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Employing Social Workers for Mental Health Calls

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Employing Social Workers for Mental Health Calls

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Employing social workers within law enforcement agencies helps reduce call volume, improve officer wellness, and enhance community relations by providing expertise in mental health crises and support services. Various models, including fully embedded social workers and co-responder units, have shown success in these initiatives.

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DALLAS - The Bloomington (Indiana) Police Department (BPD) began an embedded police social worker (PSW) program in 2019. Funded by the department budget, the program started with one PSW and has grown to three full-time PSWs. Many police agencies have seen the benefits of having PSWs on staff as it can decrease call volume and increase law enforcement effectiveness when dealing with subjects experiencing mental illness.

During a session at the 129th International Association of Chiefs of Police conference, BPD's Chief of Police Michael Diekhoff and senior social worker Melissa Stone, MSW, LSW, detailed those benefits through data and case studies that span the program's history. They also discussed the additional benefits of embedded PSW positions, such as improving officer wellness.

Memorable quotes on embedded police social worker programs

"Programs all across the country show having social workers is reducing call volume." - Melissa Stone

"People are surprised that the police department is following up on death calls, which is good for community connections." - Melissa Stone

"This is one of those changes in policing we will continue to see grow because of the national attention around police response to mental crisis calls." - Chief Michael Diekhoff

"An officer struggling with mental health can find that to be stigmatizing. Having an embedded social worker they are familiar with makes it easier for them to reach out to that person for help with their problems." - Chief Michael Diekhoff

Social worker response models

There are many different types of mental health outreach programs currently in operation in the United States. Melissa outlined the three main types of programs:

A fully embedded social worker program where social workers work within the police department, respond with LEOs to calls and are paid out of the police department budget

Co-responder models where a law enforcement agency may contract with an outside provider of mental health services to respond with the police officer and the law enforcement agency pays per billable hour.

Mobile units run outside of a law enforcement agency where social workers respond to crisis calls without law enforcement officers.

Bloomington PD decided to go with a fully embedded model for several reasons:

The agency was facing an officer shortage so wanted to try an alternative way to deal with mental health crisis calls to ultimately free up officer time

Having a social worker in-house provided the agency with access to that social worker's expertise not only to deal with community members in crisis but also to help improve officer mental well-being.

By having a social worker as a paid member of the department, the agency would not have to worry about billable hours, which would have been the case if they had contracted with an outside provider.

program success to date

During the presentation, the speakers shared data on the increase in referrals to social workers since the program started. Many of these individuals are referred to the social workers after they have some level of interaction with sworn officers, so while the social workers' caseload has increased, calls for service have decreased. Individuals may require assistance with obtaining housing or healthcare, as well as other community services.

The following chart shows the number of referrals to social workers since the program started. There was a spike in referrals during the height of COVID-19, as people struggled to cope with pandemic-related stressors.

Photo/Bloomington Police Department

The following chart shows the number of interactions the social workers have with both new and ongoing clients, which include the interactions social workers have with various community-based services to access care and assistance for the individuals in the program.

Photo/Bloomington Police Department

Improving officer well-being

As Chief Diekhoff made clear throughout the presentation, one of the main pluses of having social workers embedded within a law enforcement agency is the benefits they offer regarding improving officer wellness.

As the social workers have gained the trust of sworn officers when responding to calls for service in the community, those same officers have turned to the social workers for assistance with their own emotional well-being, as well as other non-work-related problems.

Melissa discussed one case where a Bloomington officer was struggling to find assistance for his elderly mother so turned to Melissa for referrals for service. Melissa and the other social workers can also provide officers with advice regarding obtaining services for their own mental wellness care.

The work doesn't stop there. The team of social workers hosts family events for the LEOs and their family members to attend where they can discuss the stresses associated with law enforcement families, as well as have some fun at holiday parties.

Upcoming conference

Last October, industry leaders from the law enforcement and social work fields came together for the first time to explore successful methods and best practices for embedded social workers in police departments. The event was so successful that it has been broadened to address the needs of all those in public safety working in conjunction with social workers.

The next conference will be held November 1-3 in Indianapolis, Indiana. For more information, visit https://ncpolicesocialwork.com/.

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IACP 2022: The benefits of employing social workers in your law enforcement agency

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"This is one of those changes in policing we will continue to see grow because of the national attention around police response to mental crisis calls."

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Heart team (Holistic Empathetic Assistance Response Team)Durham Community Safety Department. 

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Heart team (Holistic Empathetic Assistance Response Team)Durham Community Safety Department. 

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CoR pairs clinicians with Durham police officers to respond to certain calls for service that pose a greater potential safety risk.

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HEART is a program under the Durham Community Safety Department that works to enhance public safety through community-centered approaches to prevention and intervention as alternates to the criminal legal system.

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One in five individuals killed by police were experiencing a mental health crisis at the time.

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One in five individuals killed by police were experiencing a mental health crisis at the time.

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Cities need to change police responses to mental health crisis calls because traditional methods often worsen situations, causing unnecessary harm. Integrating mental health professionals into response teams aims to provide more appropriate care, reduce the use of force, and improve outcomes for those in crisis.

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Philadelphia police officers Kenneth Harper and Jennifer Torres were in their patrol car, sitting at a red light, when a call came in over the 911 radio dispatch.

"This job says 'female complaint in reference to dispute with daughter, suffers from bipolar, infant on location,'" Harper read off the computer near the front seat.

The officers got a little more information from dispatch. A mother needed help with her adult daughter, who had become combative after drinking alcohol.

It was a Friday morning. Harper and Torres quickly drove off in the direction of an address just a few miles away. They traveled in a white SUV, absent of any police markings, and there was a third team member in the backseat, Krystian Gardner. She is not a police officer, but rather a mental health clinician and social worker.

"Do we know the age of the daughter?" Gardner asked the officers up front. She was already preparing a list of possible services and treatment options.

As the team pulled up to a row home in North Philadelphia, the mother was waiting for them outside, on the front stoop. They spent 40 minutes with the family, working to de-escalate the immediate tension, provide the mom with support, and connect her daughter to treatment services.

The trio returned to the patrol car and got to work documenting what had happened and recording the visit in an electronic database.

Officer Torres commented on the adult daughter: "In regards to her mental health, she is taking care of herself, she's taking her medication, and she's going to therapy, so we don't need to help her too much on that aspect."

"She's actually sleeping right now, so I gave her my card and she'll call us whenever she wakes up," Torres added.

Soon, the radio dispatch crackled with their next call, to a home across town where an older woman with a history of several mental illnesses had wandered outside naked.

This visit took longer, over an hour, but had a similar outcome - help with the immediate mental health crisis, a connection to follow-up services with a case manager, and no arrest or use of force by police.

New ways to respond to behavioral health needs

Emergency dispatchers in Philadelphia are increasingly assigning 911 calls involving people in mental health crises to the city's Crisis Intervention Response Team (CIRT), which pairs police officers with civilian mental health professionals. This model is called a "co-responder program."

Cities across the country are experimenting with new ways to meet rapidly increasing demand for behavioral health crisis intervention, at a time when stories of police shooting and killing people in mental health crisis have become painfully familiar.

Big questions persist about these efforts: what role should law enforcement play in mental crisis response, if any? How can leaders make sure the right kind of response is dispatched to meet the needs of a person in crisis? And what kind of on-going support is necessary after a crisis response call?

City officials and behavioral health professionals often don't have easy answers, in part because the programs are new and hard data on their effectiveness is scarce.

Without a single, definitive model for how to improve crisis response, cities are trying to learn from each other's successes and mistakes as they build and adjust their programs.

The Philadelphia Police Department established its Behavioral Health Unit in November 2022 and officially launched the co-responder crisis response team as one of its main programs.

The department says its goal is to meet people's immediate behavioral health needs, avoiding arrests or use of force if possible. Philadelphia's program has answered about 600 calls since December 2022 - and only one case so far has resulted in an arrest, according to city data.

In about 85% of cases, people experienced one of four major outcomes: they were connected to outpatient mental health and social services, voluntarily entered psychiatric treatment, were involuntarily committed to treatment, or were taken to a hospital for medical care.

"I think the practical experiences that people have had has really opened up a lot of people's eyes to what the work does, how it's actually reducing harm to the community," said Kurt August, director of Philadelphia's Office of Criminal Justice.

Give a social worker a dispatch radio

City officials in Philadelphia looked to other cities like Los Angeles, California, Houston, Texas and Denver, Colorado that had developed their own models over the years. They contacted people like Chris Richardson.

Richardson helped found Denver's co-responder program in 2016, which pairs police officers with mental health professionals, like Philadelphia's CIRT program.

Denver residents had been unhappy with the status quo, Richardson recalled. At the time, rank-and-file police officers were the only ones responding to 911 calls about people in crisis.

"We just heard a lot of those communities saying, 'We wish there was something better,'" he said. "That's what kind of gave us that ability to start those conversations and start a partnership."

Getting buy-in from law enforcement and other emergency response teams took time, Richardson said. Eventually, the co-responder program grew to include all police precincts and several fire departments.

Then, Denver City and County park rangers began requesting the aid of mental health professionals to accompany them while on patrol in public spaces, and during emergency calls.

"And then, somewhere in the middle there, we all kind of were like, you know, give a social worker a radio. We're like, why are we sending police to this in general?" he said. "How do we take police out of things that don't need policing?"

Denver then launched a second model, its civilian response program, in 2019. It brings together paramedics with mental health professionals to respond to crisis calls - no police officers involved at all.

Now, Denver uses both models - the co-responder program with police, and the all-civilian response program - to cover Denver's crisis needs. Richardson said both programs are necessary, at least in Denver.

"It's a spectrum of care with behavioral health crises" he said. "Some of it is really low level. No threats, no safety concerns, no legal issues."

But sometimes responders or community members may face serious safety concerns, and that's when a co-response team that includes police officers is needed, Richardson said.

"We want to make sure that that person in crisis is still getting taken care of," he said.

Getting the right responders to the right call

Officials in Philadelphia want the police co-responder program to work in parallel with the city's existing network of civilian-only mental health response teams. The co-responder program is dispatched by 911, while the all-civilian program is activated when residents call 988.

The 988 system launched in July 2022, providing a single three-digit number that can be dialed from any phone by people who are suicidal or experiencing a behavioral emergency. Calls are routed to a network of over 200 local and state-funded crisis centers.

"A large percentage of Philadelphians are not aware of 988," said Jill Bowen, Commissioner of the Philadelphia Department of Behavioral Health and Intellectual disAbility Service. "I like to say that people are born knowing to call 911, kind of come out of the womb and they know to call 911. And we really are trying to reach that kind of level of awareness."

To help sort incoming calls, 911 dispatch centers in Philadelphia have been hiring mental health professionals. They can screen calls from people in crisis who don't need a police response, and forward them to 988.

Other cities and states are also struggling with confusion over how to handle the overlap between 911 and 988 calls.

Although 988 is a national network, calls are taken by regional call centers, which are overseen and managed by local governments. The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) says it is working on "building strong coordination between the two services," but it's currently up to states and counties themselves to figure out how 911 and 988 work together.

National data collected one year after 988's implementation show that most calls to the service can be handled with conversation and referrals to other services. But 2% of calls to 988 require rapid in-person intervention. In most states, the responding agency is 911, which deploys traditional law enforcement, or co-response teams, if they're available.

Next steps: a safe place to go

In states where awareness of 988 is higher, some behavioral health leaders are focused on a lack of continuing care resources for people in crisis.

During a July press conference marking one year since 988, Shari Sinwelski, the head of California's biggest crisis call center, described the ideal crisis response as a three-legged stool: "someone to talk to, someone to respond, a safe place to go." The idea was first introduced by the national Substance Abuse and Mental Health Services Administration (SAMHSA).

In California, 44 out of 58 counties have some form of mobile crisis response, meaning a team that can physically travel to someone in need, according to a 2021 survey conducted by the County Behavioral Health Directors Association of California.

However, the preparedness of these groups varies significantly. The survey identified that many of these teams don't operate 24/7, have long wait times (up to a day) for response, and aren't equipped to handle children in crisis.

The same survey found that around 43 percent of the state's counties didn't have any physical place for people to go and stabilize during and after a crisis. Wellspace is California's second biggest 988 center, by call volume, and is located in Sacramento County. A few years ago, the leaders of Wellspace decided it was time to open a crisis stabilization unit.

In the summer of 2020, WellSpace unveiled the Crisis Receiving for Behavioral Health center, or "Crib", in Downtown Sacramento. The center receives people who are experiencing a mental health crisis or drug intoxication and allows them to stay for 24 hours and be connected to other services. The group says they've served more than 7,500 people since opening.

Physical locations linked to services, like Crib, are a crucial part of a well-functioning 988 system, according to Jennifer Snow, National Director of Government Relations and Policy for the National Alliance on Mental Illness.

"Those crisis stabilization programs are really key to helping somebody not languish in the E.R. or unnecessarily get caught up in the criminal justice system," she said.

Snow said it's too early to know how the nation is progressing overall on building up these kinds of centers.

"This is something I am dying to know and we just don't," she said.

Snow explained that the crisis care system has roots in law enforcement, so it tends to replicate law enforcement's decentralized and locally-led structure.

"It makes it harder to look at it from a national perspective and, you know, be able to identify exactly where are these services and where are the gaps in services," she said.

Building additional crisis centers, and hiring enough response teams to respond quickly, at all hours, in more areas of the U.S., would require significant investment.

The current system relies heavily on state and local government funding, and more federal support is needed, Snow said.

Last year, a group of legislators introduced the 988 Implementation Act in the House of Representatives. They were able to pass a number of provisions, including securing $385 million for certified community behavioral health clinics, which operate 24/7 crisis care, and $20 million for mobile crisis response pilot programs.

The bill was reintroduced this year, with the goal of passing the remaining sections. A significant provision would force Medicare and Medicaid, as well as private health insurance, to reimburse for crisis services.

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Cities know the way police respond to mental crisis calls needs to change. But how?

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About 1 in 5 people killed by police since 2015 were having a mental health crisis. Like other cities, Philadelphia is trying a new approach: sending along social workers to respond to those calls.

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1 in 5 people live with a mental illness.

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1 in 5 people live with a mental illness.

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Nami (the National Alliance on Mental Illness) is at the forefront of the fight for people suffering from and living with mental illness. They are the standard which all other organizations work with in the community to supply information out.

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Mental illnesses are medical conditions that disrupt a person’s thinking, feeling, mood, daily functioning and ability to relate to others.