By Emily Goodell
Yakima Herald-Republic
YAKIMA, Wash. — Oftentimes, a person with mental illness or substance abuse issues who encounters law enforcement ends up in jail, rather than receiving treatment and services, regardless of officers’ attempts to help.
For the past year, health providers and law enforcement in Yakima County have partnered to change that.
The program embeds Comprehensive Healthcare mental health professionals — called designated crisis responders, or DCRs — with law enforcement officers at the Yakima County Sheriff’s Office, Yakima Police Department and Union Gap Police Department.
The goal of the program is to divert people from the criminal justice system who can be better helped elsewhere and to help those people entering the system get the resources they need.
A study of county jails in Washington found that of the 2,087 inmates receiving Medicaid booked into the Yakima County jail in 2013, 48 percent needed mental health treatment and 54 percent required treatment for substance use disorder.
While arrest is unavoidable for some people with mental health issues who commit violent offenses, that’s not always the case, Union Gap Police Chief Greg Cobb said. Sometimes, he said, people end up in jail because officers have nowhere else to put them.
“If an officer responds to those type of calls, the officer’s first responsibility is public safety,” Cobb said. “A lot of times that means taking someone and booking them into jail for a minor offense so we don’t see them four or five more times that shift.”
When someone enters the criminal justice system, it’s a revolving door, Cobb said. They go to jail, receive treatment and medication and stabilize. But once they’re released, that stability ends. As a result, they lose or reject treatment and end up getting arrested again.
That’s not good for the people trapped in that cyclical experience or the people who love them, Cobb said. It’s also not good financially for the people funding those services: taxpayers.
“It’s incredibly expensive to deal with people in crisis the way we’ve traditionally dealt with them, which is to incarcerate them because we don’t have the resources to take care of them otherwise,” Cobb said.
$92 a night
On average, it costs the Yakima County jail $92 a night to house someone with mental health issues, Cobb said. He said he’s seen people rotate in and out every other month.
If a person stays 30 days, is out for a month and comes back for another 30 days, that could cost the jail more than $16,000 a year to house that one prisoner.
And that doesn’t include paying for the time officers spend arresting the person and the staff necessary to process paperwork. It doesn’t account for hourly wages for public defenders and their support staff, prosecutors, court clerks, judges or investigators.
“Even arresting someone for a minor misdemeanor costs the public thousands of dollars,” Cobb said. “You multiply that by the thousands of times that happens in the county in a budget cycle ...”
Designated crisis responders help change that cycle. Comprehensive operates a 24-hour call center staffed by mental health professionals ready to help people in crisis. People can call directly or dispatchers can referred them.
From January to June, the crisis center received 5,122 calls. The median response time it took for a DCR to get to a person in need was 93 minutes, according to Comprehensive Healthcare Vice President Courtney Hesla.
Officers said it can take several hours for a counselor to arrive. But if the DCR is embedded, she can respond instantly.
“The sad thing about it is we do a horrible job of equipping our officers to take on those roles, but they succeed regardless,” Cobb said. “With the DCR role, we’re taking the burden of being a counselor off of them and giving it to someone who is better prepared to fill that role.”
Immediate response
Rather than having an officer assess a person’s mental health or waiting hours for the arrival of a trained professional, a designated crisis responder can respond immediately.
This is the work Nikki Rogers does every day with the Yakima Police Department. Rogers is one of four designated crisis responders embedded with law enforcement countywide. For the past year, she’s been riding in a squad car in a tactical vest to respond to people in crisis.
When someone overdoses and an ambulance takes them to the hospital for treatment or assessment, officers can’t follow them through that process, but DCRs can follow the ambulance to the hospital and talk to the patient.
“We can be there on the front end and say I’m with you through the crisis process,” Rogers said. “It just sets the tone for ‘This is not something done to you, this is something done with you,’ and that’s a huge advantage.”
When dispatchers indicate a call may involve someone with a mental health issue, Rogers will ride with an officer, who secures the scene while she talks to the person.
Part of Rogers’ job is to evaluate if the person meets the criteria for involuntary treatment, which happens if she determines the person presents harm to herself, others or property, or is gravely disabled and is at imminent risk.
In that case, Rogers will see if a bed is available at the Crisis Triage Center, operated by Comprehensive and open 24 hours a day for stabilization and treatment. If the person doesn’t meet the criteria for involuntary treatment, Rogers will connect the person with other services, such as a support group or housing assistance. She can also refer the person’s case to a non-embedded DCR for follow-up.
Another advantage to responding immediately is the ability to work with family members to do safety planning, determine next steps and support the family if the person needs to be involuntarily admitted, Rogers said.
For her work with Yakima police, Rogers received the 2018 Mental Health Professional of the Year in Kennewick at the North West Regional Crisis Intervention Team Conference.
“Cases are resolved quicker,” Hesla said. “We’re keeping people out of jail who don’t need to be there, getting people linked with treatments, diverting people or having better outcomes for those who don’t get diverted.”
‘Just the beginning’
The program is funded through a Trueblood diversion grant, which comes from fines levied against the state Department of Social and Health Services.
To do what Comprehensive Health is doing now with crisis response, it takes about $2.3 million every 18 months, or roughly $1.5 million a year. While the Yakima County grant has been renewed for 18 months, Comprehensive needs lasting, sustainable funding to continue the program and expand it.
Hesla said she hopes the county will impose a 1/10 of 1 percent sales tax for law and justice, which could help provide long-term funding for the program.
“Anybody who has a family member or friend that has mental health issues, has spiraled out of control and entered the criminal justice system would see the value in this: to keep people from making decisions that will haunt them the rest of their lives,” Cobb said.
Cobb said once someone is a convicted felon, they’re a convicted felon and the consequences of that never go away. He worries about what might happen if funding for the DCR program runs out.
“We haven’t even scratched the surface at what can be accomplished with embedding a DCR with a patrol officer,” Cobb said. “DCRs are just the beginning, not the end to this problem. Whatever money we’re spending on the DCRs to utilize them and figure out what comes next is cheap to what we have been doing.”