On June 16, one man called Biddeford police more than 15 times. Sometimes he told dispatchers he needed to talk about his mental health, other times his words didn’t make much sense. He said he didn’t need police officers to check on him, but he kept calling back anyway.

Calls like these to local police departments are increasingly common in Maine and across the country, prompting public safety officials to re-examine how they’re interacting with people with mental illness and to hire mental health clinicians better equipped to work with people in crisis.

“More people are recognizing that law enforcement response to mental health should be handled by someone specifically trained to deal with those individuals,” said Biddeford Police Chief Roger Beaupre.

On Tuesday, Beaupre will ask the Biddeford City Council to allocate funding for the police department to bring on two additional mental health professionals to work with the department’s new community engagement specialist, who in the past six months has met with more than 300 people to work through mental and behavioral health problems and connect them to resources.

In Westbrook, the police department is in the process of hiring a mental health liaison to help handle a 30 percent increase in mental health calls since last year. And in Portland, where calls related to mental health have increased nearly 16 percent since 2018 during a time when overall calls for service are down, the police department recently added an alternative response liaison with a background in mental health to assist people with mental health emergencies during and after contact with police.

“I don’t think police departments are designed to deal with the level of mental health crisis calls we get. We’re not mental health practitioners,” said Westbrook Police Chief Sean Lally. “With this uptick in calls, there’s a documented history of poor responses to them that have caused all kinds of hardships. We’re looking for creative ways to de-escalate situations and get people into treatment as opposed to putting them in prison.”

As national attention has focused on the need for police reform and questions about the role of law enforcement, there is a growing recognition that mental health crises are a public health issue, not a law enforcement or criminal justice problem.

People living with mental illness and developmental disabilities are disproportionately represented in contacts with police, and these interactions can lead to stress and dangerous situations for everyone involved, according to the Vera Institute of Justice, which in 2018 launched a national initiative to improve police responses to people with serious mental illnesses and intellectual/developmental disabilities.

One in four fatal police interactions in the United States involves someone with severe mental illness, according to the Treatment Advocacy Center. Surveys by the National Alliance on Mental Illness have found that people in a mental health crisis are more likely to encounter police than get medical attention, resulting in 2 million people being jailed each year.

Police are ill-equipped to safely and effectively serve people in behavioral health crisis and even when officers receive training in crisis intervention and de-escalation, the presence of armed, uniformed police can exacerbate distress and escalate mental health-related situations, according to the Vera Institute.

A decade ago, county sheriffs across the United States began “ringing the bell” about the number of people with mental illnesses coming into contact with police and ending up in jail, said Jeffrey Coots, director of the From Punishment to Public Health initiative at the John Jay College of Criminal Justice in New York. Conversations about this have become more common in many communities over the past year as law enforcement and public health policies and funding are re-examined, he said.

“We have viewed police as a catch-all response to any public nuisance issue that arises. We have laid many things at the feet of police and not always resourced them appropriately, but expect them to deal with that,” Coots said, noting this happens with mental health, substance use and homelessness.

Pairing police and mental health providers is part of a nationwide trend of looking for alternatives to incarceration, Coots said. Crisis Assistance Helping Out on the Streets, or CAHOOTS, is an initiative in Eugene, Oregon, that started in 1989 and is often pointed to as a model to successfully provide mental health response to crises involving mental illness, homelessness and addiction. In 2019, the CAHOOTS teams of medics and crisis workers resolved 20 percent of calls to the city’s public safety communications center.

The Biden administration’s $1.9 trillion stimulus package passed in March includes $15 million for grants to start mobile crisis programs. It also includes three years of enhanced Medicaid funding to cover 85 percent of operating costs, estimated by the Congressional Budget Office at $1.1 billion over 10 years.

“Mental health clinicians respond with a different set of tools,” Coots said. “Crisis intervention teams adding an extra clinician is a really valuable tool. It’s something we should have been doing all along.”

PANDEMIC-RELATED STRESSORS

In Maine, the pandemic has added stressors for people who were already struggling with their mental health, leading to both increases in calls to police and to crisis lines.

Sweetser has seen its average monthly intentional warm line calls increase from 1,958 in the 12 months before April 2020 to 2,791 calls during the pandemic. The statewide support line offers mental health peer-to-peer support through conversations with peer specialists who have life experience with mental health recovery.

Janet Anderson, a shift leader for the warm line, said the agency at the beginning of the pandemic added about eight people to take calls. Call volume is going up and she believes that will continue as people grapple with added stress from everything reopening and face masks becoming optional.

“We thought we’d be winding down with COVID-19,” she said. “But (the reopening) is creating more trepidation and anxiety. Now that the new variant is upon us, some of our callers are going back into isolation. That’s where we can come in, so we can help them move forward in their lives.”

At The Opportunity Alliance in Cumberland County, members of the Mobile Crisis Response Services team and Maine Crisis Line have been talking to and meeting with more people on a daily basis than before the pandemic. During the past 12 months, there was a monthly average of 8,458 calls to the crisis line, a 10 percent increase over the previous 12 months.

Of those calls, 55 percent are from callers regarding their own needs, while 13 percent of calls come from mobile crisis response units and 12 percent come from providers. The majority of calls come from family members, hospital emergency departments and law enforcement. The top four reasons for calls are mental health symptom decompensating, anxiety, acute stress and suicidal ideation.

“The people we’re seeing are much more acute. Their needs are higher, the risk is greater. We’re spending more time with clients,” said Carrie Swarthout, clinical supervisor for Mobile Crisis Response Services.

People experiencing a mental health crisis may be referred to the team by the Maine Crisis Line, which is available 24/7 by phone or text, or through referrals from police departments or other organizations such as local shelters that want to avoid a police response.

Kristin Ricciardone, vice president of programs for The Opportunity Alliance, said the general public is more accustomed to calling 911 when there is a problem and may not realize there are other options. For people in most of Cumberland County, the mobile crisis response team tries to respond within an hour to meet with someone in crisis and connect them to services.

“While many police officers do an excellent job and are well-trained, their primary job is not working with people in crisis,” Swarthout said. “We would always love to be that first call.”

Missy Esty is The Opportunity Alliance’s police liaison, a position that has existed for around 20 years. She primarily works with the Portland Police Department, but also responds to assist with mental health crises in Westbrook and other towns when she can.

One day last week, a Portland officer brought a man in his 70s who had been evicted because of hoarding to meet with Esty at her office on Lancaster Street. The man was paranoid, unable to control his emotions and had some injuries, but was initially scared of both the officer and going to the hospital, Esty said. After talking with him, the man agreed to get medical treatment and Esty spent part of the afternoon with him at Maine Medical Center to connect him with the help he needed.

“They don’t need to go to jail, so I intervene to see who their providers are and get them into a safe place,” Esty said. “I take over so they don’t end up getting themselves in trouble or getting hurt.”

While Esty will continue to handle acute cases, including people with suicidal thoughts, the Portland Police Department recently hired Andrea Taatjes as its first alternative response liaison. Taatjes, who is a licensed mental health clinician, has direct contact with people in crisis and then regularly follows up with them.

Portland police saw a 15 percent increase in calls with a mental health disposition from 2018 to 2020. While total calls for service dropped significantly from 2019 to 2020, calls that would be routed through alternative response – including suicide threats, intoxicated person, well-being checks and behavioral health – have increased and account for 8.5 percent of all calls for service. When adding in other calls that most likely involve a mental health or substance use component, such as drinking in public or overdoses, that increases to 16 percent of total calls for service, according to the department.

Taatjes said she works closely with patrol officers, community service providers and the public to assist people with mental health emergencies during and after contact with police.

“Once the threat is cleared, we can have the officers leave,” Taatjes said. “Then we can take more time to sit and talk about what’s going on and figure out what they need. Oftentimes, they need someone to talk to them.”

BIDDEFORD’S EXPERIENCE 

During his first six months as the Biddeford Police Department’s community engagement specialist, Jacob Hammer has handled 314 referrals of people in crisis or struggling with their mental health. He can help de-escalate the situation, then work with the person to connect them with the resources they need, including mental health services, medical treatment and housing.

“People are feeling at the end of their rope and don’t know what options are available to them,” Hammer said. “After they’re stabilized, I can come in and help them build a long-term plan.”

Hammer, who is contracted through Spurwink to work with Biddeford police, came to the department as calls involving mental health issues seem to be increasing.

Between Jan. 1 and June 20, Biddeford police received 334 calls involving mental illness or suicide attempts. Police, fire and emergency medical personnel spent 284 hours in the field responding to those calls. Beaupre, the police chief, said these types of calls are up, but does not have comparable data for previous years because the department started coding the calls differently this year.

Those 334 calls involved 167 individuals, an average of two dispatches per person in the six-month period. But Beaupre said that average is heavily skewed because one person was involved in 35 dispatches and five people averaged 20 calls each.

Many of those interactions with Biddeford police don’t involve criminal activity. Beaupre said the majority of mental health calls don’t involve a threat to safety and the people would be better served by mental health professionals who can connect them to treatment options.

“People don’t know where else to direct them,” Beaupre said. “(Hammer) has made a tremendous impact, not only in easing the burden on responding officers, but in referring people in dire need of assistance to the proper place.”

In 1997, Biddeford police teamed up with York County Counseling Services Inc. to have a social worker ride along with officers on mental health calls. Grant funding for that partnership ran out in 2002 and the services stopped.

“We recognized early on that the people we deal with are suffering from a variety of mental health problems that cause people to ask for police intervention,” Beaupre said. “When we respond to deal with a crisis, we need assistance and guidance from professional people.”

Beaupre said that while Hammer’s role in Biddeford has been critical in responding to the need in the community, more is needed. On Tuesday he will ask the City Council for money to add two licensed mental health workers to work with patrol officers on the street. The additional people would allow the department to have someone available at night and on weekends.

The estimated cost to add two additional community engagement specialists plus clinical supervision to the contract with Spurwink is $229,778 for the first year. That includes Hammer’s salary, which is already included in the police department’s operating budget, Beaupre said.

In Westbrook, the police department is in the process of hiring its first mental health liaison, who will work alongside the community policing and recovery liaisons. The mental health liaison will respond with officers to mental health calls depending on the situation, work with residents to connect them to the help they need and help train first responders on better de-escalation strategies.

Lally, the police chief, sought funding for the new position this spring after seeing an estimated 30 percent increase in the number of mental health-related calls coming into the police department from the previous year. The exact increase and number of calls is hard to pin down because many of those interactions begin with something that doesn’t necessarily indicate a mental health component, such as erratic driving or a well-being check, he said.

“COVID has done no favors for people,” said Meg Perry, Westbrook’s community policing coordinator. “It’s exacerbated things that are existing for people and made them harder.”

Perry said the new mental health liaison will work closely with her and the recovery liaison to work with people in need of help navigating treatment and other resources. She sees the addition of a mental health liaison as an exciting and effective way to better serve the community.

“When you work with a mental health liaison whose focus is that system of care, they know how to navigate that in a way that feels less challenging or less daunting,” Perry said. “When someone is in crisis or needs support, having someone to say here are your options and you’re not going to have to go through this alone is huge.”

People can connect with the Maine Crisis Line (1-888-568-1112) by phone call or text message. The intentional warm line is available at 1-866-771-9276. Both are staffed 24 hours a day, seven days a week.

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