Building Community Capacity to Help Persons with Mental Illness

Abstract

In a time of crisis, persons with mental illness who encounter the police are often sent to jail or are involuntarily committed for psychiatric evaluation when mental health services are not readily available. To better serve these persons and the community, law enforcement and mental health professionals in one Iowa county joined together to ensure these individuals received the assessment and treatment needed. The results of a mixed methods program evaluation are detailed and suggest that the process to develop the program was as critical as the conduct of the program itself. Implications for program development are discussed.

Barriers and facilitators to implementing an urban co-responding police-mental health team

“…Stigma emerged as a noteworthy barrier to implementation and was part of a larger issue related to role clarity; this is consistent with the extant literature which suggests that on co-response teams roles, missions, and beliefs do not always align (Scott, 2000; Steadman et al, 2000; Hartford et al, 2006; Saunders & Marchik, 2007; Kisely et al, 2010; Rosenbaum, 2010; Department of Health and Human Services, Victoria, 2012; Kirst et al, 2015). Police in particular felt ostracized by fellow first responders.…”

“…Despite these barriers, the findings offer several important facilitators to build out and implement first-responder co-response teams. For example, information sharing (or “triangulation”) was one of the most salient facilitators to both the MCAT in this study and other co-response teams (Lamb et al, 1995; Scott, 2000; Steadman et al, 2000; Ratansi, 2004; Baess, 2005; Hartford et al, 2006; Saunders & Marchik, 2007; Kisely et al, 2010; Rosenbaum, 2010; Department of Health and Human Services, Victoria, 2012; Kirst et al, 2015). New forms of data and lenses by which these data could be interpreted appeared to serve as a reinforcement mechanism that enabled team members to understand PMI experiences, track progress, and to try new solutions or those that were perceived to have previously worked.…”

“…The difficulties presented by a lack of treatment services for program consumers surfaced multiple times throughout the research literature on co-response teams (Lamb et al, 1995; Scott, 2000; Steadman et al, 2000; Steadman et al, 2001; Ratansi, 2004; Baess, 2005; Hartford et al, 2006; Saunders & Marchik, 2007; Kisely et al, 2010; Rosenbaum, 2010; Department of Health and Human Services, Victoria, 2012; Kirst et al, 2015), and unfortunately this barrier existed for the MCAT as well. One MCAT stakeholder stated,“This is the biggest fear for me; you do all of this work on the front end, but there are no real services on the back end, so these people aren’t getting the help, because there are not enough beds or mental health professionals that will work with them, or they don’t have insurance.”…”

“…Indeed, according to Mental Health America, 24% of adults in Indiana have unmet mental health needs, largely due to lack of insurance as well as lack of various treatment types and providers (Mental Health America, n.d.). The difficulties presented by a lack of treatment services for program consumers surfaced multiple times throughout the research literature on co-response teams (Lamb et al, 1995; Scott, 2000; Steadman et al, 2000; Steadman et al, 2001; Ratansi, 2004; Baess, 2005;Hartford et al, 2006; Saunders & Marchik, 2007; Kisely et al, 2010; Rosenbaum, 2010; Department of Health and Human Services, Victoria, 2012; Kirst et al, 2015), and unfortunately this barrier existed for the MCAT as well. An increase in mental health services would facilitate co-response team success as clients are referred to and receive treatment.…”

Crisis event dispositions following a crisis response team intervention.

“…Police officers often respond to mental health-related emergencies (Lamb, 1984), and studies suggest that PMI are more likely to be arrested than the general population (Borum et al, 1997; Charette et al, 2014; Fisher et al, 2011; Swartz & Lurigio, 2007; Teplin, 1984), which is explained in part by the lack of alternative response options following a mental health crisis (Borum, 2000; Engel & Silver, 2001; Hails & Borum, 2003; Lamb, 1984; Teplin, 1984). An emerging intervention to address mental health crises are co-responding police-mental health teams, also called co-response teams, mobile crisis teams, or crisis response teams (hereafter referred to as CRTs), which involve the pairing of a police officer with a social or medical service provider to provide initial emergency and/or follow-up response (Baess, 2005; Hay, 2014; Kirst et al, 2015; Kisely et al, 2010; Ratansi, 2004; Rosenbaum, 2010; Saunders & Marchik, 2007; Scott, 2000; Shapiro et al, 2015; Steadman et al, 2000; The Allen Consulting Group, 2012). There exists much variation in how CRTs are operationalized and implemented (Puntis et al, 2018), making it difficult to compare models; however, overall reported outcomes of CRTs are generally positive, with findings showing reductions in detainment and hospitalization of PMI and increased referral to community care services (Puntis et al, 2018; Shapiro et al, 2015; Watson et al, 2019).…”