Streetwise clinician helps bring more humane approach to police calls in Berkshires

In this article, "Streetwise Clinician Helps Bring More Humane Approach to Police Calls in Berkshires," reporter Amanda Drane highlights various types of situations Richard has been able to assist police with by co-responding to calls for service. The Co-Response Jail Diversion model puts clinicians on the scene of 911 calls with police officers; this allows not only for individuals in mental health crisis to be diverted from arrest and into treatment if appropriate, but it also allows the opportunity for diverting individuals from unnecessary emergency room visits.

Our own Dr. Sarah Abbott, Advocates Jail Diversion Program Director, who pioneered this model was interviewed in the article. "Arresting someone or bringing them to a hospital are any officer's 'default position.' It provides an immediate solution, but it's also expensive and involves taking someone with a mental health issue against their will,"she explained. Thanks to the work of Collins and the Brien Center, officers in the Berkshire community now have another option.
 

The partnership between Pittsfield Police and the Brien Center has helped 1,636 people to date, Richard Collins said. He estimates that represents about $3 million in diverted hospital bills for those would-be emergency department visits, which, he said, usually are paid for under state-provided health insurance.

That's assuming that each emergency department visit costs about $2,500, and he said that's a conservative estimate.

The estimated $3 million in savings assumes every person for whom a Section 12 order was not issued would otherwise have gone to a hospital if the program were not in place. Ambulance transport costs were not included.

Collins said the program reduces strain on tight police rosters and on Berkshire Medical Center's emergency mental health unit, which is always busy.

The program ensures that the system works the way it should, he said, meaning people sent to a hospital are the ones who need it most.

"But I'm only one person working 50 hours a week," he said. "I know there are a lot of mental health calls that don't get noticed."

Heat lightning flashed against the night sky as Richard Collins and three Pittsfield Police officers descended on a Memorial Drive home. The lights were on and the door was ajar.

Just inside, child-size shoes lay askew on the hardwood floor.

No one was there, but a 911 caller had just warned that her daughter, the woman who lived in the home, was in danger. Earlier that evening she promised to drive off a bridge, then gave her 8-year-old son a stuffed toy and said goodbye, the caller told dispatchers.

"What do you think, Richard?" Pittsfield Police Lt. Jeffrey Bradford asked Collins, a social worker with the Brien Center.

"With those kinds of statements, we should," he replied, launching the group toward a Section 12 order. The measure empowers officers to bring someone to a hospital for a mental health evaluation.

Police officers regularly face decisions like this one, and now cops in Berkshire County have backup. What began three years ago as a partnership between the Pittsfield Police Department and the Brien Center has evolved into a countywide effort to provide mental health services as a first response and to reduce the number of involuntary transports.

On Memorial Drive, Collins called the mother who had dialed 911 as officers worked to reach the woman on her cellphone. A sedan slid into view about 10 minutes later. The woman they were searching for shuffled out of the car.

Her eye was black. She was angry to see police.

"We're concerned," Collins said, his voice low. "We're just checking on your well-being."

It wasn't her boyfriend who hit her, she told them. It was "a girl on the street."

"You guys are ridiculous right now," she said, slurring her words. Two officers flanked her and guided her into a police cruiser.

Collins later likened her behavior to a child in trouble. Her defense mechanisms were kicking in, he said. "You have to look for those little clues," he said.

In a rear wing of Berkshire Medical Center, hospital staff admitted the woman, taking from her anything she could use to harm herself. Collins filled out forms and briefed nursing staff.

By this time, the officers had left.

"Police are always getting called away," Collins said.

And that's why he's embedded with the department four days a week, responding to calls for which mental health services are needed. The program began three years ago with money from the Massachusetts Behavioral Health Partnership, but now it's entirely funded by health insurance.

Last fall, Collins expanded the work into North Adams, where he spends one day a week. And in April, the program stretched south into Great Barrington, with another clinician working alongside police officers in South County twice a week.

The program has helped 1,636 people to date across the county, Collins said. He hopes to build relationships with more departments.

"We know the need is there," he said. "They tell us constantly, everywhere we go."

"We don't want to wait for that person to get to that bridge, ready to jump," Collins said.

Many of the Pittsfield department's mental health calls, including streetside disturbances, suicidal statements and distraught seniors in care facilities, repeatedly involve the same people. Officers move on, but Collins stays involved.

A mother's struggle

Laura Gingerich said her son, Billy, was diagnosed with schizophrenia at age 18. During his first year of college, she felt something was wrong when he started talking about CIA cameras in trees.

She knew her son was sick, but when he suffered his first psychotic break, the yard filled with cruisers.

"The ambulance doesn't come," she said. "The police do."

Gingerich, who lives in North Carolina, said she arrived at her son's house in Clarksburg this month and found him thin and eating from dirty plates and silverware. The carpets were pulled up and the crevices of the home boarded and blocked.

"I came up and I was concerned that he was spiraling," she said.

Billy was worried that a snake or a mouse would get in, she said, and was staying up all night. He had contracted food poisoning.

"I was afraid that he would die here," she said.

Collins started checking in on him last month, she said.

"It was great when Richard came on board," she said.

He, too, noticed Billy's decline. Everyone in Billy's circle, in fact — his mother, his medical provider, North Adams Police Officer Erik Thomas and Collins — agreed that he needed more care.

And so that circle worked to have Billy admitted for treatment at Berkshire Medical Center. It wasn't the first time his mother had to have him taken to the hospital involuntarily.

The process is painstaking. In the past, she has had to prove to a magistrate that her son poses a danger to himself. That involves a lot of paperwork and stress, she said.

She knows because she has done it 17 times.

Arranging treatment for Billy hinges on her ability to use the right legal jargon, she said. Sometimes, he calms down enough that he appears too functional for involuntary commitment and her argument falls flat.

With Collins on board, "I didn't have to do any of that."

Collins' program keeps people like Billy out of jails, she said, and gives those with mental health issues the support they need to avoid hospitalization, when possible. The police have been great, she said, but there's no substitute for having a mental health professional on the scene.

"It's an illness," she said. "It's no different than any other serious illness."

Without people like Collins, she said, "we're asking police officers to be psychologists."

A new model

Sarah Abbott started this work 16 years ago in Framingham.

She said she developed the so-called co-responder model after the Framingham Police Department requested support from the mental health field. Officers wanted help breaking the cycle of arrests for those with mental health conditions.

Arresting someone or bringing them to a hospital are any officer's "default position," Abbott said. It provides an immediate solution, but it's also expensive and involves taking someone with a mental health issue against their will.

"The police were doing this back then because there was no other alternative," said Abbott, who works as the program director for jail diversion at Advocates. "They were arrested, sent to the hospital or they were being ignored."

Meantime, she said, mental health professionals in the city worked in a separate silo. "It was ineffective. Doing the screening right there in the living room is not only more humane, it's cost-effective and it's a win for everyone."

Together, she and the department launched the Northeast region's first program in 2003 and expanded into Marlborough in 2008. In 2015, she helped launch the first regional program, based in Middlesex County.

More recently, she said the state's Department of Mental Health provided her organization with funding for a training center. Abbott said she feels driven to saturate the commonwealth with these kinds of programs.

There are more than two dozen co-response projects in Massachusetts, according to information provided by Abbott and the DMH. Some serve a single community, while others take a more regional approach.

The commonwealth spent nearly $2 million on those programs during the previous fiscal year, said Daniela Trammell, director of communication and community engagement for the DMH.

The co-response programs exist largely in the eastern part of the state. The Berkshire effort launched under Collins is the only such program in Western Massachusetts.

Pittsfield Police Chief Michael Wynn praised Collins' work to reduce the number of involuntary transports.

"It's better for the patient; it's better for the outcome; it's better for the Pittsfield Police Department," he recently told members of the newly formed Police Advisory and Review Board.

Paul Hickling, vice president of service operations at the Brien Center, said his organization's mission is to keep the people it treats in the community, where they can access their support system. Collins is part of a national movement to embed clinicians in police departments, Hickling said.

Social workers are in the field all the time, but they mainly help those who voluntarily have sought them out. This program serves those who don't normally ask for help.

"That's where there's a big gap, I think," said Ivy Goodwin, the clinician spearheading the Great Barrington-based branch of the program.

In the work that they do — embedded with law enforcement — clinicians meet people where they are at, in a moment of need, and try to build a relationship. They're often people who don't realize or don't want to acknowledge a mental health issue, Goodwin said.

"Those are people that would otherwise be refusing services," she said, calling the chasm between them and services a "no-man's land."