Cuyahoga County could save millions of dollars, disrupt fewer people’s lives and avoid tragedies like the 2020 murder of George Floyd by implementing a non-police care response program for people in mental health crises, according to a new report. But the estimated price tag for a pilot program, $1.65 million, is just one obstacle.
Dr. Mark Hurst, a psychiatrist and healthcare consultant, presented the report to the county’s Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board at its meeting on Wednesday.
Hurst, former medical director of the Ohio Department of Mental Health and Addiction Services, said he and his team found articles on non-police crisis response — also called care response — from the late 1990s, long before deaths like Floyd’s and Tanisha Anderson’s in Cleveland in 2014 ignited nationwide interest in new models of crisis response that don’t involve law enforcement officers.
“So the public has very rightfully insisted that we find a better way to do things in crisis response to avoid these kinds of disasters,” he said.
The report recommends that Cuyahoga County “implement a community-based, unarmed Care Response program that will be rapidly available and staffed by behavioral health professionals and peers,” Hurst said during his presentation.
What is care response?
In care response, behavioral health providers, often social workers, are the first to respond to behavioral health crises in the community.
In most existing programs, the team is made up of a licensed behavioral health professional and a peer support specialist, or someone with lived experience with mental health or substance use disorder who has been through training and certification. Some teams also include an emergency medical technician.
Most people who have crisis intervention in the community right now end up in hospital emergency rooms, which are not very well suited to meet the needs of individuals with mental health disorders
Dr. Mark Hurst, psychiatrist and healthcare consultant
The team tries to resolve a crisis on site whenever possible, Hurst said.
“They often occur in a context of unemployment, of homelessness, and of hunger, of other kinds of things that contribute to the crisis itself,” he explained. “And resolving and dealing with some of those things is every bit of support as doing a psychiatric or behavioral health assessment.”
Resolving the situation in the community also leads to fewer arrests and hospitalizations and less incarceration, Hurst said. This would save the county money and decrease disruption in a person’s life.
“Most people who have crisis intervention in the community right now end up in hospital emergency rooms, which are not very well suited to meet the needs of individuals with mental health disorders,” he said.
Hurst said he and his team found that care response programs in other cities have been well received by community members, by families of those impacted and by law enforcement. There is less crime in those areas, and people helped by the care response process are more likely to keep follow-up appointments, decreasing the likelihood of experiencing a crisis in the future.
Hurst recommended that the county start with a pilot program in one or more areas chosen according to the needs of underserved communities, the volume of mental health-related calls, and the level of community support for the program.
“The interaction between care response and the community is probably one of the most important things to have a successful program,” he said. “The moniker in trauma-informed care is ‘nothing about me without me,’ and many of these areas in the community have been traumatized. And their involvement in the planning, in the execution of this, the assessment of it is really something that’s very important.”
The report estimates that an 18-month pilot program with two teams would cost $1.65 million. That includes training, vehicles, equipment, and salaries of a lead trainer, licensed behavioral health professionals and peer support specialists. The budget estimate for one team for 18 months would be almost $1.3 million.
Hurst recommended the county consider multiple streams of funding, from local, state and federal sources as well as from billing insurance companies.
A cost-savings calculator from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) estimates potential annual savings of almost $81 million in a population of 1.25 million, or about the size of Cuyahoga County.
Cuyahoga County already has some crisis care response, meaning the estimate isn’t entirely accurate. The estimate also assumes nine care response teams, which is a reasonable target for how much the program could grow, Hurst said.
What’s next?
At the Wednesday ADAMHS Board meeting, board member Bishara Addison asked how a dispatcher will be able to decide whether to dispatch a care response team instead of police or EMTs for a call. Hurst emphasized that a large part of implementation will be training dispatchers.
Bishara also asked Scott S. Osiecki, CEO of the ADAMHS Board, how prepared he feels to move forward with the program and how it fits into the board’s mission. Osiecki said a care response program would be “another tool in our tool box.”
Hurst acknowledged there is a lot to consider as the board decides whether and how to implement a care response program.
“You may not be able to do it all at once,” Hurst said. “But moving forward is something that certainly can be done.”
City and county officials and advocates for the program have been learning about existing programs in other cities. In April, a group met virtually with members of a care response program in St. Petersburg, Fla.
Last week, a group of about a dozen people, including representatives of the Cleveland Department of Health, police department, ADAMHS Board, Magnolia Clubhouse, Policy Matters Ohio and other groups, visited Cincinnati to learn about that at the city’s Alternative Response to Crisis (ARC) program.
They learned from Bill Vedra, executive director of the Emergency Call Center, how the dispatch center works with their ARC team. Cincinnati’s dispatch center was separated from the police department in 2018, which made it easier for the city to start a pilot care response program last year. That will be a challenge in Cuyahoga County, which has several 911 jurisdictions, said Piet van Lier, senior researcher at Policy Matters Ohio.
Another important piece will be finding places other than hospital emergency rooms to transport people to, van Lier said.
“There’s a lot of pieces and parts to making the system work,” van Lier said. “We can’t just say, ‘Let’s do care response’ and we’re done. But, ‘Let’s do care response,’ and as we do that we’ll see where other needs are and we’ll keep on moving to sort of transform the whole system. I think there’s a lot to be done.”
The ADAMHS board staff will spend some time looking at the report and make a recommendation on how to move forward with implementing a care response program in Cuyahoga County. The board will then vote on that recommendation.
