By Elena Eberwein
As communities seek new ways to respond to mental and behavioral health crises, the co-response model where mental health clinicians respond to calls with police has been adopted in communities across Massachusetts.
The co-responder model for responding to mental and behavioral health crises is not new to Sarah Abbott, Massachusetts’ first co-responder and Director of the Center for Crisis Response and Behavioral Health at Williams James College.
Co-response refers to the model of mental health crisis response that has been adopted by police departments across the country where law enforcement and mental health clinicians respond to calls together.
“I don’t think people choose law enforcement, but there are gaps in the system such that it is their resource,” said Abbott, of police who are one of the only 24/7 resources available in some communities.”It’s not their role but is the role they’re in, it makes sense to me to work alongside them and bring services to the scene.”
Advocates, a human services company based in Framingham, launched the first pre-arrest co-response program in Massachusetts in 2003. Abbott was the first co-responder hired.
Abbott said the program idea came from Craig Davis, deputy chief at the Framingham police at the time. He saw people in the community getting arrested for nuisance, or minor offenses and then ending up involuntarily behind bars when they were in vulnerable states.
“If courts are closed, people could be in a cell for multiple days,” said Abbott. “The place to intersect is the arrest.”
The co-response model has been proven to be “a sought after highly effective strategy for when calls come to 911,” said Abbott. On average, 75 percent of behavioral health calls can be diverted from arrest, according to Advocates’ website.
When the Advocates program began in Framingham, Abbott said that her services were voluntary for officers to use so that co-response was viewed as a tool instead of a punishment. Nearly 18 years later and Framingham has almost 24/7 co-response coverage.
In Framingham, co-responders ride in the vehicle with police officers to be able to respond to a scene as quickly as possible. It also gives officers and clinicians a chance to talk about the situation they’re entering or an opportunity to debrief afterwards.
During Abbott’s first summer as a co-responder, she said there were many police calls for pool deaths. The role became less strictly about diversion, but about providing any support needed on scene for the loved ones of those who had died.
“Who is there for them when it becomes a law enforcement matter?” said Abbott.
The scope of co-response work is larger than just responding during times of imminent mental health crises. Oftentimes, co-responders are there during moments of grief, such as a sudden death in the family.
“Once the officer delivers that news to the family or loved ones, we’ll be there to support the family,” said Kallie Montagano, call response training and technical assistance center manager at Advocates. While the police process a scene, the co-response clinician can be there for whoever may need support at that moment.
In the growing field of alternative mental and behavioral health response, communities are deciding how best to train mental health professionals, law enforcement, and community members.
In her role as director of the Center for Crisis Response and Behavioral Health at William James College, Abbott has developed a graduate certificate program in crisis response and behavioral health. The program will launch in the fall as efforts to further co-response and law enforcement cross-training in Massachusetts continue.
“There has been no consistency of co-responder training,” said Abbott.
Abbott said there is a need for a baseline mental health training across the board for law enforcement. On the other hand, some co-responders may be unfamiliar with law enforcement culture and the goal of the program is to create consistency where students can bring this training back to their jurisdiction.
“Finding quality candidates is a hurdle, because not only does it have to be a fit for clinical experience and crisis experience, but they have to be a good fit for the police culture as well,” said Taylor Hayden, a co-response jail diversion program supervisor at Advocates in Hudson.
The inaugural cohort will begin class on September 1 and is comprised of six law enforcement officers and six co-responders invited to participate from across the state. In three classes, one per semester, students will learn about topics like negotiation skills, building rapport without force, responding to public health crises, responding to hoarding situations, and performing threat assessments from social media posts.
The third course will use MILO range virtual simulation technology to do scenario-based training, said Abbott.
Across the state, police departments are hiring co-responders as they expand programming and coverage.
Behavioral Health Network Crisis Services operates co-response programs in western Massachusetts through Department of Mental Health grant funding. Kristin Cianciolo, a clinical co-response supervisor based primarily out of the Springfield Police Department, said they’ve been operating some sort of co-response for nearly five years.
Cianciolo studied psychology as an undergraduate and worked at Behavioral Health Network Crisis Services as a mental health crisis counselor while she earned a degree in forensic mental health counseling. She said it’s becoming a more apparent career path option for psychology students.
She said they often get graduate student interns who have expressed interest in becoming a co-responder. “So, we kind of start them training more so that towards the end of their internship they’re ready to go right when they graduate,” said Cianciolo.
Currently co-responders in this region do not respond in cruisers with the police the way they do in Framingham. Cianciolo says that is the eventual goal because the best responses happen when the clinicians and law enforcement arrive at the same time. Springfield is the most staffed town in the region with a clinician on every shift, while some of the smaller towns in western Massachusetts were only approved by the Department of Mental Health for funding for 24-hours of co-responder staffing a week.
Besides co-response there are other forms of training being implemented within police departments to ensure positive outcomes in responding to behavioral and mental health crises.
In Somerville, MA, Patty Contente, a licensed clinical social worker, has worked in partnership with the Somerville PD since 2010. She officially moved from the health department to the police department in 2016 to work at their in-house Community Outreach Help and Recovery Department.
The Community Outreach Help and Recovery Department does not use the co-response model but assists with assessments, referrals, follow-ups, alternatives to arrest as well as trainings and workshops for law enforcement and the community. Contente said she believes it is important to keep the departments separate to ensure trust between her and those she offers services to in the community. While she has the same qualifications as a co-responder, she has a different point of view.
“If I’m showing up with a police jacket,” said Contente, “what you’re seeing is that police jacket, you’re representing that you’re part of that system. Where if I show up in my usual, right, it truly does give an alternative.”
Her aim is to follow the guiding principle of social work which is self-determination, and meeting people where they’re at.
“Especially if someone’s still actively using drugs, there’s a lot of concern if you’re gonna have to report this or not,” said Contente. “Absolutely not.”
She works to build rapport with the individuals she helps, and believes in interdisciplinary teams that each bring their own track of knowledge to the team.
Contente also works with Metro CIT which offers Crisis Intervention Training classes beyond Somerville. The classes are five days and officers learn about the foundation of crisis intervention training, the basics of mental health disorders, crisis negotiation skills, and how to serve specialized populations. Community partners are brought in to review the available resources for individuals with behavioral or mental health challenges.
Though there is criticism of whether or not co-response is a true alternative to traditional police response, those who work in the field speak highly of the model and partnership.
“I will say, I wouldn’t go to any call without a police officer,” said Hayden of her work as a co-responder at Advocates. “It’s a huge collaboration, I feel very safe on calls.”
Abbott said the co-response model was created, “Purely to stop a cycle that was ineffective and didn’t address why people were coming into contact with police.”
In response to tragedies of fatal police encounters, more and more police departments are asking to implement co-response programs in order to create the most positive outcomes when mental and behavioral calls are dispatched..
“What gets me out of bed is knowing this is a profoundly impactful model that prevents tragedies and prevents injuries and reduces arrest and more than all of that brings a compassionate ambassador to the scene,” said Abbott. “That partnership when it works well it’s magical.”