs such as this are what we need more of. Those not taking their medications or those waiting for an outpatient appointment and need medication are exactly what this stabilization center can do. This, in turn, frees up the ER as well as needed police resources.

Alternatively, some emergency rooms have gone a step further by having hospital-based psychiatric emergency rooms to stabilize persons within 24 hours, freeing up needed inpatient beds, and getting the person on the path to recovery. Once again, this allows for more structured treatment which helps to break the cycle of going in and out of the ER. Officers having to transport persons to a State Mental Health Facility can also be avoided by utilizing these two types of interventions as typically 70-80% of psychiatric emergency room patients can be successfully stabilized and returned home or to outpatient treatment in less than 24 hours. This may also significantly reduce the need for certificate and petitioning/involuntary commitment, 5150, chaptering etc., as the person may be more willing to go to a crisis center than a hospital.

Many of you are thinking, this sounds good, but what about those people who still interact with the police, with a CIT trained officer? How do we keep them from repeating that cycle of law enforcement going back and forth to their house monthly, weekly? Here in Lake County, IL the Crisis Outreach and Support Team (COaST) program was started in 2018 and what started out as a pilot program, has now been made a permanent part of the department. The COaST program supports persons with mental or behavioral health illnesses who interact with law enforcement. The team has one deputy and one licensed mental health counselor, who within three days of a law enforcement officer having a mental health interaction, the COaST deputy arranges a meeting or cold call their residence. During that meeting, the deputy does a well-being check of the person and determines if they have sought any treatment or services since the initial event. The deputy then provides a “warm handoff” to the Health Department counselor, who conducts a brief assessment, and if necessary, refers the person to appropriate services.

While this program is not a new idea, it is effective. Many communities across the United States have seen success implementing these types of programs, resulting in a reduction in law enforcement interactions with people having a mental illness. These programs are also shown to reduce the likelihood of individuals being arrested or re-arrested. The COaST program to date has successfully contacted 83 percent of the referrals to offer and help set up service to those with behavioral health and substance abuse challenges. The program has also expanded to include several municipal agencies along with the Sheriff’s Department.

Let’s not forget something else that keeps popping up every so often, and that is having social workers going alone to handle crisis calls. Once again, sounds tempting right, but is it realistic? The short answer is no. Let’s face it, EMS won’t even go in until LE clears it. How can we expect to send an unarmed social worker into an unknown situation that has the potential to turn violent? There is no such thing as a routine crisis call nor this idea that social workers can respond to non-violent crisis calls. How would that be determined? What percentage of certainty would dispatch be able to give to say, without a doubt, that the crisis call is non-violent? Here is something for our politicians to also consider. Thanks to the negativity and defunding talk over the last 3 years, we have less police officers. And while you could have a lone social worker respond to a crisis call, what happens when he or she needs to call 911 to assist and there are no available units to respond? This is where I want to emphasize one of my original points to independently fund mental health without taking away other vital services to the community. If anything, let’s have an officer and a social worker respond together to these crisis calls, not separately. Let’s create a unit designated for crisis calls only (think of Ernie and Joe – Crisis Cops). The point is if we are really going to address mental health in this country, it will not be from sacrificing one thing for another. It is going to be sitting down, politicians, police, healthcare, as well as community members and truly making a plan that gets away from band aid approaches to real meaningful community resources. Start with a solid CIT program that has follow up, have hospitals with psychiatric emergency rooms, have a crisis stabilization unit, and please have and adequately fund outpatient community mental health centers so people have somewhere to get proper care. This is how you start to create meaningful results. This is how you break the cycle. This is how you solve problems instead of repeating them year after year.

Thoughts? E-mail us at: editor@calibrepress.com

About the Author

NICHOLAS GRECO IV, M.S., B.C.E.T.S., C.A.T.S.M., F.A.A.E.T.S., is President and Founder of C3 Education and Research, Inc. Nick has over 25 years of experience training civilians and law enforcement. He has directed, managed and presented on over 700 training programs globally across various topics including depression, bipolar disorder, schizophrenia, verbal de-escalation techniques, post-traumatic stress disorder, burnout, and vicarious traumatization. Nick has authored over 325 book reviews and has authored or co-authored over 45 articles in psychiatry and psychology. He is a subject matter expert for Police1/Lexipol and Calibre Press as well as a CIT instructor for the Chicago Police Department, CIT Coordinator and Lead CIT Trainer for the Lake County Sheriff’s CIT Program as well as other agencies. Nick is a member of the International Law Enforcement Educators and Trainers Association (ILEETA), IACP, IPSA, LETOA, and CIT International, Mental Health Section Chair for IPSA, Co-founder of Protecting the Guardian, and a member of the Wellness support team for Survivors of Blue Suicide (SBS).