Courtney Tran starts her day by arriving at her desk at the Aurora Police Department’s third precinct, and files paperwork until the dispatcher’s voice crackles over a two-way radio. She’s spent almost a year learning what to expect from these calls—reports of a suspicious trespasser, a domestic disturbance, somebody threatening suicide—but still grapples with the sheer unpredictability of the work. As the radio blares, she straps on a heavy bulletproof vest, jumps into a police car with an officer, and speeds to the scene.
Five years ago, Tran got her start in clinical work with Aurora Mental Health Center, a private nonprofit clinic. But over the past 11 months, in conjunction with her employer, she’s been embedded with two other mental health professionals in the Aurora Police Department as part of a two-year program funded by the Department of Justice (DOJ). Accompanying a police officer on calls where mental illness is a suspected factor, once on the scene, the two can perform full mental health evaluations and suicide screenings, arrange for placements into psychiatric or substance abuse clinics, and contact case managers to take over. Most notably, Tran is lending her expertise in an arena many say desperately needs a therapist’s empathic touch and careful discernment.
One afternoon, just weeks after Tran started work at Precinct 3, the dispatcher radioed in about a suicidal teenager, potentially armed and dangerous. She looked the boy up in the police database and discovered he’d been aggressive with officers in the past. After arriving at his house, Tran followed standard procedure and waited in the police car while the officer accompanying her searched the surrounding area to make sure it was safe to proceed. He returned a few minutes later. “He’s barricaded himself in the basement,” he told Tran. “He’s not coming out. But he says he’ll talk to you.”
After speaking briefly with the boy’s worried mother, Tran entered the home and walked to the locked basement door. “Sir, my name’s Courtney,” she said. “We just want to talk. Can we do this face to face?” The boy refused. The police had tricked him before, he told her. She turned to her partner and asked if he could back off for a moment to give them some space. “No way,” the officer replied. “If he’s got a weapon, that’s not happening.” The boy replied that he was unarmed. Still, they were at an impasse. Tran convened with the officer to discuss options, and they came up with a plan. “Sir,” Tran yelled down to the boy, “If the officer promises to move back to the sidewalk, could you and I chat outside? He’ll need to check you to make sure we’re safe, but that’s it.” Finally, the boy agreed.
After a quick pat-down, which at Tran’s suggestion involved the officer gently explaining what he was doing and why, the boy took a seat on the sidewalk. “Let’s hear about what’s going on,” Tran said, taking a seat next to him. Over the next 20 minutes, he told her about how he’d been repeatedly bullied at school. “I don’t want to go back,” he said. Tran told the boy she’d make sure that the school would address the bullying and he’d feel safe enough to return. She gently touched his back. “Does that sound okay? Feeling a little better?” The boy nodded. His mother began to cry, and then hugged Tran and the officer. It was the first time, she told them, that her son had opened up about what was going on. “We need more programs like yours,” she continued. “I’ve never met an officer who was willing to try something different.”
Tran says this was just one case where, without her therapeutic skills in de-escalation and mediation, a police visit might’ve had a very different outcome. According to a 2016 report from the National Alliance on Mental Illness, 15 percent of men and 30 percent of women booked at US jails every year have mental health problems. And with nearly 25 percent of victims of fatal police shootings having a diagnosable mental disorder, programs like these can be lifesaving.
An Uphill Battle
Calls for greater collaboration between police and clinicians are nothing new. In 1988, the Memphis Police Department developed the Crisis Intervention Team (CIT) model. It advocates police partnerships with universities, corrections departments, homeless assistance providers, and hospitals, and it mandates a 40-hour mental health training course. It’s one of the best-known and most widely adopted police models for addressing mental illness today. But as of 2016, only about 3,000 of the nation’s approximately 18,000 police departments had some or all of their officers go through CIT training.
In fact, most states have no mandatory police mental health training, even though police often “are not only operating as law enforcement officers, but also assuming the responsibility of social workers and other community support roles,” notes a 2016 report from the International Association of Chiefs of Police. “Officers often lack clear policy direction and training to effectively serve [the mentally ill].”
To step up collaborative efforts, the DOJ’s Bureau of Justice Assistance selected six police departments in 2010 to act as test sites for more robust police–clinician collaborations: those of Houston, Texas; Los Angeles, California; Madison, Wisconsin; Portland, Maine; Salt Lake City, Utah; and the University of Florida in Gainesville. Several of these police departments, with large staffs and sizeable budgets, already had experimental police–clinician teams in place, attracting the BJA’s attention. But in more isolated areas, getting co-responder programs off the ground remains a challenge.
Attitudes toward Aurora’s needs shifted in 2012, after the movie theater shooting that killed 12 and wounded 70 made national headlines. It “put us on the map,” Tran says, even though the city’s mostly blue-collar population, numbering more than 365,000, had long struggled with access to mental health care. In the months following the shooting, area mental health services got a facelift in a smattering of new 24-hour walk-in mental health clinics and psychiatric hospitals. But there was still a disconnect between how local law enforcement and clinicians like herself tackled mental illness, Tran says, and minimal collaboration. Some officers were quick to consider behavior spurred by a psychiatric episode as criminal; others, short on time and options, would simply admit the mentally ill to already overbooked hospitals.
In the winters, when the temperature dipped below freezing and Tran and her then-colleagues ventured out to deliver supplies to the homeless, she’d sometimes encounter officers on their rounds. Their run-ins were cordial but tense, she says. “We came from different cultures,” she explains. “It was an adversarial relationship, where each side thought it knew what was best for people.”
When Tran first applied for the DOJ grant in 2014, her application was rejected. But after reapplying late last year, she was given a green light. Aurora’s third precinct now serves as a testing lab for what’s been dubbed the Crisis Response Team, comprising two full-time clinicians (Tran included), a case manager, and 30 officers trained to work with the mentally ill. But with the fate of the program resting on a mere three clinicians, Tran says she’s fighting an uphill battle.
For guidance, Tran turned to Officer Rebecca Skillern, who manages trainings for the co-responder program in Houston, Texas, currently in its 10th year. Like Tran’s, the program Skillern now manages started with just three clinicians. Today, it has 12, in addition to 3,200 specially trained officers who answer a total of 37,000 mental health calls per year. According to statistics provided by the Houston Police Department, the program saves them almost $488,000 annually by rerouting service calls that would otherwise eat up valuable time and manpower. Reducing ambulance and firetruck calls, it saves Houston’s Fire Department almost $843,000 annually. Numbers like these are hard proof, Tran says, that a program like this would pay off for Aurora.
But getting a co-responder program off the ground takes more than showing it can save money, Skillern says. “It means changing the public mindset about what police work involves.” And in Texas, which has consistently ranked between 47th and 50th per capita in funding for the mentally ill, this was no small hurdle. The new program not only involved cutting and reassigning officers, but led to occasions where police and clinicians butted heads. Skillern, who rode by herself before the program began, says having another person in her car took some getting used to. She’s also been in situations where a clinician tried to overrule police or seemed to dislike the institution of policing in general.
Still, most pairings go off without a hitch. “Therapy and police work are actually complementary professions,” Skillern says. Officers and clinicians hold joint interviews with their superiors to ensure they’ll be a good match. And the mandatory 40-hour training programs the pairs go through—an increase from the previously required 15-hour training—offer each group a glimpse into each other’s worlds. In addition to covering de-escalation techniques, safety protocol, conditions, and symptoms, they do role-plays with paid actors, sometimes combat veterans familiar with mental illness. “This work humanizes each side to the other,” Skillern says. “It keeps officers from thinking that every therapist is a touchy-feely type. And the clinicians see there are a lot more officers who care about people’s well-being than those who just want to throw people in jail.”
Even though many therapist recruits have a background in trauma and crisis interventions, Skillern clarifies that this work is a far cry from the 50-minute office sessions most clinicians are accustomed to. These therapists have access to extensive electronic databases that contain arrest records, treatment histories, medication records, and notes about compliance that they need to brush up on quickly. Skillern says the goal isn’t to get to the root of a person’s underlying issues, but to resolve the immediate crisis and get them into appropriate treatment, whether a hospital, treatment facility, or homeless shelter. “We’re not turning the police call into a therapy session,” she says, “but we’re also training officers not to rush these things.”
Clinicians working in this capacity are taught to keep interventions short—“usually no longer than 30 minutes,” says Chuck Lennon, who’s spent 15 years working with the LAPD’s co-responder program and 21 years as a social worker for the LA County Department of Mental Health. Today, as program manager for the LAPD’s Mental Evaluation Unit, he oversees the work of all 46 clinicians in the program, who answer almost 800 service calls per month. Some clinicians can do this quick, short-term therapy well, Lennon says, but for others, it’s more of a challenge. “Are most aspiring therapists in school learning how to do this work? Are they hearing about these types of innovative programs? Usually, no. That needs to change.”
Tran says the learning curve for police and therapists is quick, and sees herself at the forefront of a cultural shift. “I sometimes have to tell officers that charging people with a crime will be counterproductive,” she explains. “The things that deter people from certain behavior, like the threat of arrest, aren’t always going to work when you’re dealing with mental illness.”
The work has been equally humbling for her, too. “A lot of us think that police are just going to bust down the door and arrest people,” she says. “But the scenes they encounter are often unpredictable and unsafe. Assisting the police is totally different from anything I’ve ever done before.” Since the program began, Tran says she’s seen a gun pointed at a geriatric-services employee and walked into houses to find that someone had just died by suicide. Unsurprisingly, she says a good deal of informal counseling occurs between officers and their therapist partners, whether before or after a dispatch, or after hours over the phone. For all intents and purposes, her department’s chief of police recently told her, she’s become a police officer. “This department has never had a mental health professional as part of their staff,” she says, “but I’m viewed as a coworker at this point. I’m with the police every day. I know where they’re coming from.”
Despite their progress, Tran says the Aurora program’s future is uncertain. The life span of the Crisis Response Team, which only has funding through next August, depends on the impact Tran and her associates make in the short time given. They also need to impress Aurora city officials and the DOJ, either of which could decide to extend or withhold future funds. And as much as the higher-ups in Tran’s police department approve of her work, she says she’s still battling a police culture that views mental health work as a distraction, not a solution. “I’ll be honest,” she says. “There are still people in my department who don’t want me there, who believe they shouldn’t be doing this kind of work.”
Skillern and Lennon understand her challenges. Still, both say that a sense of shared mission and collaboration have been driving forces for other co-responder programs trying to find their way. They frequently do site visits and hold information sessions in communities considering a program like this. They meet with council members, stakeholders, and advocacy groups, and explain how their model might work in a place that’s never considered something like this before.
In meeting like-minded people, as far away as they may be, the newcomers and veterans alike find renewed inspiration. “Sometimes you feel like you’re the only one doing this work,” Lennon says, “but it’s made all the difference knowing there are other people out there and you’re not alone. When I meet two or three therapists in the middle of nowhere who are doing this, it pushes me even harder. They’re working miracles.”
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Chris Lyford is the Senior Editor at Psychotherapy Networker. Previously, he was Assistant Director and Editor of the The Atlantic Post, where he wrote and edited news pieces on the Middle East and Africa. He also formerly worked at The Washington Post, where he wrote local feature pieces for the Metro, Sports, and Style sections. Contact: email@example.com.