The man had mental health problems and would often stand on a street corner in midtown Tulsa. When he had mentally unstable behavior, paramedics would take him to an emergency room.
But that was rarely the place he needed to go. Most of the time, he needed a mental health facility. And when he ended up at a hospital, law enforcement would have to make calls to paramedics. Then an officer would have to be staffed to transport the man to a facility.
It became a pattern.
The man is the type of person who gave rise to the city’s Community Response Team — or CRT — a mobile mental health co-responder unit that responds to people who have emergent mental health needs.
CRT is part of an emerging shift in Tulsa to free up law enforcement and emergency services, connect people to the proper resources and change the way mental health calls are handled.
The team complements CARES, a collaborative program that aims to reduce the number of calls made by “super users,” people who call 911 more than 15 times per year for mostly nonemergency situations.
The CRT program has been in a pilot stage since January, taking place once per week. But on July 31, the program began running at four days.
The uptick in CRT shifts is an effort to gather data to see how well the program is working and how much it costs, said Capt. Shellie Seiber, mental health coordinator for the Tulsa Police Department.
“We’re trying to look at time on task, resources that are saved with the unit, and is the quality better for the person,” Seiber said.
‘We can get to them faster’
A CRT shift on Tuesday was made up of Michael Baker, EMS chief for the Tulsa Fire Department, Susannah Ralston, TPD mental health liaison officer, and Rachel Diacon, a therapist with Family & Children’s Services.
During that shift, the team checked on the wellbeing of a gray-haired man who calls 911 frequently. He has mental health problems, no health insurance and lives alone in his midtown Tulsa apartment.
One of CRTs goals is to not only respond when a 911 call is made, but also to mitigate problems before it gets that far, Baker said. The team aims to divert people from jail and crisis mental health centers.
“So someone who is in full panic or having a mental health crisis, we can de-escalate them, they can stay home versus having to go somewhere,” he said. “We offer a lot more tools than some of the responders might be able to.”
Before the team even arrived to the man’s home, Diacon checked her laptop to see whether he’d had any previous interactions with Family & Children’s Services, and found that Community Outreach Psychiatric Emergency Services (COPES) contacted him a month ago when he was suicidal.
“I think the biggest advantage is you know, (Rachel’s) running people, I know people, (Baker) knows people, it’s from all three sides,” Ralston said. “Medical, mental health and police, and we can piece together a pretty good picture.”
The team is familiar with the man, who is in his 60s. He’s considered a “super user” and is involved in the CARES program.
“(CRT) does overlap with CARES a little bit,” Baker said. “The difference is, we have some people who are CARES folks that kind of are good candidates for CRT, and then when we have some downtime we might do a follow up, or go visit with them or kinda try to tackle them as a team together.”
After the team visited the man, who appeared skinny and in poor health, they discussed what to do next.
“I was really surprised when I walked in. He looks horrible,” Baker said.
“He’s sick,” Ralston said.
Diacon added: “He’s one of the ones who’s been calling 911.”
The team made plans for a case worker to follow up. On the way to another mental-health call, Baker explained he’s seen the man look healthier and the condition of his apartment had deteriorated.
Who would have checked on him if the CRT wouldn’t have stopped by?
“Nobody,” Baker said.
Minutes later, a Family & Children’s Services member told the team the man had become suicidal, and they returned to the home. He was soon admitted to an emergency room.
That same day, the team responded to six calls that showed a variety of tasks the members do. Since the team started four-shift weeks, they’ve responded to six to 11 calls per day, Diacon said.
The Community Response Team constantly monitors 911 calls through a dashboard in the vehicle members travel in.
After seeing a new call for a suicidal subject call on the dashboard, Ralston contacted the caller and learned the woman the call was made for was OK and went to work. She left a number for mental health services in case the woman decided she wanted to talk later.
Normally, Ralston said, at least one police officer, a paramedic and possibly a COPES member and a firetruck would have responded to a call about a suicidal person.
On the way to respond to another call about a suicidal person, Diacon searched records on the woman’s history.
“I can look at this and look through our records and see if they’ve been violent in the past, and then we know for sure if we’re responding to a mental health call,” Diacon said. “Because sometimes a check on a wellbeing may not necessarily be mental health, but then if I can cross check it with this, it’s like, ‘Oh yeah, we’re going to a mental health call.'”
Arriving on scene as a team not only saves resources, it also strengthens communications between the different agencies, the team said.
“We can get to them faster,” Diacon said. “Most of the mental health calls, since we’re looking for them, for police officers they may be a lower priority call.
“Like someone with psychosis who isn’t an immediate harm to themselves or anyone else, it could sit for awhile just because that’s not going to be a high-priority call for TPD. But we can see it come up on the dashboard and we can go ahead then.”
Ralston said the vehicle they travel in helps, too. Instead of arriving in a police car, they ride around in a white Tulsa Fire Department EMS truck. Team members say it can help keep the people they respond to calm.
‘Expertise across the spectrum’
Tulsa police respond to 1,000 to 1,200 mental health calls each month, Ralston said. But they rarely end in an arrest.
“Our department is usually really good at not just trying to clean up the mess by taking them to jail, even if they’re drunk,” she said. “If we realize there’s a mental health problem, we do a really good job of not just trying to take them to jail.”
Mike Brose, Mental Health Association Oklahoma CEO, said not only can CRT divert people from jail and crisis mental health centers, it can also save taxpayers money and lead to better outcomes for people in need of help.
“There’s something about three services working together as a team,” Brose said. “There’s support for each other, there’s cross-expertise across the needs spectrum.
“Having a law enforcement officer with that team really frees up the EMT and mental health professional to have the confidence and comfort to do there job.”
The CRT and CARES programs are based on Colorado Springs Fire Department’s initiatives, which use a similar approach through a collaborative-care model.
As a result of CARES, within the first three months of 2017, the Tulsa Fire Department saw a 70 percent decrease in 911 calls from its top 10 users, Baker told The Frontier in June.
“(CRT) helps all three of our agencies — healthcare, behavioral health and law enforcement — all interact and really it helps us make sure that individual who is in crisis goes to the right spot,” Baker said.
“A lot of times people who are going through a significant behavioral emergency, you know we can de-escalate the situation rapidly and maybe calm him down.”
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