Lessons learned from implementing a co-response police-mental health team
The objective of the program was to divert people from jail and connect them with treatment where possible
By Katie Bailey
Cities across the country are implementing diversion strategies to address high rates of persons with mental health issues in jails and prisons. Recently researchers studied the implementation of the first-ever police-mental health co-response model in Indiana, a pilot program based in Indianapolis that began in 2017.  The purpose of the implementation study was to document the barriers and facilitators to implementing such a team in a metropolitan city. This article details the findings of the research, which was published in Health and Justice. 
THE INDIANAPOLIS MCAT MODEL
The Mobile Crisis Assistance Team (MCAT) co-response model was established as a pilot program in one police district in Indianapolis, Indiana, in August 2017.
Initially, there were two teams consisting of one crisis intervention trained (CIT) police officer, one certified mental health clinician and a paramedic.  The MCAT vehicle was not emergent, but teams listened to police radio and self-dispatched to emergency calls involving mental health or substance use issues.
Sometimes the MCAT was requested to the scene of an emergency by other first responders. Initially, the teams were available 24/7 in the pilot district. 
The objective of the MCAT program was to divert people from jail and connect them with treatment where possible. Additionally, MCAT aimed to support other first responders by allowing them to return to duty while MCAT handled time-consuming or complicated behavioral health situations.
Researchers conducted a series of focus groups and interviews with leaders from the City of Indianapolis, the Indianapolis Metropolitan Police Department (IMPD), the Indianapolis Emergency Medical Services (IEMS) and Eskenazi Health, as well as members of the newly established MCAT.
Also, researchers conducted a ride-along where they were able to observe the MCAT in action.
Transcriptions of all of these forms of data collection were analyzed to uncover major themes and shared in a report to the City of Indianapolis.  Researchers also surveyed law enforcement officers who worked in the police district where the MCAT pilot occurred to gather their opinions about working with the team.
BARRIERS TO MCAT IMPLEMENTATION
Four barriers were identified:
Policies and procedures: Given that MCAT was initially a pilot program, leadership wanted to remain flexible and refrain from imposing hard-line rules for the team, preferring instead to allow for discretion such that the team could learn and adjust practices as they worked. However, the MCAT team found that a lack of clear direction sometimes led to confusion, variation in crisis responses and frustration. Ultimately, it was important to establish clear guidelines in a polices and procedure manual while still allowing for flexibility as the team learned how to best incorporate itself as a new emergency response option. The final manual included a mission, role definitions, training requirements, self-dispatch protocols and schedules among other clarifying information.
External communication: The pilot MCAT teams and leadership quickly realized the need to communicate the goals and responsibilities of the new team to external stakeholders such as other first responders, outreach organizations and the public. Ultimately, team members found that more public outreach to clarify the role of the MCAT would facilitate their work. One way of addressing this moving forward was for researchers and/or IMPD leadership to attend role calls to briefly present the role of the MCAT to other officers.
Treatment services: While the primary goal of MCAT was to divert persons with mental health emergencies from jail, team members and stakeholders lamented the lack of available appropriate treatment for these community members. MCAT can provide referrals or transport patients to a hospital but found this did not ensure treatment engagement. Thus, it is important to simultaneously assess treatment availability when implementing a diversion program.
Role conflict and stigma: Adjusting to a new type of role was difficult for MCAT police officers. Negative feedback from colleagues and other first responders contributed to MCAT officers feeling their new position with a specialized unit was considered less respectable. The official MCAT attire is more casual than typical police uniforms, which also contributed to the stigma felt by MCAT officers. Leadership stressed the importance of choosing the right officers to contribute to a specialized mental health emergency response unit: someone trained in crisis intervention and with a passion for this type of work is key for overcoming the negative impressions of participating in this type of specialized team.
FACILITATORS TO MCAT IMPLEMENTATION
Three facilitators were identified:
Agency collaboration: The collaboration between multiple agencies to initiate the MCAT program was crucial. The fact that the City of Indianapolis had a long history of working with the collaborating health network facilitated the involvement of mental health clinicians with the local police department for the MCAT program. Stakeholders felt the top-down approach from the Mayor’s office to initiating this type of program was key to garnering successful collaboration.
Information sharing: The MCAT team members expressed their improved emergency response capabilities due to the sharing of information from two separate data sources. MCAT clinicians could compare information from their data systems with the information held in the IMPD database. The combination of information sources provided a more complete picture of an individual’s emergency and mental health treatment histories, which better prepared the MCAT team in their responses to these individuals.
Team building: Before program initiation, the MCAT teams were trained together over a series of several weeks. Team building activities created synergies between team members that facilitated their working together to respond to mental health crises.
The study of the MCAT in Indianapolis identifies lessons learned in initiating a new type of police-based response to mental health emergencies. Interested jurisdictions can use these findings to help plan for co-response models. However, it is important to continue to study co-response teams to understand whether this approach truly contributes to better outcomes for persons experiencing mental health crises, as well as the cost-effectiveness of such interventions relative to other options.
1. Bailey K, Paquet SR, Ray BR, et al. Barriers and facilitators to implementing an urban co-responding police-mental health team. Health Justice, 2018; 6:21.
2. Ultimately the agencies involved decided the inclusion of an EMS paramedic was not necessary or cost-effective for the model and the paramedic role was removed in 2018.
3. After assessing call volume by time of day and day of the week, the MCAT now operates during day shifts only.
4. Bailey K, Ray B. Evaluation of the Indianapolis Mobile Crisis Assistance Team: Report to the Indianapolis Office of Public Health and Safety, 2018, p. 30.
About the author
Katie Bailey serves as a research project manager at the Center for Behavioral Health and Justice (CBHJ) at Wayne State University in Detroit, Michigan. Before joining CBHJ, Katie conducted research at the Center for Health & Justice Research at Indiana University's Public Policy Institute in Indianapolis, Indiana. Katie manages several community-engaged research projects spanning the topics of harm reduction, homelessness, police and court-based diversion, re-entry and substance use treatment, among others. In 2019, Katie served as a technical specialist to the monitoring and evaluation team of the Peruvian national government's substance use prevention and treatment office as a Fulbright Public Policy Fellow.
Katie is interested in using research and evaluation to identify policies and programs that reduce the risks related to substance use, successfully divert people with substance use disorder and/or mental health issues from the criminal legal system, and increase access to quality treatment.