Tuesday, November 6, is fast approaching, and Denver residents are now voting on various state- and citywide ballot initiatives. One such initiative is Caring 4 Denver.
Created by Representative Leslie Herod and endorsed by influential Coloradans like Wilma Webb and Cynthia Coffman, the initiative would raise Denver's sales tax by .25 percent to bolster the city's mental health resources and substance abuse treatment programs. If the initiative passes, 10 percent of the revenue would be earmarked for the Crisis Intervention Response Unit within the Denver Police Department.
This already-existing co-responder unit pairs clinicians with police officers so that the department can intervene effectively in mental health crisis situations. With this earmarked money, the unit would expand its staff and hours of operation, and a more robust program would lessen 911 calls by frequent callers and could help individuals struggling with mental health issues get the help they need, according to proponents of the initiative.
The department started pairing mental health clinicians with its officers in 2016 because "Denver noticed it was getting an increased number of mental health calls to 911. If someone was acting bizarrely in the community, 911 got called, even though there may not have been a legal element to what was happening," says Carleigh Sailon, assistant program manager for the Crisis Intervention Response Unit.
This oversaturation of 911 calls for mental health crises wasn't just a matter of city resources getting tied up. Renee Rivera, a licensed clinical social worker who works as a local policy strategist at Mental Health Colorado, says that sending only police to a 911 call involving a mental health crisis heightened the risks for all involved.
"Police are trained to deal with much more serious situations, so there can be situations when they’re over-responding to someone with a mental health disorder," Rivera says. "That’s the concern: that someone can get hurt."
She also points out that without mental health clinicians co-responding with them, Denver police officers generally had two main tools for dealing with mental health crises: They could either send someone to jail or take that person to an emergency room.
Since the city's co-responder program began in spring 2016, clinicians with the Mental Health Center of Denver have been pairing up with police officers to respond to 911 calls and help provide alternatives to sending people to jail. The unit, which gets its funding from the city and Medicaid, has innovated with its strategy, according to Scott Snow, director of DPD's Crisis Services Division. Rather than creating protocols and policies around the program first and then implementing them next, the program paired its clinicians with officers and let them learn best practices through their experiences.
"We said, 'Let's find the right people and have some general operating guidelines. Then we'll have our experiences determine our future outcomes,'" says Snow.
Snow says that at first, there was concern that officers might not accept clinicians riding in their cars. But that concerned quickly disappeared after officers saw how effective clinicians were in de-escalating potentially volatile situations. "Then officers started competing to have clinicians," says Snow.
From March 2016 until April 2018, the unit operated in only two police districts. But as praise rolled in from both police officers and clinicians, the unit sought more funding.
"We identified the top ten [individuals utilizing] hospitals, jails and general first-responder time. We were then able to produce numbers and dollar figures for these individuals. After that, we reached out to Medicaid. Medicaid said, 'Yes, that saves us money in back end, [so] we’ll front-load for eight more clinicians,'" says Chris Richardson, program manager of the unit.
Medicaid allocated $1.2 million for Mental Health Center of Denver to hire these additional clinicians. Since April, fourteen clinicians have been working in the field with police officers, co-responding to possible mental health situations.
From the beginning of this year to October 1, less than 5 percent of the calls in which a co-responder was dispatched resulted in an arrest or citation. The other 95 percent avoided legal issues, either ending up hospitalized on a 72-hour mental health hold or connecting to services.
The clinicians, either licensed clinical social workers or licensed professional counselors, pair up with police officers and ride with them all day. When responding to mental health crisis situations, the co-responders try to de-escalate the situation and can either connect people with mental health services if necessary or follow up with a call or an in-person visit within 72 hours. Some of the clinicians, who dress in royal blue shirts as their uniform, have offices in the district stations.
In this mobile office, clinicians also go with their police officer co-pilots to calls that are not necessarily mental health situations. Sailon recounted that one of her teammates responded to a car accident and was able to calm down a very distraught woman and get her to explain to the police officer exactly what happened. There was no 911 call about a mental health crisis, but the clinician's skills helped ameliorate the situation.
The Crisis Intervention Response Unit also works with Denver's Department of Public Health and Environment on hoarder cases. In these non-crisis situations, clinicians join the hoarding task force and direct individuals toward possible mental health services and support groups.
Sometimes jail cannot be avoided. But plenty of individuals getting locked up in Denver for crimes like public urination, public intoxication and trespassing are also dealing with mental health issues. That's why a clinician from Mental Health Center of Denver, Lindsey Henrickson, works at Denver's Downtown Detention Center as a behavioral health navigator.
Henrickson receives referrals from district attorneys, public defenders and jail psychiatric staff about inmates with mental health concerns. Her job is to make sure that she meets with those inmates to do initial intakes and evaluations, which she does while they are serving time at the jail. Henrickson says that it's important to do the intakes while the inmates are actually in jail because some of them might not have phones or transportation.
"This gets rid of barriers for them making it to the appointment. Then they can do it a lot quicker," says Henrickson.
One gap right now that could possibly be fixed with Caring 4 Denver revenue is that the Crisis Intervention Response Unit doesn't have a designated behavioral health navigator for the Denver County Jail. Henrickson tries to visit the county jail for high-needs cases but says that ideally there would be one person based there.
Clinicians work with DPD officers every day from 10 a.m. to 10 p.m. Snow would like to see the program expand to 24 hours, seven days a week.
Clinicians like Randi Nordin feel that having more colleagues would be beneficial. "It's not uncommon that I'll be doing something else and hear that there is another person that I'd be an appropriate person for, but I can't go there because we don't have the coverage," she says.
Denver Fire Department and EMTs have expressed interest in getting their own co-responders, according to unit staffers.
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"If you call, we respond with fire trucks," says Jeff Linville, operations captain at the Denver Fire Department. "If that 911 service is not being utilized for what it was designed for, true 911 emergencies, then resources are tied up. When a true emergency comes in, we’re always going to send a truck, but there may be a delayed response."
Linville believes that if co-responders worked with the fire department, high utilizers of 911 might finally get the help that they need.
Regional Transportation District police are also thinking about a possible co-response program for peak travel periods when officers may have to deal with mental health crises, according to Steve Martingano, deputy chief of RTD Transit Police. Martingano and his team have already launched a pilot program with a clinician from Mental Health Center of Denver and hope to get a clinician working full-time with RTD transit police officers.
"We’ve always felt there was a need for it as well. We're going to do this with or without Caring 4 Denver," he says.