Mental Health Response in Pleasanton, Part 2: a Solution
In our previous article on the police and mental health reform in Pleasanton, we explained the need for alternative solutions of responding to someone experiencing a mental health crisis rather than the police. This new system would let mental health professionals aid those in need, rather than officers who are inadequately equipped to handle such situations effectively. This article highlights two solutions that were successfully implemented in other parts of the U.S. and how they may apply to Pleasanton.
In light of the national protests sparked by the death of George Floyd, including those in and around Pleasanton, the city council held listening sessions on what the city should do about policing. Many referenced the deaths of 3 mentally ill residents during encounters with the PPD to point out a simple question about our current responses to calls about mental health crises: Why are police officers being sent there?
In response to the community’s concerns in the listening sessions on policing, the City of Pleasanton has begun to consider alternative responses to mental health calls. But while many agree that officers should not be put in charge of dealing with mental health crises, there is less clarity on what should be done instead. After assigning staff to search for potential solutions, the city is considering two approaches to an alternative mental health response: the PERT and CAHOOTS model.
Overview of PERT
The Psychiatric Emergency Response Team, or PERT, is a program in which a licensed mental health provider and an unarmed, PERT-trained law enforcement officer act as first responders to mental health crises. PERT teams are trained to de-escalate and redirect individuals in crisis to mental health services rather than unwillingly hospitalize or incarcerate them, as is currently the case.
San Diego County’s use of the PERT model is indicative of the program’s success in responding to mental health crises. Cases where hospitalization or incarceration would have typically been used to resolve a situation — both of which are far less responsive and effective in aiding patients — were redirected to PERT teams in over half of their interventions. The 2014-15 fiscal year in San Diego County saw 49% of PERT interventions result in 72-hour hold hospitalizations, and 51% of mental health calls result in referrals to community resources where patients could get help. Because of its success, San Diego County increased the size of its PERT program by 300%. As of the fiscal year 2019-20, San Diego County has a total of 70 PERT teams serving 3.34 million citizens.
The PERT program provides extensive and comprehensive training to the officers that accompany mental health professionals, emphasizing de-escalation training and having a compassionate response to those experiencing health crises while keeping themselves and citizens safe. San Diego County’s PERT teams are also available to citizens 24/7 in order to make sure only PERT officers respond to mental health crises at any point of the day.
After its success in San Diego County, PERT has been adopted by ten police departments in California since its implementation. Because PERT response teams make police departments more effective and cost-efficient in their response to mental health crises, PERT would undoubtedly be a far better alternative to the status quo in Pleasanton as well. But the issue of mental health in Pleasanton does not have only 1 solution.
Overview of CAHOOTS
Eugene, Oregon is home to America’s longest lasting alternative response team: Crisis Assistance Helping Out on the Streets — better known as CAHOOTS — which is run by a non-profit social services organization called the White Bird Clinic. CAHOOTS is quite similar to PERT, in that mental health workers (and an EMT in this case) are sent to respond to mental health crises and emergency calls. But while PERT teams are all accompanied by an unarmed officer, CAHOOTS sends only mental health workers in-lieu of the police. However, CAHOOTS workers do work closely with the police and are dispatched through 911. Dispatchers in Eugene filter calls, sending the violent and criminal ones to the police, and those with strong behavioral health components to CAHOOTS.
CAHOOTS responds to a wide variety of calls including substance abuse, suicide threats, helping homeless residents, counseling, and requests for transportation to facilities. Their team has three vans with medical equipment and supplies for the homeless. The dispatched team can also call for an ambulance or police support if necessary. In 2019, 24,000 calls (or 17% of the calls to the Eugene Police Department) were handled by the CAHOOTS program, with the police intervening only 0.625% of the time (roughly 150 total calls). Staffers, who have undergone extensive crisis intervention and de-escalation training, arrive at the scene in casual clothing and are able to provide a less threatening environment for residents in crisis than armed police officers. Additionally, no CAHOOTS worker has ever been seriously injured or killed in their 30 years of interventions.
The Eugene Police Department’s $70 million budget, which serves around 170,000 people, only allocates around 3% to CAHOOTS which handles almost 17% of calls. Diverting calls away from the more expensive police department to CAHOOTS saves the city $8.5 million in public safety costs and taxpayers $14 million in ambulance trips and emergency room costs annually.
The White Bird Clinic also provides consulting to cities interested in implementing similar programs. They allow officials from other cities to observe their workers in action and offer to send CAHOOTS members to other cities to do field training. They also offer help with developing training manuals and policies.
The Eugene Police Chief, Chris Skinner, has endorsed the effectiveness of the CAHOOTS, saying that the EPD and CAHOOTS have a symbiotic relationship that better serves their city’s residents, and that it’s time for law enforcement to stop being a catch-base for all their community’s needs.
In our view, Pleasanton’s effort to implement one of these two models is a great first step in protecting our most vulnerable residents while also potentially making a better use of our city funds. Based on our research, we maintain that CAHOOTS would be the best model for Pleasanton to adopt, due to its clearer independence from law enforcement and its compatibility with the reallocation of resources.
One of our main concerns with the PERT model is whether mental health experts on a PERT team could properly act independently of the police. Because of their differing professional perspectives, a mental health expert might view one resident as having a difficult but ultimately harmless mental crisis, while an officer might reasonably perceive a threat that requires force. In a more extreme example, police officers and PERT workers might disagree on what takes priority: the provision of mental health services, or detainment in compliance with the law.
While a mental health expert is present as a service provider, a police officer has the authority of the law. It is unclear if mental health workers can act in line with their professional expertise if they think the police officer could overrule them. A CAHOOTS model avoids these power dynamic issues, as the workers arrive on scene separately from police officers, only calling them if the situation clearly requires law enforcement. Maintaining this distinction seems like the best way to ensure that social workers are able to preserve their professional independence, and that no unnecessary friction between law enforcement officers and social workers arise.
A CAHOOTS model would also be a more effective way to reallocate responsibilities away from the police than PERT. The PERT model keeps mental health workers and police officers tied together, which may defeat the purpose of redirecting mental health calls away from the police in the first place. If Pleasanton is seeking to reduce government expenditures in the way that Eugene has, then PERT would not be ideal, as the number of calls that the PPD would have to respond to would be the same and the PPD’s budget would possibly increase as well. Redirecting these calls to a separate, designated social work team could help Pleasanton see the financial benefits that Eugene has experienced.
Despite the benefits that we see in adopting CAHOOTS over PERT, our group holds that any step towards properly implementing either of these two approaches would be some progress towards making Pleasanton safer and more humane. We continue to urge the council to commit the resources and willpower necessary to make a program like CAHOOTS work in Pleasanton, and urge our community to call on our elected officials to do this. But there are still many more reforms Pleasanton needs to adopt, beyond just this.