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ProfessionalFull Access

Texas County Expands Tele-Crisis Response Program

Published Online:https://doi.org/10.1176/appi.pn.2021.2.24

Abstract

One hundred and fifty deputies—including many training officers—in the Houston region now have access to mental health specialists via iPads as part of the countywide expansion of the Clinician and Officer Remote Evaluation program.

Photo: Sergeant Jose Gomez checks his iPad –which has ready access to mental health specialists—before he heads out on patrol.

Sergeant Jose Gomez checks his iPad –which has ready access to mental health specialists—before he heads out on patrol.

Harris County Sheriff’s Office

Walter Wallace Jr., 27, was a Black man with bipolar disorder in crisis when police arrived at his home in Philadelphia in late October 2020. Despite warnings by family members to police about Wallace’s history of mental problems and city records of judges referring Wallace for psychiatric treatment, Wallace was shot and killed by the police after he refused their orders to put down a knife.

Wallace’s death reflects an all-too-common outcome when police respond to calls involving people with mental illness.

“His death is yet another tragic reminder that our nation’s police are ill-equipped to respond to people in crisis,” APA President Jeffrey Geller, M.D., M.P.H., said in a statement shortly after Wallace’s death. “We need to rapidly expand our crisis intervention capacities with teams led by mental health professionals to respond to people in a mental health crisis.”

In Harris County, Texas, the success and expansion of a crisis response program shows police and mental health providers can join forces to help people in crisis receive care.

For the past three years, the Harris County Sherriff’s Office has been building a crisis response program in which deputies can reach out to a behavioral health specialist via an iPad.

What started in December 2017 as a test project involving three deputies has since evolved into a $900,000 program involving 100 officers and a seven-person team at the Harris Center for Mental Health available 24/7.

“I believe this is the future of policing,” said Frank Webb, a retired Houston police officer and project manager for the Clinician and Officer Remote Evaluation (CORE) program.

“There is always a need for in-person crisis response teams; they are the ‘Cadillac’ of the first response to a mental health crisis,” Webb continued. “But co-responder units pairing an officer and mental health specialist are expensive and face logistical hurdles.” For instance, some small or rural jurisdictions may lack the necessary mental health specialists, and more populous counties like Harris (which has nine co-responder units to support a population of 5 million) may require extensive driving time to or from a crisis scene, he said. “If our team has to spend an hour in a car each way, we want them to go only where they are absolutely needed.”

By providing deputies with a remote connection to specialists at the Harris Center for Mental Health, deputies can access the same expertise whenever they need it, and only when they need it.

“The calls involving mental health are very complex, and first responders are placed in difficult situations where they may not have time to wait for assistance,” noted Sergeant Jose Gomez, who supervises the day-to-day operations of the CORE program. “These iPads provide our deputies with a resource to give them more confidence when these situations arise.”

Gomez, who is a veteran of Harris County’s co-responder program, was one of the three deputies who participated in the first pilot studies that tested the feasibility of tele-crisis response back in 2017. The success of these pilot studies led the county in 2018 to fund a one-year trial examining the crisis response of 20 Harris County deputies given remote access to the crisis care team (see Psychiatric News).

The University of Houston recently completed a detailed assessment of the 361 calls processed by the Harris Center for Mental Health during the year-long evaluation. They found that with the help of the behavioral specialists, the deputies were able to resolve 42% of their mental health calls on the scene. Almost all the remaining cases ended with a person being sent to the emergency room or a psychiatric hospital; only two cases resulted in a person being sent to jail. Based on follow-up interviews, the deputies indicated that 64 of their calls would have resulted in transporting a person to jail if not for the remote assistance.

These findings led Harris County in February 2020 to approve over $900,000 to support the remote intervention program in full for one year. The initial projections suggested this amount could support 100 iPad-equipped deputies with 24/7 access to a dedicated six-person clinical team along with a team supervisor at the Harris Center for Mental Health. After a few months, the Sherriff’s Office decided to increase the CORE force to 150 deputies. As part of the program, the Harris Center for Mental Health also provides follow-up calls to all people who deputies reached out about after 24 hours.

Webb told Psychiatric News that the $900,000 is roughly equivalent to the annual cost of the county’s nine in-person co-responder teams. “You can see how remote care greatly increases overall access, while also optimizing our response by reserving in-person units for the most serious emergencies.”

He noted the expansion of the CORE program in February 2020 was especially timely since the in-person responder units were temporarily suspended in the spring as part of the social distancing response to COVID-19.

Avrim Fishkind, M.D., a telepsychiatrist in Houston, thinks the continued expansion of the CORE program is welcome news for the county. In 2017, Fishkind—then Chief Executive Officer of JSA Health Telepsychiatry—approached the Sherriff’s Office with a proposal for adding telepsychiatry services to police officers at the scene of psychiatric emergencies.

After the first pilot was completed by JSA Health, the Sherriff’s Office partnered with the Harris Center, which uses master’s level specialists such as social workers to manage the calls rather than psychiatrists.

“I think some of the initiatives they are doing with this program, especially following up with people over the phone after the police encounter, are really smart,” Fishkind said. Looking ahead, Fishkind thinks CORE—and other crisis programs—should continue to work on optimizing costs but also focus on providing the best resolution for individuals, improved linkage to community wide outpatient services, and successful community tenure.

“Despite the emphasis on diversion, in the long run, a person might benefit from a stay at an inpatient hospital for a few days,” Fishkind continued. “Maybe that time could be used to reconnect someone with family or finalize paperwork so they can start receiving social security benefits. If you get to understand the people on your beat and offer them the right level of quality care when they need it, the cost savings will come naturally.”

Gomez is hopeful that as CORE continues to mature, it will set a new standard for community policing. While the initial pilot studies with the CORE program involved deputies such as Gomez who already had experience with mental health crisis response, the program supervisors decided on a different model for the broader rollout.

“We wanted to deploy these iPads with all our field training officers, so that the next generation of officers will get first-hand experience with this new crisis approach,” Gomez said. (All 20 deputies involved in the 2019 pilot remained part of CORE as well).

CORE was funded again for 2021, and Webb said the goal for this year is to distribute 100 additional iPads among deputies in the Harris County Constable Offices which oversee individual precincts (bringing the total to 250).

The growth of CORE is just the latest effort to change how Harris County police engage with people dealing with mental health and substance use problems, especially in minority communities.

Since 2017, the Harris County Sherriff’s office has required all incoming deputies to complete a 40-hour education course on mental illness (CORE members must take a refresher course each year and complete a second training course on telemedicine). Last September, the office incorporated a program known as Project Guardian to improve police encounters with people with autism. Initially developed by the Newport News Police Department in Virginia, this program enables family members to enter a photo and vital details about their loved with autism into a registry. Knowing an individual is startled by flashing lights, for instance, can better prepare police during otherwise tense situations.

“We are looking to change our culture,” Gomez said. “It is not going to happen overnight, but the current feedback we are getting suggests we are headed in the right direction.” ■

More information on the Harris County CORE program is available here.