Mental health crisis teams face challenges in rural areas.

Mental health crisis teams face challenges in rural areas.

If you or someone you know is in crisis, call, text or chat via 988the national Suicide & Crisis Lifeline.

NEWTON, Iowa — Jeff White knows what can happen when 911 dispatchers receive a call about a discouraged or agitated person.

He experienced this on several occasions: the 911 operators dispatched the police, who often took him to the hospital or to prison. “They don’t know how to deal with people like me,” said White, who struggles with depression and schizophrenia. “They just don’t. They are just guessing.

In most of these cases, he says, what he really needed was someone to help him calm down and find follow-up care.

That’s now an option, thanks to an emergency response team serving his area. Instead of calling 911, he can contact a state-run hotline and request a visit from mental health professionals.

The teams are sent by a program that serves 18 mostly rural counties in central and northern Iowa. White, 55, has received help from the crisis team on several occasions in recent years, even after heart problems forced him to move into a nursing home. The service costs him nothing. The team’s goal is to stabilize people at home, instead of admitting them to an overcrowded psychiatric unit or imprisoning them for behaviors stemming from mental illness.

For years, many cities have sent social workers, doctors, trained outreach workers or mental health professionals to calls that were previously handled by police officers. And the approach has gained traction amid concerns over cases of police brutality. Proponents say such programs save money and lives.

But crisis response teams have been slower to set up in rural areas, even though mental illness is just as prevalent there. That’s partly because these areas are larger and have fewer mental health professionals than cities, said Hannah Wesolowski, advocacy manager for the National Alliance on Mental Illness.

“It was definitely a tougher hill to climb,” she said.


Melissa Reuland, a researcher at the University of Chicago Health Lab who studies the intersection of law enforcement and mental health, said solid statistics aren’t available, but small police departments and sheriff’s offices seem increasingly open to seeking alternatives to a standard law enforcement response. These can include training officers to better handle crises or seeking help from mental health professionals, she said.

The shortage of mental health services will continue to be a barrier in rural areas, she said: “If it was easy, people would have solved it.”

However, the crisis response approach is gaining ground, program by program.

White lived most of her life in small towns in Iowa surrounded by rural areas. He is happy to see mental health care efforts being strengthened beyond urban areas. “We are forgotten here – and it is here that we need the most help,” he said.

Some crisis teams, like the one helping White, can respond on their own, while others are paired with police officers or sheriff’s deputies. For example, a South Dakota program, Virtual Crisis Care, equips law enforcement with iPads. Agents can use the tablets to set up video conversations between people in crisis and counselors from a telehealth company. It’s not ideal, Wesolowski said, but it’s better than having police officers or sheriff’s deputies trying to handle such situations on their own.

Jeff White has been aided several times in recent years by crisis response teams serving some rural Iowa counties.
Jeff White has been aided several times in recent years by crisis response teams serving some rural Iowa counties. White, who suffers from depression and schizophrenia, can now call a state-run hotline and request a visit from mental health workers, rather than being admitted to a psychiatric unit or jailed by police.KC McGinnis for KHN

Counselors help people in mental health crisis to calm down and then discuss what they need. If it is safe for them to stay at home, the counselor calls a mental health center, which then contacts people to see if they are interested in treatment.

But sometimes counselors determine that people are a danger to themselves or others. If so, counselors recommend officers take them to the ER or jail for evaluation.

In the past, sheriff’s deputies had to make this decision themselves. They tended to be cautious, temporarily removing people from their homes to make sure they were safe, said Zach Angerhofer, a deputy from Roberts County, South Dakota, which has a population of about 10,000.

Detaining people can be traumatic for them and costly for the authorities.

MPs often have to spend hours filling out paperwork and commuting between emergency rooms, jail and psychiatric hospitals. This can be particularly painful during times when a rural county has few deputies on duty.

The Virtual Crisis Care program helps to avoid this situation. Nearly 80% of people who complete their video assessment end up staying home, according to a recent state study.

Angerhofer said no one refused to use the telehealth program when he offered it. Unless he perceives an immediate security concern, he offers people privacy by leaving them alone in their homes or letting them sit alone in his patrol car while they talk to a counselor. “From what I saw, they’re a totally different person after the tablet was rolled out,” he said, noting that attendees seemed relieved afterwards.

The South Dakota Department of Social Services funds the Virtual Crisis Care program, which received start-up funds and design assistance from the Leona M. and Harry B. Helmsley Charitable Trust. (The Helmsley Charitable Trust also contributes to KHN.)

In Iowa, the program that helps White still has six pairs of mental health workers on call, said Monica Van Horn, who helps run the state-funded program through the nonprofit. lucrative Eyerly Ball for mental health. They are sent through the statewide crisis line or the new national mental health crisis line 988.

In most cases, Eyely Ball crisis teams respond in their own cars, without police. The low-key approach can benefit customers, especially if they live in small towns where everyone seems to know each other, Van Horn said. “You don’t necessarily want everyone to know about your business — and if a police car pulls up outside your house, everyone and their dog will know within the hour,” she said.

Van Horn said the program averages between 90 and 100 calls per month. Callers’ problems often include anxiety or depression, and they are sometimes suicidal. Other people call because children or family members need help.

Alex Leffler is a mobile crisis responder with the Eyerly Ball program. She previously worked as a ‘behavioural interventionist’ in schools, has returned to college and is about to earn a master’s degree in mental health counselling. She said that as a crisis responder, she met people in homes, workplaces and even in a grocery store. “We answer just about anywhere,” she said. “You can just make a better connection in person.”

Thomas Dee, a Stanford University economist and professor of education, said such programs can garner support from across the political spectrum. “Whether someone is ‘defund the police’ or ‘back the blue,’ they may find something to like in these types of first responder reforms,” ​​he said.

Police critics have called for more use of unarmed mental health experts to defuse tense situations before they turn deadly, while law enforcement officials who support such programs say they can give officers more time to respond to serious crimes. And government officials say the programs can reduce costly hospitalizations and prison stays.

Dee studied Denver’s Support Team Assisted Response program, which allows 911 dispatchers to dispatch doctors and behavioral health experts instead of the police to certain calls. He found that the program saved money, reduced low-level crime, and did not lead to more serious crimes.

Dr. Margie Balfour is an associate professor of psychiatry at the University of Arizona and a trustee of Connections Health Solutions, an Arizona agency that provides crisis services. She said now is the time for rural areas to start or improve these services. The federal government has offered more money for the efforts, including through pandemic response funding, she said. It also recently launched the 988 crisis line, whose operators can help coordinate such services, she noted.

Balfour said the current national focus on the criminal justice system has drawn more attention to how it responds to people with mental health needs. “There are still a lot of things we disagree about with police reform,” she said. “But one thing everyone agrees on is that law enforcement doesn’t need to be the default first responder when it comes to mental health.”

Arizona has crisis response teams available across the state, including in very rural areas, as a 1980s class action lawsuit settlement required better options for people with mental illnesses , Balfour said.

Such programs can be done outside cities with creativity and flexibility, she said. Crisis response teams should be seen as just as vital as ambulance services, Balfour said, noting that no one expects police to respond to other medical emergencies, such as when a person has a heart attack or stroke.

“People with mental health issues deserve a health response,” she said. “It’s worth trying to figure out how to get this to the people.”

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