August 31, 2020

A Co-Response Model That Works: An Interview with Michelle Muething, Executive Director of the Hope Center, on Clinicians and Law Enforcement Responding to Mental Health Crises – Part II

By Fred Bernard, MA

In Co-Response, Part I Michelle Muething of the Hope Center discussed the center’s approach to providing crisis services alongside a local police response. In Part II, JKBF talks with Michelle about the opportunities of this approach for other communities, and why she believes pairing, not replacing, is important.

JKBF: Are there any high-profile instances of police brutality that have occurred in this country that you think could have been avoided if a co-response model of some kind was applied? If so, how so?

MEUTHING: I don’t know of anything high profile that I think could have been prevented, but I can tell you that locally dozens of things have been prevented. I have clinicians that have been on scene, myself included, for hours while we talk people out of homes with guns in them.

Just a month ago, we literally spent six hours on scene with a guy who was in a house with guns with his nephew, and he wouldn’t come out. A crisis clinician is not going to walk up to a door of a home where someone has weapons and is unstable and we don’t know what their issue is. Law enforcement is vital. If someone shoots at a law enforcement officer, they have a bulletproof vest. I do not. The officers stood at the front door and talked to this person with our clinician in earshot guiding the officers with what to say and how to help until this guy came out of his house.  It prevented him from being arrested; it prevented people from getting shot. He didn’t even end up going to the hospital. It was a six-hour ordeal that was 100 percent worth every minute of those six hours.

Also recently, a psychotic person was in his home, not thinking, mumbling, dressed in a crazy fashion that made no sense. Law enforcement was trying to get a warrant to be able to get in and get him out, and we sat there and talked to him and were able to subdue him enough. He ended up in the hospital, but he could have ended up hurting someone or an officer could’ve hurt him, and it didn’t turn out that way.

I think some clinicians feel like law enforcement is not necessary. But at the Hope Center, we won’t go somewhere without them, because they’re our safety. We have watched too many situations go bad really fast.

A year into this, I got a phone call from a gentleman. He sounded perfectly calm, denied drinking, denied having any weapons, said his suicide plan was to drive off the Pass. After about five minutes, I said, “I would love to continue this conversation in person. Is it okay if I come and we can sit on the park bench?” He said that would be fine. I called law enforcement and I told them I was headed over there. They met me there, and as the officer walked up to the front of the car, he saw that there was an empty vodka bottle and a loaded nine-millimeter gun sitting on the front seat of his car. You can’t always trust what people tell you over the phone. He told me he hadn’t been drinking, he was not slurring his words, he was making a lot of sense. But his alcohol level when he got to the emergency room was .32, so he was very intoxicated. He had a loaded gun sitting right there when he told me he didn’t have any weapons.

The clinicians are going to help people to the best of their ability. But in order for them to be focused and pay attention to the person they’re meeting with, they have to know they’re safe. That’s the element of what law enforcement brings.

Really, really interesting side note story. We were brought to work in Eagle County at the request of law enforcement. It was just a little over a year later I went through all the departments and met with all the officers and said, “Tell me how this program has impacted you, your work, your department.” So many of the officers in one county, after one year, said ‘people in the community who used to hate us- we would drive by, and they’d flip us off or they’d pretend to shoot us- now wave at us.’

Law enforcement is seen as this power and authority, right? They don’t have to say a word. They look authoritarian. But then you take that person, put them next to me or a clinician in front of you, and you watch me turn to that officer and say, “You know what? I’ve got this. If you want to go ahead and step out, I’m going to keep this going.” Community members are now watching the person that used to have the highest amount of power and control now being relieved of a situation, and me, some lowly commoner, civilian, having the power and control.

What we heard in Eagle was the community is seeing that. It’s changing perceptions of people about law enforcement. I think that is one of the most enormous successes of a co-response program. If it’s done right, law enforcement can give power of a situation to a clinician once the scene is safe, and then behavioral health issues can be stabilized without any force or power from law enforcement.

The Aspen Valley isn’t a particularly violent area. Do you think mental health workers would feel safe going along with police officers if this model were to be applied to a big city, like Chicago?

The violence is different (from mental illness). Psychiatric patients are not violent individuals. They’re unpredictable individuals. So whether you’re in an inner city with a psychotic patient or a rural cabin with no cell signal and a psychotic patient, the risk of safety being jeopardized is the same.

I think the biggest success that we’ve had is really being able to educate law enforcement and keep people out of a hospital. In one year after we opened in Eagle County, we reduced emergency room transports and evaluations by 78 percent. People were not being sent to an emergency room for an eval. They were being evaluated on the scene. Those are huge successes for us. They show that our program does what we set out to do.

Funny enough, the Hope Center was built on a model of co-response that started in the 1990s with the LAPD (Los Angeles Police Department). Co-response has been around a long time. Colorado is behind the eight ball. The Indianapolis program I was in had a co-response program. They’re all over the country. They’re a little bit different everywhere you go, depending on what the community wants and who is overseeing it.

Do I think our program could be successful in other places? 100 percent. Because a lot of it is the philosophy from the top; it is the philosophy in the foundation of what we believe. I definitely believe it’s possible to recreate what we have in other places.

How is the Hope Center funded? Do you think other communities that are more financially strapped than the Aspen Valley would be able to afford something like a co-response program and be able to maintain it at high standards over time?

In (Aspen Valley), we have been about 50% to 60% funded through private donations, along with receiving small amount of grants and contracts with law enforcement, fire, EMS and schools. We’ve had donors who have said, ‘If someone has a behavioral health emergency, I don’t want them to end up in the ER. It’s a small community; too many people know too many people. Let’s keep them in the privacy of their own home.’

In Eagle County (Editor’s note: the average annual income in Eagle County is $39,355; in Aspen, it’s $67,885), we are 96% funded by law enforcement, fire, and EMS, because it is a true co-response program. Basically, in the world of law enforcement, your first responders all pay into the county’s 911 dispatch center, because the 911 dispatch center dispatches your calls. When we brought the model into Eagle, we thought, “What better way to function than if we are embedded with law enforcement and helping them on scene? Then perhaps they could pay into the Hope Center like they pay into dispatch.” We are funded to keep individuals in their homes and take the burden off law enforcement.

Do I think you could take a program like this and put it into a rural community or a community that doesn’t have as much funding? Yes.

I think it depends on finding people within that community that have a vested interest to be your stakeholder group. The Hope Center has been asked to duplicate our crisis program in multiple counties. They buy it. They really do. I’ve got a community right now I’m working with that doesn’t have the funding for the crisis clinicians. They’re willing to do telehealth with one of our clinicians, but they have a whole team of volunteers. These volunteers rotate kind of like Meals On Wheels volunteers. They rotate taking calls. If that’s how a community is going to serve itself and those are the people that are dedicated, more power to them. We’ll help you figure it out.

In a lot of communities, it does seem like the police are, by default, the only social service available. Does that come about because there isn’t that core of invested people in some communities, or it doesn’t occur to people that what we’re talking about is possible? What do you think might be the hindrance?

I don’t think it occurs to people, but I think it’s also how our culture has evolved. I’ve been in on conversations with the Colorado State Crisis Line, and they want communities to start calling this really long crisis number if they have a behavioral health emergency instead of dialing 911. I said, “Well, number one, the biggest hurdle you have to cross is that everybody knows 911. Kids are taught in kindergarten, ‘If ever you have an emergency in your family, you dial 911.’” You shouldn’t have to memorize a nine-digit 800 number if you’re depressed and staring at a knife.*

* The National Suicide Prevention Lifeline should be reachable by dialing 988 in July 2022. However, co-response and similar programs will need to be available to respond to 988 calls for this change to be effective.

Number two, it’s embedded in our culture that when you have a crisis, you call for an emergency person to help you, and those emergency people are first responders, law enforcement, fire, EMS. We have to have a culture shift to be able to either take 911 calls that are not legal or medical and divert them to a behavioral health triage that’s dispatched just like law enforcement or fire, or you have to get communities to start calling nine-digit 800 numbers instead of 911.

One of the easiest things I think to do, in theory, is to have a dispatch center such that when you call and say, “My husband is having a heart attack,” they dispatch an ambulance; if you call and say, “My mom and dad are fighting. My mom just pulled out a knife,” they send law enforcement; but if someone calls and says, “I just tried to kill myself. I have some marks on my wrist,” they send behavioral health with an ambulance. I think that might be the best way to do it. You’re going to have to put clinicians in first response programs. I think state and federal laws are starting to change too, and a lot of money is going to be put down for mental health for these types of programs.

If I could wave a magic wand, (I would) create crisis graduate programs. (Right now) you can go to school to be a substance abuse counselor, you can be a licensed marriage and family therapist, you can be a social worker. In a perfect world, I think it would be amazing to have a crisis program where people learn how to do crisis response and part of their training is even doing law enforcement graduate work.

Currently, every police department has investigators for when there are crimes; they have canine units, and then they have their patrol folks. Wouldn’t it be great if every law enforcement department across the country had a behavioral health team? It would be really, really cool, but it would have to be run through mental health departments that understand law enforcement. The two have to mesh and both sides have to respect and understand one another, and you don’t always find that.

Do you see a kind of push happening to create any of those kinds of graduate programs or to create a more institutional basis for this kind of work?

No. It’s not happening now, but I think it will probably start. Something is going to shift. Maybe I’ll try to be that shift. That sounds like a fun challenge.

Fred Bernard is a board member of the James Kirk Bernard Foundation and clinical psychology doctoral student at The Chicago School of Professional Psychology. He has a Master’s Degree in Psychology from The New School for Social Research.