In Rappahannock County, Trained Clinicians Respond to Mental Health Calls
*This story by Randy Rieland for the Foothills Forum was posted in partnership with the Virginia Center for Investigative Journalism.
The call was about a man threatening suicide. In response, a Fauquier County sheriff’s deputy drove to the scene, hoping he could talk him out of it.
He never got the chance.
When the man spotted a police car pulling up, he rushed back inside his house. There, with little hesitation, he shot himself.
That death last summer stayed with Sheriff Bob Mosier. He wondered if things would have played out differently if someone other than a uniformed deputy had shown up. He knew that for some people struggling with mental health issues, just the presence of law enforcement officers can escalate matters. They fear they’ll be taken to an emergency room, or even worse, to jail.
Mosier felt it was time to try something different. He raised the subject with Jim LaGraffe, executive director of Rappahannock-Rapidan Community Services (RRCS), which led to a larger conversation with other law enforcement, mental health and social services officials in the region. The result is that first in Fauquier County and Warrenton, and more recently in the town of Culpeper, a licensed clinician has been going out on calls — primarily those having a mental health component — with sheriff deputies and police officers. (At this point, more sparsely populated counties such as Rappahannock, Madison and Orange don’t generate enough mental health calls to justify the cost of embedding a clinician with their local law enforcement departments.)
“Is one clinician in Culpeper and one clinician in Fauquier going to solve this? Absolutely not,” said Culpeper Police Chief Chris Jenkins. “But they can have an impact in people’s lives instead of just defusing a situation.”
The idea of having mental health professionals answer emergency calls is hardly new. More than 30 years ago, a program called CAHOOTS (Crisis Assistance Helping Out On The Streets) was launched in Eugene, Ore. It was built around teams of medics coupled with mental health workers who would respond instead of police officers. Some communities have adopted variations of that model, but in most places, the role of dealing with mental health crises remains with law enforcement officers.
“Law enforcement is the default for every failed social program in America,” said Jenkins. “In most cases, we’re the only ones responding.”
That has sparked a rise in Crisis Intervention Training (CIT) among police officers, a program designed to help them respond more perceptively and compassionately to people experiencing mental health trauma. But those with the training are still outnumbered by those without it in many police departments. And even officers with CIT can find mental health calls challenging with situations that can quickly turn volatile and threatening.
“When you introduce a law enforcement officer into the scenario, it ratchets everything up,” Mosier said.
And that can be deadly. Since 2015, police in the United States have shot and killed almost 1,500 people with mental illnesses, according to a database maintained by The Washington Post. One such shooting by a Richmond officer in 2018 led to passage last year of a Virginia law establishing what’s become known as the “Marcus Alert” system. Named after the victim, Marcus-David Peters, a high school biology teacher killed while having a mental health crisis, the law is designed to ultimately shift more of the responsibility for handling these cases from police to behavioral health professionals.
But that won’t happen overnight, and for now, the challenges facing law enforcement officers are particularly daunting. Earlier this month, the Virginia Department of Behavioral Health and Developmental Services announced that due to staffing shortages, it was temporarily stopping admissions to five of the state’s eight psychiatric hospitals. Fewer beds are now available for mental health patients, which means they aren’t getting treatment and are more likely to end up interacting with police.
Then there are the ripple effects of the COVID pandemic. “Over the past year, we’ve seen more people have mental health crises that law enforcement officers have had to respond to,” said Lisa Peacock, director of Culpeper Human Services. “Many times officers out in the field desperately tried to figure out how they were going to deal with a situation.”
Reading things differently
Justine Burns understands this. Since the beginning of the year, she has been embedded as a “co-responding clinician” with the Fauquier County Sheriff’s Department. By her count, Burns has gone out on about 70 calls with county sheriff deputies, and another 10 or so with Warrenton police officers. She also has followed up on mental health-related, non-emergency calls that have come into the office.
She’s seen firsthand how intense and chaotic things can get. Burns admits that she’s had to adjust from what she was used to as a crisis clinician at the RRCS. By the time she saw people there, they had calmed down. Not so on the street. “People don’t want you to talk to them, or they’re yelling and cursing at you to go away,” she said. “But in this field, you can’t take any of it personally. You’re seeing people on their worst day.”
Still, Burns said she has never felt unsafe, despite the unpredictability of her new job. “The sheriff’s deputies have done a really good job of making me feel they have my back,” she said.
She has also learned to appreciate how she and the officers with her can read the same situation differently. “Say we’ve been told a person is suicidal. With their CIT training, the officers might see certain cues that make them believe that the person needs to be put under an emergency custody order (ECO) for an evaluation at a hospital,” Burns explained. “But with my training, I can assess the suicide risk further and determine that this person is not at immediate risk. So, an unnecessary ECO has been averted. The person doesn’t end up with a hospital bill.”
Conversely, Burns might recognize that a person needs more help than officers can provide. “She has a much, much broader knowledge of what resources are available,” said Lt. Andy Marshall, who is coordinator for the co-responder program. “There might be times when our folks think that while a person might need more resources, they can leave them at home. But she might say, ‘No, there’s something bigger here. Let’s take them to the hospital.’ Or a deputy might not pick up on something, and she may say, ‘No, this person needs some resources. Let me have an extra conversation with them.’”
She also has the training — and time — to dig deeper. “The difference with Justine,” Sheriff Mosier said, “is that she doesn’t just say, ‘There’s an issue here.’ She asks, ‘What is causing the issue?’ That’s where clinical expertise comes in. It gives you amplified understanding.”
“The element of follow-up is key to the quality of mental health treatment. But a lot of times, that’s where the ball gets dropped."
John Bankas describes the role of co-responder as the “missing piece” of his career. He is Burns’ counterpart with the Culpeper Police Department, although he’s been riding with officers on a more limited basis for two months while finishing training. Bankas, a native of Ghana, was hired not long after moving to Virginia from California, where he had been a minister, a dean at a bible college in Oakland, then a behavioral health clinician. His new position, he said, allows him to combine his work as a minister helping a community with his professional training as a therapist.
He admits that he’s had to get used to riding in a speeding police car. Like Burns, he said he’s been impressed with the empathy police officers have shown to people with mental health issues. But they’ve also acknowledged their limitations. “Officers have told me, ‘I’m not wired for this. This is your baby,’” said Bankas.
He believes that in addition to the perspective he brings to assessing people in crisis, his value has as much to do with what happens afterward. “The element of follow-up is key to the quality of mental health treatment,” Bankas said. “But a lot of times, that’s where the ball gets dropped. Police are more focused on the here and now. They don’t have time to focus on one person’s situation all week.”
Chief Jenkins concurs. “An officer can give someone a card with phone numbers on it,” he said. “But the plan was to have someone who could follow up with these folks, who would dig down into a person’s history. Someone who could help them navigate the services, and keep them from becoming a chronic burden on a community that has very few resources.”
A mental health reboot
While having two embedded clinicians aligns with the priorities of Marcus Alert, their hiring was already in motion before the law was signed by Governor Ralph Northam in December. According to LaGraffe at RRCS, that likely was a factor in the agency being awarded a $600,000 grant and being chosen as one of five public agencies around the state to develop pilot programs that start shifting safer mental health calls away from law enforcement.
Some of that money will go to setting up and marketing a voluntary database to which people can submit relevant mental health information about themselves, family members and children under 18. That could be relayed by dispatchers to responders in an emergency, and could include information about people to contact, medications the person takes or stressors that could trigger an aggressive reaction.
LaGraffe is also using grant money to staff a 24-hour “recovery center” in Culpeper, where people suffering mental health trauma in Rappahannock and elsewhere in the region could be taken to meet with a clinician or peer, or simply calm down in a comforting environment. “This could be a game changer,” he said. “Right now, if you have a mental health situation, it’s either you go to the hospital or you stay in your home, which may not be the best place for you. There’s a huge void.”
But LaGraffe acknowledges that doing a reboot on how mental health crises are handled will take time and patience. Some decisions on whether to send police to the scene will be easy, such as when a person has a weapon. Others will be tougher calls. And, except for what are obviously safe cases, should law enforcement officers always be positioned nearby in the event an interaction turns dangerous? How will police adapt to clinicians making the call on how to resolve a situation?
“Law enforcement is never going to get out of this business.” Jenkins said. “Do you think there will be squads of mental health workers responding to all these calls 24/7? That’s not going to happen.
“But I do think this is the wave of the future. These clinicians can make a difference when people truly need it.”