Clinicians, cops a promising pairing

Since 2020, a rise in such programs cropped up around the country, in large part a by-product of racial and criminal justice movements, which pushed for fewer law enforcement responses to mental health crises and more clinician involvement. But the evidence on the effectiveness of such an approach has been mixed.

“It’s not that the prior research has shown that co-responder models haven’t worked. It’s that there is such a national movement to adopt these programs, we’ve had an absence of evidence … most of the programs have been so new, we just don’t know,” said Tom Dee, one of the researchers behind a recent Stanford University report commissioned by the county as part of a five-year, $584,000 agreement to evaluate the program

Each crisis response program is different. Some, such as San Diego’s program, embedded mental health professionals in patrol cars with an officer, while others collaborate with law enforcement but by and large operate independently. But the main goal is to safely de-escalate tense situations and better connect individuals experiencing mental health crises with the care they need.

“We have crisis intervention training so we can get on scene and pick up signs and behaviors that would tell you it's more of a mental health crisis,” said Officer Jerami Surratt, spokesperson for the San Mateo Police Department. “But if you're a patrol officer and respond to multiple calls a day, and you show up to a mental health crisis, there are limited things you can do. You can try to de-escalate or put them on a 5150, and when you’re done with that, you're done with the case.”

Not only can the clinicians de-escalate a situation, but individuals could receive follow-up care and can be referred to other services at StarVista or other behavioral health or social service agencies. Oftentimes, Surratt said, an individual hasn’t taken their medication and the clinician can help them or their family follow up with getting the medicine filled or receiving psychiatric care — something officers may not have the knowledge or capacity to do.

In 2021, San Mateo County signed a a nearly $7 million contract with StarVista to establish its own crisis response program, in which one full-time clinician works within the police department of the county’s largest cities — San Mateo, Daly City, Redwood City and South San Francisco — and responds to calls with an officer, usually during the weekday.

Though the county’s initial pilot program ended, all four cities decided to extend their program mostly using their own funds. And other cities, such as Menlo Park, East Palo and San Bruno now have similar programs.

Hiring a clinician that collaborates well with law enforcement usually requires an adjustment period, said Scott Campbell, South San Francisco police chief, adding that it took some time to establish a shared understanding of officers’ roles versus clinician duties when individuals experiencing a crisis had also committed a serious crime.

“It's definitely something new for law enforcement, having a clinician involved in a co-response model. It took maybe a couple months to get comfortable,” he said. “I think the most important thing is finding a clinician that is a good fit for your culture and the way that your city operates … now, when our clinician isn't available, our officers have learned some of the tactics and ways to better de-escalate situations when we're dealing with volatile situations that involve some sort of mental health crisis.”

Surratt added that there is often a stigma or apprehension when a non-sworn officer is embedded with law enforcement. But he said the results speak for themselves. Not only did San Mateo extend the pilot program, but it recently added another clinician, who will split their time between San Mateo and Foster City.

“We never heard resistance … what we heard was there is a learning curve — a learning curve around how to interact together at the scene, what is the clinician noticing that the officer isn't noticing, what is the officer noticing that the clinician isn't noticing,” said Kristin Geiser, who was also a researcher on the report.

The report from Stanford’s Gardner Center, which has also worked with the county on evaluating other programs, saw an overall 16% decrease in 5150 holds between the end of 2021 and end of 2023, the pilot’s start and end dates. It also saw a 17% reduction in mental health-related 911 calls. Call times also seemed to decrease over time as everyone involved, including dispatcher, got their footing, Geiser added.

While the report didn’t focus on financial savings, she said there it is likely to have helped save health care costs, such as emergency room visits and other types of care in the long run.

Officers typically undergo crisis intervention training so they are better prepared to respond and de-escalate crisis situations, but Dee said it’s hard to tell how helpful it is.

“The available evidence on the impact of crisis intervention training is not encouraging. It’s about 40 hours of training, so one could understand why that might not be enough to equip a law enforcement officer to respond to different types of mental health needs,” Dee said. “Police may overutilize psychiatric detentions. They want to be helpful but aren’t exactly sure [how].”

StarVista CEO Sara Mitchell said the program has been a mutual learning experience.

“Now [an officer] is more likely to say, ‘If a mental health clinician were here, what would they say, what would they do?’” she said. “It means much better outcomes for the whole community.”

alyse@smdailyjournal.com

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