Robert Patrick
St. Louis Post-Dispatch
ST. LOUIS — Last year, calls to 911 in St. Louis started to change.
Some callers seeking help with a mental or behavioral health crisis, have begun to say, “We don’t need the officers. Send the purple shirts,” said Felicia Spratt, clinical director of Behavioral Health Response, a contractor hired to work on a new program pairing mental health clinicians with first responders.
Launched one year ago this week under former Mayor Lyda Krewson’s administration, the program has two parts.
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The 911 diversion program sends calls about mental health issues to Spratt’s company to see if they can be addressed by specially trained employees instead of by sending police officers or an ambulance.
The second, the Crisis Response Unit, or CRU, puts a police officer with specially trained Behavioral Health Response staffers, the “purple shirts,” to respond to crisis calls that can’t be handled over the phone.
They respond to mental health calls but also incidents involving domestic violence, drug overdoses and trespassing, and are equipped to spend the time to connect people to social services around the city.
In the first eight months of the program, officials estimate it’s saved millions of dollars and nearly 2,000 hours of police and EMS workers’ time. The first year of the program was funded by about $1.6 million out of the city’s budget, according to the mayor’s office.
Proponents also say it’s resulted in fewer people being brought to jail or the emergency room. They say it has helped reduce violent crime by allowing officers to focus on that, not mental health crises.
Homicides and gun assaults both fell by more than 20% in St. Louis from 2020 to 2021, following a surge in both in 2020, but the reason for the drop remains up for debate.
“Someone experiencing a mental health crisis does not need to come into contact with police or be thrown in jail,” Mayor Tishaura O. Jones said during a call Thursday with reporters marking the one-year anniversary of the program. “That doesn’t make our neighborhoods safer. It just introduces people into our revolving door criminal justice system while tying up police resources on a call that they may not be suited to handle.”
Jones said she’s committed to expanding the program.
Before it started, there were few options for police when someone was having a mental health crisis that triggered a 911 call: a trip to the emergency room or to jail. Or nothing, when officers were unable to access the network of disparate services that might help.
Police officers simply weren’t trained and often didn’t have the time to figure out how to access all the services people might need, said Wilford Pinkney Jr., director of Children, Youth and Families for the mayor’s office and liaison to the program.
The 911 diversion program answered nearly 700 calls, Pinkney said, with 75% not resulting in a response by police officers.
For the nearly 5,000 people who encountered the CRU teams, the program’s data focuses on what didn’t happen, saying 95% weren’t arrested and 87% didn’t make a costly trip to the hospital, according to statistics provided by Behavioral Health Response and Mastercard, which donated staff time to analyze the program.
Many were referred to community behavioral health providers, reconnected to their existing service providers or provided with other resources on the spot, Pinkney said in an interview.
‘Inspiring’ statistics
Pinkney called the statistics “inspiring.” He said, “We’re really feeling positive about ... the numbers.”
CRU clinician Randall Richardson said on Thursday’s call that he often begins his work with the phrase, “I’m just here to help.”
“There’s a preconceived notion about what officers are here for and my purple shirt brings that tension down,” he said. “Sometimes those first five minutes are very critical to establish a rapport, a relationship with people and bringing down that blood pressure a bit.”
Richardson likened it to a bridge to other organizations that provide specialized services.
“We’re not here to solve your entire life in one day, but what’s the next step,” Richardson said. “Can we set up an intake appointment? Can we get you with a peer?”
Spratt said CRU members such as Richardson have an app they use to locate shelter beds. If someone needs to sober up, they take him to the “sobering house.” Traditionally that person might have been taken to the jail to sober up, she said, adding “That’s not good for anyone.”
The person might not have money for psychiatric medications, or might not have been able to get an appointment because of COVID. They might need to go to the hospital, but they’ll be taken to the behavioral health side, not the emergency room, she said.
Spratt said often people recognize the problem, telling responders, “I need to get back on my meds. I need help.”
Pinkney said many people simply needed help on weekends or after hours, someone to calm them, de-escalate the situation and reach the professionals who have been providing the person care, or help get their prescribed psychiatric medications.
The clinicians from Behavioral Health Response are able to do that, as well as contact the court system if the person has an ongoing court case, he said.
“And that’s why a program like this is great,” Pinkney said, adding it supplies “the right person for the call.”
Training sessions
Officers receive crisis intervention training as well as “intensive” training from Behavioral Health Response. The officers and clinician partners train together, Pinkney said.
Spratt agreed, saying of the clinician-officer relationship, “They’re not a civilian. They’re their partners.”
There are three CRU teams on a morning shift and three in the evening. They are not always free when a call comes in, because each interaction can take from 15 minutes to several hours.
“We always can use more,” Pinkney said of the CRU teams. “You can’t control when people are in crisis.”
Trish Johnson is a peer specialist the CRU connects people with specializing in helping find substance use counseling. She uses her own experiences with past substance abuse to relate to those she helps.
“Nobody ever sat with me in a jail cell to talk to me ... (and say) ‘You don’t have to keep coming back here,’” Johnson said. “We have someone who can help you stay clean. We have someone that can help you and divert you from keep coming here because you think this is the only way to live.”
Dr. Robert Poirier, clinical chief of the emergency room at Barnes-Jewish Hospital, said he hopes the program continues and expands.
“We’ve definitely noticed a difference over the last year and its highly appreciated by us in the emergency department,” he said.
Poirier said that it is hard to sort out the relevant statistics, but said, “We have noticed that with some of our familiar faces ... that some of those cases and visits have significantly decreased. And we know that is the result of these CIT/CRU teams.”
About 10% of the patients who arrive at the ER are there because of behavioral health issues.
Poirier said the cases that do arrive do so with more information, including a more comprehensive report on the patients, thanks to CRU.
Jones has pledged to use $5.5 million in federal COVID-19 relief funds to add more funding to alternative public safety programs such as the CRU unit, and said she’d like to see the unit move toward a model in which clinicians arrive without a police officer, similar to a program in Denver.
Jones visited Denver in July to learn more about the program.
“If I could wave a magic wand, I would love to see a full civilian diversion in St. Louis like the one I saw in Denver,” she said. “But we’re taking steps toward that goal.”
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