Description of original award (Fiscal Year 2022, $255,000)
The Crisis Intervention Response Initiative (CIRI) builds upon the existing Crisis Intervention Response Team (CIRT), 4 licensed behavioral health clinicians that respond with police officers to calls involving behavioral health issues. Since early 2021, CIRT has seen more than a 240% increase in call volume. To meet the increased need, CIRI will provide two additional behavioral health clinicians to respond with officers. CIRI will also add a case manager to provide in-depth follow up, assist with benefits and housing, facilitate discharge planning from hospitals, and better track outcomes to reduce repeat crisis episodes.
This project is well aligned with the Department of Justice activities and mission, specifically its Office of Justice Programs mission “to increase public safety and improve the fair administration of justice across America through innovative leadership and programs.”
Partnerships like CIRI are innovative programs that offer the opportunity to increase public safety and fair administration of justice by providing behavioral health expertise to properly de-escalate and safely resolve crisis situations. Through CIRI, police officers, clinicians and case managers can support community members and their families by connecting them to support systems and avoiding unnecessary emergency room use or justice system involvement. This results in safer communities, more just outcomes for individuals and improved police-community relations by providing the right response to police calls for situations with behavioral health as the root cause. The field of police/behavioral health co-response is still relatively new, with limited research completed. The formal evaluation that would be part of the CIRI project would fill important knowledge gaps for program planning with learnings to increase public safety not just in Boulder, but across the nation by adding quality research to this field. This type of formal research on outcomes is particularly important as a model during a time when cities across the nation are calling for more “alternative response” programs.
Why is this project a good use of taxpayer funds?
According to the National Alliance on Mental Illness, 1 in 5 U.S. adults experience mental illness and 1 in 20 adults experience serious mental illness. The COVID-19 pandemic and the tragic Mar. 22, 2021 King Soopers shooting have further increased the behavioral health stress in Boulder.
The need for robust behavioral health support in many calls to the police department is clear. In 2020, Boulder police responded to at least 1300 calls for service that were directly related to behavioral health issues. It is difficult to obtain a precise number of behavioral health-related police interactions, but officers report a constant increase in the number of people they contact that suffer from behavioral health problems.
The community benefits of police/behavioral health partnerships (also known as co-responder programs) such as CIRT are diverting community members from arrest and hospitalization, helping people connect with ongoing behavioral health supports in the community, and helping improve interactions between law enforcement and the communities they serve, per a 2020 evaluation of Colorado’s co-responder programs by Colorado Health Institute. This report also notes the high number of people involved with the criminal justice system with behavioral health and substance use issues, stating “In Colorado…35 percent of the inmate population has a mental health need and 74 percent has a substance use disorder.”
Co-responder clinicians can provide on-scene assessment, which reduces police use of involuntary mental health holds and transport to the hospital. Avoiding involuntary treatment and hospitalization whenever possible are best practices to reduce trauma to the individual as well lifetime suicide risk. Susan Stefan’s Rational Suicide, Irrational Laws underscores that “Involuntary psychiatric detention increases rather than decreases the risk of suicide for many people...It is not only that hospitalization is ineffective, but in some cases it is extremely damaging...mental health professionals believe that involuntary institutionalization can be a traumatizing experience that increases the likelihood of suicide in the long run.” (pp 119-120) Live Through This, an online project to gather stories of suicide attempt survivors, documents the damaging experiences of psychiatric hospitalization, including here in Colorado. Having a co-responder work with law enforcement on scene increases the likelihood that the community member in crisis will be able get support in the moment, access voluntary treatment, and avoid the trauma of an emergency room visit or psychiatric hospitalization. Having a case manager can also help address quality of life issues, such as support in accessing benefits and housing, or finding ways to increase community connection. Being able to follow up with additional resources after the crisis decreases the likelihood of future crises.
Similar to nationwide trends, the Boulder community has expressed a significant interest in increased mental health training for police officers as well as alternative response programs, including the co-responder model represented in the CIRI project. The city has received many resident comments asking about how it is supporting behavioral health needs, particularly when the police are called into situations involving behavioral health. When a recent newspaper article ran about the CIRT team, the city also received many supportive comments and inquiries about the program asking if it could be expanded.
While the CIRT team follows up with people it helps through crisis situations, there is not currently capacity for more intensive, ongoing case management to help people avoid future crisis situations. The addition of a full-time case manager as proposed in CIRI would bridge this gap.
Goals of CIRI:
Strengthen relationships between clinicians and officers for more coordinated response to behavioral health crisis situations,
Connect residents to ongoing community services to support behavioral health needs,
Provide better outcomes for community members experiencing behavioral health challenges and avoid unnecessary use of force, arrests or hospitalization
Objectives of CIRI:
Increase the number of calls for service that CIRT responds to, allowing appropriate service response to more acute calls,
Track and increase engagement of community members in ongoing community services after initial crisis contact to reduce repeat crisis calls,
Reduce involuntary mental health holds, track and increase engagement of community members in ongoing community services after initial crisis contact to reduce repeat crisis calls
Hire and train two clinicians (10/22)
Hire and train one case manager (9/22)
Integrate clinicians and case manager into police department team (10/22)
Expand CIRT operating hours (10/22)
Reduced number of mental health holds (4/23)
More capacity to respond to behavioral health crisis (4/23)
Reduced burnout and increased clinician retention (8/23)
August 2022: hire and onboard two clinicians and one case manager
September 2022: case manager training complete
October 2022: clinician training complete, expand CIRT operating hours
April 2023: evaluate call response data
August 2023: assess clinician burnout/retention