Why rural Iowa is trying out mental health response teams rather than police


KHN (Kaiser Health News) is a national newsroom that produces detailed journalism on health issues. KHN, along with Policy Analysis and Polling are the three main operating programs of KFF. KFF is an endowed non-profit organization that provides information to the nation on health issues.

NEWTON, Iowa — Jeff White is well-versed in what happens when 911 dispatchers get a call from someone feeling depressed or agitated.

It happened repeatedly. The 911 operators dispatched the police who took him to hospital or jail. White, who has schizophrenia and depression, said that they don’t know how people like him should be handled. They don’t know how to handle people like me,” White said. They are just guessing.”

He said that he needed someone to calm him down and provide follow-up care in most cases.

Thanks to the availability of a crisis team in his area, this is now possible. Instead of calling 911, he may contact the state hotline to request a visit by mental health professionals.

A program serves 18 rural counties in central and north Iowa. The dispatching of the teams is done by the program. White, 55 years old, has been able to receive assistance from the crisis team many times over the past few years, even though he was forced into nursing home due to heart disease. He pays nothing for the service. The team’s goal, rather than incarcerating or admitting people to a crowded mental health unit, is to stabilize them at home.

Many cities have been sending social workers, doctors, and trained outreach workers to handle calls that were previously handled by police officers for years. The approach gained popularity because of concerns over police brutality. These programs are argued to save lives and money.

Despite the fact that mental illness is equally prevalent in rural areas, crisis response teams have taken longer to adapt. This is partly due to the fact that rural areas have more mental health professionals than urban areas, according to Hannah Wesolowski chief advocacy officer of the National Alliance on Mental Illness.

She said, “It was certainly a harder hill than I expected.”

Melissa Reuland is a University of Chicago Health Lab researcher. She studies law enforcement and mental healthcare. Although solid statistics aren’t available, she said that smaller police departments and sheriffs offices are more open to exploring other options to standard law enforcement responses. She said that these could include training officers to better handle crises or seeking out mental health professionals.

She said that rural areas will continue to face a shortage of mental healthcare services.

Program by program, the crisis response approach continues to make inroads.

White spent most of his adult life in rural Iowa, where he was surrounded by rural areas. White is happy to see mental healthcare efforts expanded beyond urban areas. He said, “We out there get forgotten — out here is where the most help is needed.”

White’s crisis team, for example, can handle their own response while others work with sheriff’s deputies or police officers. Virtual Crisis Care in South Dakota equips officers with iPads. Officers can use the tablets for video chats between crisis victims and counselors from a Telehealth company. Although it isn’t perfect, Wesolowski stated that it is better than having officers or sheriffs’ deputys try to manage such situations themselves.

Counselors assist people with mental health problems to calm down, and then they discuss their needs. If they feel safe to stay at home, the counselor will call a mental center. The center then contacts the individuals to determine if they are interested in treatment.

Sometimes counselors find that people pose a threat to themselves or others. Counselors will recommend officers to take the person to an emergency room, or even jail for evaluation.

In the past, sheriff’s deputies had no choice but to make this decision. They were cautious and temporarily removed people from their homes in order to make sure they were safe. Zach Angerhofer is a deputy in South Dakota’s Roberts County with approximately 10,000 residents.

The process of detaining someone can be very stressful for them as well as costly for authorities.

Many times, deputies spend hours filling in paperwork and transferring people between the ER and psychiatric hospital. This can be especially difficult in rural counties where there are few deputies.

Virtual Crisis Care helps to avoid this situation. According to a state study , nearly 80% of its video assessments end up staying at home.

Angerhofer stated that no one has refused to use the telehealth program he offered. If he doesn’t see an immediate safety risk, he will leave people alone at home or let them ride in his squad car as they talk to a counselor. He said that the participants are “a completely different person after the tablet is deployed.”

The Virtual Crisis Care program is funded by the South Dakota Department of Social Services. It received startup funding and design assistance from the Leona M. and Harry B. Helmsley Charitable Trust. KHN is also supported by the Helmsley Charitable Trust.

According to Monica Van Horn, Monica Van Horn manages the state-funded program via the Eyerly Ball mental healthcare nonprofit. They can be reached via the state crisis line or the national 988 mental healthcare crisis line.

The Eyerly Ball crisis response teams arrive in their own vehicles, and without the need for police. Van Horn stated that clients can benefit from the low-key approach, especially if they live near each other. She said that you don’t have to want everyone to know your business. However, if a police vehicle pulls up in front of your home, all your neighbors and their dogs will be informed within one hour.

Van Horn stated that the program receives an average of between 90-100 calls per month. Many callers are suffering from anxiety and depression and may even be suicidal. Others call to seek help for their children or loved ones.

Alex Leffler works as a mobile crisis responseer for the Eyerly Ball program. She was previously a behavior interventionist in schools and is now working towards a master’s in mental health counseling. She stated that she has worked as a crisis responseer in homes, offices, and grocery stores. She said, “We respond to almost any place.” “You can just make a better connection in real life.”

Thomas Dee is an economist at Stanford University and an education professor. He said that such programs can attract support from all political parties. He said that no matter what political ideology someone may be, they will find something they like in these first-responder reforms.

Critics of police call for greater use of unarmed mental healthcare experts to defuse tense circumstances before these turn deadly. Law enforcement leaders who support such programs claim they can allow officers to respond more quickly to serious crimes. The government also claims that the programs could reduce hospitalizations and jail stays.

Dee examined the Denver Support Team assisted response program. This allows 911 dispatchers to send behavioral health specialists and medics to certain calls . The program was cost-effective, reduced low-level criminality, and didn’t lead to more serious offenses.

Dr. Margie balfour, associate professor of psychology at the University of Arizona, is administrator for Connections Health Solutions. This agency provides crisis services in Arizona. She stated that now is the right time to improve or start such services in rural areas. She said that the federal government has offered more money, including funding for pandemic response. She also noted that the 988 crisis phone line was recently launched. Operators can coordinate such services.

Balfour stated that the national attention on the criminal justice system has made it more important to pay attention to the treatment of people with mental health issues. She said that there are still many things to disagree about with police reform. “But there is one thing everyone agrees on: law enforcement does not need to be the default first response for mental health.”

Because of the settlement of a 1980s case, Arizona has Crisis Response Teams available throughout the state. This is to help people with mental illness.

She said that such programs can be implemented outside of cities using creativity and flexibility. Balfour stated that crisis response teams should be as important as ambulance services. She also noted that nobody expects police officers to respond to other medical emergencies such as a stroke or heart attack.

She stated that people with mental health issues deserve a health response. It’s worthwhile to work out how to make that happen.

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