Chicago’s New Mental Health Response Model

No one would send police officers to put out a fire. Yet in many parts of the country, police officers are routinely dispatched to 9-1-1 calls that are mental health-related.

Unfortunately, outcomes of these calls handled by first responders without the necessary training can turn tragic—both for the public and the responders.

This is why the City of Chicago is trying a new approach. Specially trained mental health teams are responding to select calls as part of the city's Crisis Assistance Response and Engagement (CARE) initiative. CARE is an interagency pilot program supported by the Chicago Fire Department (CFD), Chicago Police Department (CPD), Chicago Department of Public Health (CDPH), and the Office of Emergency Management and Communication (OEMC), with support from the mayor's office.

“The CARE program seeks to ensure that individuals experiencing a mental health crisis are assisted by teams of behavioral health professionals, with resources to address their unmet health and social needs,” said Jonathan Zaentz, CFD’s district chief of special projects, who is in charge of CARE. “Even before the national dialogue on mental health made headlines, the City of Chicago has sought to elevate its ability to respond to an individual experiencing a mental health crisis.”

How CARE Works

In general terms, CARE teams respond to any emergency event within their jurisdictions whenever a mental health component is the primary reason for the 9-1-1 call. Exceptions to this rule are calls with a medical component such as injury or illness (EMS covers this), or if there is reasonable belief in a clear and present threat to responding units such as a gun on scene and/or violence (police respond to this).

An example of a typical CARE case: “A clinician is on a telemedicine call with a client when the client begins to decompensate and starts expressing suicidal ideation,” said Zaentz. “The clinician calls 9-1-1 and asks for a mental health response to ensure the client receives personal interaction and is properly assessed in their moment of need. The CARE team responds.”

At present, Chicago’s CARE program is testing two different physical response models. The first uses a Multi-Disciplinary Response Team (MDRT) consisting of a community paramedic, a licensed mental health professional, and a Crisis Intervention Team (CIT) law enforcement officer. The second uses an Alternate Response (AR) team, comprised of a community paramedic and a licensed mental health professional.

The decision to send MDRTs or AR teams rather than police on their own is made by CARE-trained 9-1-1 call-takers in Chicago. “Those calls are then dispatched directly to the units which respond, without lights and siren, to the location,” Zaentz explained. “Upon arrival, the crew utilizes de-escalation, mental health assessment, referral to community services, and transportation to community-based destinations as appropriate. The program also provides 1-, 7-, and 30-day followup contact with encountered individuals to address continuing issues and help empower the individual.”

CARE teams also monitor active calls within their region and can choose to assist on calls that already have a CPD or CFD unit responding. These decisions are made collectively by the CARE team members, who assess the situation based on their mental health expertise. As well, police officers at a scene within a CARE region can also directly request a CARE unit response.

As for coverage? “The CARE team is operating in three pilot geographic areas within the city of Chicago identified as having a high density of 9-1-1 calls with a mental health component,” said Zaentz. “As the program is new, hours of operation are limited but have been designed to target high-volume time periods.”

The Right Stuff

All Chicago CARE team members are well trained for their jobs. CARE’s community paramedics are state-licensed CFD paramedics who have attended an accredited program consisting of 120 hours of instruction and education. They have a minimum of 5 years' experience with the CFD.

CIT police officers undergo a minimum of 40 hours additional training beyond their academy training. They come from specialty units within CPD focused on mental health response and care, and have street patrol experience.

Finally, the program’s licensed clinicians are master's level, state-licensed practitioners who were interviewed and selected by CDPH to ensure they have applicable crisis work experience.

“In addition to the above education, all members attended a 120-hour interagency training program of mixed-classroom and scenario-based exercises designed to build collaboration as well as give additional information on this form of crisis response.” said Zaentz. “As part of our program, we perform a 100% CQI process including specific case reviews of events.”

Making a Difference

The positive results of Chicago’s CARE program, even in pilot phase, speak for themselves. “In our first year of operation, we have responded to over 330 events,” Zaentz said. “We are very proud that none of those events has resulted in a use of force or arrest. We have also performed over 270 followup encounters beyond the initial 9-1-1 response.”

The benefits don’t stop here. “Often, we can perform an in situ evaluation and determine that the individual is not in immediate need of transportation services,” Zaentz said. “Whereas a police or traditional EMS response would have likely transported the individual to an emergency room, the CARE team is able to provide service linkage to help address needs in a manner that is more effective for the individual. Moreover, the followup services performed by the team help ensure these outcomes are effective.”

As well, CARE teams can transport individuals to community-based crisis stabilization centers, where they can receive mental health services plus housing, food and other social aid. Meanwhile, “by utilizing a methodical non-urgent approach, some situations are de-escalated and an individual who would have been an involuntary admission through an emergency room is converted and willingly goes with the team to seek services,” said Zaentz.

The payoff: “Having the CARE resource available in our community, and particularly allowing our police officers to request it, adds a significant tool to their skill-set in providing safety, care, and service to the communities we serve,” he told EMS World. “We also have already seen the program contribute to reduced repeat 9-1-1 usage.”

The City of Chicago and its first responder agencies are heartened by the positive results they and the public are receiving from the CARE program. The city is expanding the program by adding mental health professionals to their 9-1-1 call center to respond to mental health calls, building additional crisis stabilization centers to serve as alternatives to emergency departments, and expanding CARE’s coverage and hours of operation.

This is an approach that Zaentz advises all jurisdictions to consider. “Mental health is not an urban or rural issue,” he said. “While each community needs to evaluate what its population requires, and what resources are available to meet those requirements, broadening 9-1-1 services to include mental health is nationally accepted. 9-8-8 (the national three-digit suicide hotline) is one clear example of this national movement.”

James Careless is a frequent contributor to EMS World.