Dallas to expand crisis program partnering medics, social workers, police

Some activists expressed concerns about the inclusion of police in mental health crisis teams


Nic Garcia and Brooklynn Cooper
The Dallas Morning News

DALLAS — On the first day of July, Otho Jones was hiding from the sun under a southern Dallas bridge when the delusions started.

The 55-year-old who lives with schizophrenia had been wandering the streets homeless for more than a year.

RIGHT Care team members, from left, Parkland Memorial Hospital Psychiatric Social Worker Sarah Holigan, Dallas Fire Department Driver/Engineer Abel Rodriguez and Dallas Police Officer Aaron Rucker are photographed at the South Central Dallas Police Department. Dallas plans to expand the RIGHT Care program, adding more teams to respond to mental health crises. (Photo/Tom Fox, The Dallas Morning News)
RIGHT Care team members, from left, Parkland Memorial Hospital Psychiatric Social Worker Sarah Holigan, Dallas Fire Department Driver/Engineer Abel Rodriguez and Dallas Police Officer Aaron Rucker are photographed at the South Central Dallas Police Department. Dallas plans to expand the RIGHT Care program, adding more teams to respond to mental health crises. (Photo/Tom Fox, The Dallas Morning News)

Dehydrated and sleep-deprived, Jones hallucinated that someone was trying to cut him with a knife. In a fit of panic, he tore up the few dollars he had in his pocket and called 911.

Had Jones called for help from any other neighborhood in Dallas, a team of police officers likely would have surrounded him, possibly whisking him to jail. Instead, a social worker, a paramedic and a police officer showed up together to help Jones in his time of crisis.

They gave Jones a lemon-lime sports drink and took him to a nearby behavioral health clinic for treatment.

“They took all the problems away,” Jones said.

The three-member team, called RIGHT Care, is a pilot program run by the Dallas police and fire departments and Parkland Health & Hospital Systems. Started in 2018 to change how Dallas police respond to the 13,000 mental health crisis calls that emergency dispatch receives each year, the team is on patrol from 7 a.m. until 11 p.m. daily in the city’s south central neighborhoods.

And now, City Hall and its partners plan to expand RIGHT Care across Dallas as part of its response to a summer of protests against police brutality and systemic racism.

But some city activists who have called for sweeping changes to the Dallas Police Department are wary of the police’s continued involvement in the RIGHT Care program. They argue that sending an armed officer to a mental health emergency is an open invitation to escalate an already tense situation.

“Police come with the burden of the badge and are grossly undertrained, and underprepared, to engage in the type of services people in mental health crises need and deserve,” said Sara Mokuria, a co-founder of Mothers Against Police Brutality, a nonprofit that tracks police violence. The group also has advocated for shifting resources from the police toward community programs.

But RIGHT Care supporters and the organizations that work with Dallas police to run the program say law enforcement is necessary for its success because trained officers provide security.

As long as they’re not responsible for making medical decisions, they are the only ones who can ensure the welfare of all parties, said B.J. Wagner, a senior fellow at the Meadows Mental Health Policy Institute who helped lead the research team that fueled the creation of RIGHT Care.

“It’s very hard to predict what is really going on at a scene,” she said. “A central part of law enforcement has always been to secure the scene, ensure the safety of the community and the person in need, and to ensure that no one has been a victim of a crime.”

Spike in calls

RIGHT Care — or the Rapid Integrated Group Healthcare Team — was launched after a study by the Meadows Mental Health Policy Institute found that the number of mental-health related 911 calls to Dallas jumped 18% between 2012 and 2015.

The same study also found that about 17,000 people with mental illness were booked in the Dallas County jail annually, and 40% were jailed at least twice a year.

Wagner said the institute’s goal was to find solutions that kept people living with mental health illness out of the criminal justice system and removed the burden from police to make health care decisions, which they’re not trained to do.

“The expectations on law enforcement have grown so expansive. They’re being asked to do things in which they’re ill-equipped,” she said. “We expect them to be the first line of response for everything.”

The RIGHT Care program began after Dallas police had killed Jason Harrison and Tony Timpa — two men in the midst of mental health emergencies. In both situations, police were responding to 911 calls.

Harrison, 38, was shot by police officers June 14, 2015, as he stood in the doorway of his own home. Police were answering a 911 call from Harrison’s mother, who said he was bipolar and making violent threats. The Black man was holding a screwdriver when police arrived. Officers claimed Harrison lunged toward them before they shot him five times within a minute of arriving at the family’s home.

Timpa died Aug. 10, 2016 after he told the 911 dispatcher he suffered from schizophrenia and depression and was not taking his medication. Police mocked the 32-year-old white man as he cried for help more than 30 times while officers pinned his shoulders, knees and neck to the ground. He later fell unconscious and died.

“We knew there was something we had to do differently and something we had to do better to protect individuals and their families,” said David Pughes, a 30-year Dallas police veteran who now leads the city’s new department of integrated public safety, which is responsible for ending crime with non-police alternatives.

Before pitching RIGHT Care to the City Council, Wagner and her team interviewed 500 first responders and behavioral health specialists throughout Dallas County. They scoured the country for models to replicate.

Ultimately they settled on what is now in place today.

The pilot version was launched in Dallas police’s South Central patrol division, which includes four ZIP codes: 75241, 75216, 75203 and 75232. Like most of southern Dallas, these four zip codes are home to mostly Black and Latino families. And they are typically poorer than the rest of the city. The average per capita annual income, according to the Census, ranges from $13,000 to $20,000, compared to the city’s average of $34,016. The region was selected because it had the highest number of mental health calls in the city.

Since the program’s inception, officials have lauded the results.

According to data from Parkland, during the first nine months of 2019, the hospital saw a 20% drop in psychiatric emergency room visits from those four zip codes. Arrests between Jan. 1 and July 31 of that year also dropped 8% compared to the prior year. And citations dropped 10% during the comparable time period.

“If it’s possible to avoid arresting somebody to get them mental health services, we’re going to do that,” said Kurtis Young, director of social work for behavioral health at Parkland. “If we can get someone mental health services — without taking them to a busy ER — that’s a success.”

Working together

When 911 receives a call from the south central area, a team of caseworkers listens for those they believe would be better answered by RIGHT Care.

Once the team arrives at the scene, the police officer first assesses the threat level, said Sgt. Jennifer Wells, who oversees RIGHT Care for the police department. Officers complete 40 hours of training on how to identify and communicate with people who are mentally ill.

If the officer believes that there is no physical threat to the rest of the team or the person being treated, the paramedic and social worker step in.

The paramedic checks the person’s physical health, and normally the social worker evaluates a person’s needs afterward.

All three will work to establish a connection with the person in crisis. However, if a person feels more comfortable interacting with the paramedic or police officer, those officials finish the evaluation.

“If we made a personal connection on scene and are able to relate to that person… we’re able to ask mental health questions in order for [the social worker] to obtain needed information to handle the call,” said Fire and Rescue Lt. Isaac Gooch, who has worked on the RIGHT Care team as a paramedic since its inception.

When Jones, a former line cook, was taken to the behavioral health clinic, he was assigned a caseworker who helped him get the medicine he needed to keep the delusions away, steady housing and other basic needs.

Jones, who is now living in a boarding house, receives daily phone calls from his caseworker at MetroCare, which is one of several other organizations that work with RIGHT Care.

“I’m doing the right thing and doing the right life,” he said. “They want to help me in the best way they can.”

All three members respond to calls in the same vehicle, which was an adjustment — especially for Parkland clinicians.

“You have people at the top of their game in each profession all trying to solve the issue of the call,” Young said. “At first, there were some toes stepped on.”

Today, they couldn’t imagine responding to mental health calls any other way.

Wells said that each member of the RIGHT Care team focuses on different danger signals. While police might be looking for signs of aggression, paramedics are ensuring the client doesn’t need serious medical attention. Those steps help the social workers feel safer assessing the person’s mental health needs.

“If we remove one member of the team,” Wells said, “that would throw it off.”

Police alternative

Critics of the Dallas Police Department say there is another way to handle mental health emergencies. Over the summer, a committee of police reform activists and city managers throughout Dallas County met to discuss policing alternatives to such calls.

Among the programs highlighted was CAHOOTS from Eugene, Oregon. CAHOOTS, short for Crisis Assistance Helping Out On The Streets, was established in 1989 by a health clinic that provides crisis intervention and drug counseling.

The conversations happening in Dallas are not new, said Tim Black, the clinic’s director of consulting. Police officers across the country since at least the 1970s have been sent “out for behavioral health crises, for addiction, for housing, for mediation and dispute, where there was no crime being committed,” he said. “And there was a need for a different type of responder going back that far.”

Similar to RIGHT Care, CAHOOTS is part of the local 911 dispatch system. Unlike the Dallas program, CAHOOTS employees initially respond without a police officer.

That program handled 23,000 calls last year, Black said. CAHOOTS called for police backup in less than 1% of the cases.

Similar efforts are taking place across the country. In Sacramento, emergency room nurse and activist Asantewaa Boykin helped launch MH First, a community-based response team that works outside the criminal justice system.

Boykin’s much smaller operation — made up of only volunteers and a donated RV — answers about 40 calls a month but has been largely sidelined due to the coronavirus pandemic.

She was critical of health care workers in Dallas who said they felt they needed police protection to respond to mental health emergencies.

“If you need a man with a gun to make you feel safer, perhaps you’re doing the wrong job,” she said. “The people who you want to call you are traditionally distrusting of the police.”

Partner organizations, including Parkland and MetroCare, said since the summer protests, they have reevaluated whether to continue with the police department as part of RIGHT Care. For now, they said, they’re sticking with the model as is.

Jasmine Brown, a clinical manager at MetroCare’s Lancaster Clinic, where the RIGHT Care team often brings people in crisis, said officers not only add a level of safety but can help repair the relationship between the Black community and police department.

“We’re restoring hope and faith and trust within the community,” she said.

Expansion plans

Expanding the RIGHT Care team is the cornerstone of the city’s response to demands that policing change. Dallas City Manager T.C. Broadnax, as part of his proposed budget, wants to double the city’s investment in RIGHT Care to $2 million next year.

The goal would be to increase the number of teams to cover the entire city from one to five by next spring. By 2022, a total of 10 teams would be on the street at any given time.

Like several other law enforcement leaders, Dallas Police Chief U. Reneé Hall has publicly supported alternatives to sending police to mental health emergencies. Currently, when police respond to a mental health care call, at least four officers and a supervisor are sent to scene.

That’s no longer an appropriate response or use of police resources, said Hall, who recently announced plans to resign at the end of the year.

“We’re looking forward to in the future that maybe this is more of a community-based program than it currently is,” Hall told The News' editorial board recently.

The City Council is expected to approve the budget at its Sept. 23 meeting. County commissioners last week approved Parkland’s budget which earmarked more than $1 million for the team, more than tripling its current budget.

Pughes, the former police leader who now works at City Hall, said he wants to develop more and different responses to crisis calls. He says now, after more than 30 years of law enforcement, he sees the need for a holistic approach and greater investment in the community.

“If we don’t make those types of changes, if we don’t go to the source and make impactful sustainable changes, it’s a Band-Aid,” he said. “As we expand this, we have to look at being able to change our philosophy and practices. We may have RIGHT Care teams down the road that don’t have a police officer in them.”

Mokuria, the community activist, said Dallas should not delay in adopting those types of programs.

“The immeasurable suffering that families across this city have endured because of the failures of the city of Dallas to adopt evidence-based best practices is unconscionable,” she said. “We can’t wait. The time is now.”

Staff writer Cassandra Jaramillo contributed to this report.

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©2020 The Dallas Morning News

McClatchy-Tribune News Service

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