SAN JOSE - OCTOBER 15: San Jose Police officer Emerald Perkins, left, officer Dionna Grant, center, and Sgt. Jason Barton, right, members of the Mobile Crisis Response Team stand next to each other before a press conference outside of the Don Lowe Pavilion in San Jose, Calif., on Thursday, Oct. 15, 2020. (Randy Vazquez/ Bay Area News Group)

Police responding to citizens’ mental health episodes without the benefit of a trained professional will soon be just an afterthought when the city launches a pilot program next month. In 13 Chicago neighborhoods, certified mental health specialists will accompany police responding to calls regarding someone undergoing a crisis. Mental health workers and even some police officers have long maintained law enforcement isn’t always equipped to handle someone going through a mental lapse, regardless of the severity.

The pilot program will send teams consisting of a paramedic, police officer and mental health crisis intervention professional and is set to begin in August. Communities on the  West Side, North Side and South Side have been identified. 

The program, Crisis Assistance Response and Engagement (CARE), was announced in June at Mayor Lori Lightfoot’s Violence Prevention and Reduction committee meeting.  The targeted communities include; Auburn Gresham, Chatham, Chicago Lawn, East Garfield Park, Gage Park, Humboldt Park, Lakeview, North Center, Uptown, West Garfield Park, West Elsdon, West Englewood and West Lawn. Officials  have yet to announce how long the pilot will last. The majority populations in these communities are either African-American or Latino.

Amy Watson, who has studied issues involving persons with serious mental illness that come in contact with the criminal justice system noted, although there isn’t much research on the kind of program the city is piloting; however,  some evidence suggests they can reduce unnecessary transports to emergency rooms and increase connections to mental health care. Individuals in distress often experience long wait times in the emergency room, according to the National Alliance on Mental Illness (NAMI).. Reducing unnecessary visits can help individuals get the help they need sooner.

“Having the clinician there can help determine that doesn’t need to happen whereas if it’s only an officer, the officer will err on the side of caution because they don’t have the training to do that assessment,” she added.

Calls for reform have also been driven by the large number of people with mental illness in jails and prisons. On any given day, between 25 to 30% of the individuals in custody at Cook County jail suffer from mental illnesses, according to the Cook County Sheriff’s office. That’s upward of about 2,000 inmates among the county jail population, which sometimes reaches more than 9,000 inmates.

The pilot is part of an effort to take a “public health approach” to crisis response and to look toward other places to take those in crisis “besides the emergency room or a lockup,” Lightfoot’s policy advisor for public safety, Alex Heaton said during the June meeting.

 These locations of the help sites  are places individuals can go to be checked for “underlying conditions and connected to community-based treatment instead of going to places that are very expensive or that could possibly be very traumatic,” according to Heaton.

“Our current crisis response system is really narrow”

Similar to the Los Angeles Police Department’s communications division, mental health professionals from Chicago Department of Public Health (DPH)  will be staffed in the city’s 911 call center in October. They will respond to calls that can be resolved over the phone and  provide support and consultation to callers, call takers, dispatchers and response teams.

Jen McGowan-Tomke, chief operating officer at NAMI Chicago, said the city is heading in the right direction with the pilot because “our current crisis response system is really narrow.”

“It relies on our first responders, which is not the best use of resources and the response is different from what folks might need,” she said.

When dispatching 911 calls for service, the Office of Emergency Management and Communications assigns identified mental health-related calls to Chicago Police Department officers. Sometimes they are assigned to officers who’ve voluntarily completed the 40-hour CIT training that educates them about mental illness signs, symptoms and de-escalation techniques.

In 2019, CPD officers responded to more than 40,000 calls with a mental health component, Superintendent David Brown said. Officers report these encounters can be problematic because those with a mental health condition may not respond well to traditional police tactics, according to Watson’s article. With limited options to resolve situations, police become the “gatekeepers of the criminal justice and mental health systems.” How officers respond to encounters with those individuals impacts whether someone receives treatment or is funneled into the criminal justice system.

Watson said his research found that some officers were frustrated “about the lack of responsiveness from the mental health system” in Chicago. “They felt they were responding to things that the mental health system should be funded to respond to. They were seeing people repeatedly that they tried to link to services but the services just weren’t there.”

“There are a number of things in the system that need to be built and the pilots are a component to that and a step in the direction of building a more comprehensive crisis response system,” McGowan-Tomke said.

Arturo Carillo, a licensed clinical social worker who works at the Brighton Park Neighborhood Council, contends police should not be involved in crisis situations because “the presence of police officers escalates the situation, intentionally or unintentionally.”

Some interactions between law enforcement and those experiencing a mental health crisis have ended in tragedy such as the 2015 shooting deaths of Quintonio LeGrier and Bettie Jones in Chicago.

On Dec. 26, 2015, LeGrier called 911 three times, saying someone was threatening his life and he needed help. LeGrier’s father, Antonio, called 911 soon after. He said his son had a baseball bat and was trying to break into his room. Quintonio was shot by the responding officer, Robert Rialmo. Quintonio allegedly swung a baseball bat at the officer outside of Quintonios father’s house. Jones, 55, a neighbor of the LeGriers, had come to the front door and was also fatally shot.

This situation “laid bare failures in CPD’s crisis response systems,” according to the DOJ report. A U.S. Department of Justice showed the dispatcher did not recognize LeGrier’s call as one involving someone in crisis and didn’t ask questions that could have revealed clues.

For Cheryl Miller, these instances justify an alternative response to crisis situations absent of police. “The majority of mental health and behavioral health calls do not involve violence and they don’t involve a crime,” said Miller, a community organizer for Southside Together Organizing for Power (STOP). “People are calling because they need help, because someone in crisis does not have the proper pipeline.”

She said a more effective model would be establishing a 24-hour hotline to connect people with crisis response units separate from 911. The units would consist of social workers and paramedics, similar to programs that exist in other cities.

Some advocates say the pilot program highlights the need to not only reform the city’s crisis response but also the city’s mental health care system. Chicago has seen a pattern of disinvestment in mental health services amid reduced spending and mental health clinic closures, according to a 2019 report authored by Leticia Villarreal Sosa, a licensed clinical social worker. Between 2008 and 2011, an average of $3.6 million was from the city’s general fund allocated to mental health salaries and positions per year. Between 2012 and 2018, $817,730 was allocated from those funds on average.

The city had 19 public mental health clinics in the 1970’s but by 2004, seven had closed. In 2012, six more were closed and another clinic was privatized. According to the Chicago Department of Public Health, staff at the city’s 12 clinics were spread thin in 2011, which made it difficult to provide consistent care to clients. The rationale was also that community organizations could meet the demand for mental health services and outsourcing care could help save the city money. There are five public mental health clinics in the city that remain, with one that is privatized in Roseland. They include Englewood Mental Health Center, Greater Lawn MHC, River North MHC, Greater Grand MHC, Lawndale MHC.

When the clinics closed, Reeves, the former CPD officer, noticed more “people on the streets talking to themselves,” he said. “That was a very bad thing for our community. People need help, they need those clinics.”

CDPH has said there were over 200 private providers equipped to meet the city’s service needs, But Carillio said after the closures many patients fell through the cracks. City clients transferred to private providers saw long waits  for appointments. Others were tasked with going to clinics that were far away from where they lived. These are still barriers many residents face, he said.

“Many people were unaccounted for and many people died as a result,” Carillo said.

The impact of the closures is hard to measure, Sosa said, but a survey by Collaborative for Community Wellness highlighted a limited availability of free services despite a high demand from residents. The coalition of nonprofits, mental health professionals and residents surveyed 378 Chicago residents between August 26, 2020 and March 3, 2021.

When asked if they’d go to a city-run mental health clinic in their neighborhood that offered free services, a combined 340 respondents (90%) reported either “Yes” or “Probably Yes.” There were 325 (86%) residents who answered “No” when asked if they believed there were enough mental health services available in their neighborhood.

Residents have not only cited access as a challenge to care but affordability. Many non-profit providers charge on a sliding fee scale, which can cost someone seeking care  $20 to $100, whereas public mental health clinics offer care for free, Carillo said. He also said many of the nonprofits lack the kind of accountability needed to maintain quality care.

“All the nonprofits are under the direction of a board and they are only accountable to that board. There’s no one else they are accountable to, so one of the challenges is that when those services are poor quality, when there’s a waitlist for services or when they start charging clients for use, you’re essentially stuck with that being your only option and you’re left without care,” Carillo said.

How has the program worked elsewhere?

Other cities have implemented programs similar to the one slated for Chicago, which has a population of 2.7 million. That includes Los Angeles, which has a population of nearly 4 million people. The Los Angeles Police Department has used Systemwide Mental Assessment Response Teams (SMART) since 1993. The teams consist of a crisis intervention team (CIT) trained police officer and a Los Angeles County Department of Mental Health clinician, according to Doug Winger, a sergeant at the LAPD’s mental evaluation unit. The clinicians are trained to conduct on-site mental health evaluations to determine the type of care the individual needs. The SMART teams respond to about 8,500 calls a year, Winger said. On an average day the LAPD deploys 17 teams throughout the city.

“The idea was just a way to help reduce the amount of time patrol officers were dealing with a mental health call,” said Winger. Police typically spend more time dealing with mental disturbance calls than they spend on calls involving traffic accidents, burglaries or assaults, according to an article on improving responses to persons with mental illness, authored by Watson and colleagues. Winger added the department has seen a decrease in the number of those in crisis repeatedly calling for services. “In part because the clinician that’s there is able to provide the client and their family with information, saying ‘hey, there’s no need for a police officer. Next time you can call a civilian mobile psyche unit or you can call these individuals. They can help you differently than the police can help.’”

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