Successful Co-Responder Programs require strong stakeholder relationships. Organizations must know whom to communicate to during a crisis and do so quickly and accurately.
Pre-planning sessions should involve an array of stakeholders that includes those familiar with handling crisis calls such as law enforcement, EMS, 911 call center operators, hospitals and clinics, and mobile crisis teams. Other vital stakeholders can include behavioural health professionals, peer support individuals, family members of people with mental health disorders, housing providers, government representatives, neighbourhood watch groups, faith-based leaders, and more.
These groups should establish clear protocols and develop a practical communication component. In addition, national-level organizations and associations such as the National Alliance on Mental Illness (NAMI), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the National Council on Behavioral Health, can provide resources and guidance which can be adapted to individual community plans.
Successful co-responder programs involve stakeholders early and often
The importance of these stakeholder meetings for Co-Responder Programs cannot be understated.
Together, this group can develop a crisis continuum of care that promotes the development of and access to quality mental health and substance use disorders treatment and services. The articulation of shared goals helps to establish buy-in among the partners, allowing for successful implementation of necessary items such as:
- Detailed policies and procedures that ensure consistency and proper coordination
- Compliance guidelines for appropriate release and sharing of information
- Guidelines outlining which partners should be identified in a particular crisis
- Establishment of response protocols
- Guidelines for data sharing and tracking
Mental Health Crisis Response Should be Tailored to Your Community
There is no “one size fits all” approach to crisis response. Instead, each community is characterized by differences in culture, resources, skills, and funding support.
Thus, each location’s Co-Responder Program must be specific to the unique characteristics of that community. Policies and procedures should be detailed, clear, and comprehensive to ensure proper coordination, communication, access to services, and consistency within the team(s).
The roles of law enforcement and each community partner should be outlined in detail to include training, staffing, and work standards.
Secure Compliant Sharing of Information Among Community Partners is Key
The sharing of information is at the heart of co-responder programs. Having access to behavioural health information promptly is crucial. Stakeholders should frequently meet to review compliance guidelines regarding the release and sharing of information.
Because there are often misconceptions regarding federal and state privacy laws, including a legal representative in meetings as a partner can help to ensure that the program is always in compliance. For example, the Health Insurance Portability and Accountability Act (HIPAA) is often cited as a barrier to information sharing.
Behavioural health professionals are understandably reluctant to share mental health or addiction treatment information with law enforcement and other partner agencies. Fortunately, communities across the country are developing strategies that demonstrate it is possible to share information and remain in compliance with HIPAA legally.
Additionally, law enforcement agencies with behavioural health programs are not looking for clinical summaries. Instead, they would like basic information showing whether the person is in fact in treatment for mental health or substance abuse and the name of their clinician or, at a minimum, the organization they are receiving treatment at. This vital information allows the responding officer to reach out directly to the clinician and potentially bring that individual to the clinic for help.
While these strategies are jurisdiction-specific and were developed according to each community’s unique needs, they can serve as templates for other jurisdictions. In addition, the Council of State Governments (CSG) Justice Center has developed a brief that includes practical strategies communities can use to share behavioural health information legally and safely.
Role of Community Partners in Crisis Response
The respective role of all partners should be made clear before a crisis ever occurs. For example, interagency information-sharing protocols can be established during stakeholder meetings to ensure that all agencies effectively respond when quick decision-making is crucial.
Advance collaboration among partners aids in establishing what information can be collected and shared during an encounter and identifies which partners should be involved in various scenarios. For example, specifying the types of calls each partner responds to a community should establish clear response protocols.
Daniela Gilbert, director of policing program at the Vera Institute of Justice, has stated that “multiple response systems can get complicated, so cities must have protocols that establish the types of calls each team responds to.” As a result, communities across the United States are implementing various programs to address the issue of which agency should respond to a crisis.
In Philadelphia, a new 911 script was introduced to aid dispatchers in identifying a mental health crisis. The first question asked is: Are you or the person you are calling about experiencing problems with mental health, substance use, or suffering from any developmental disabilities? The idea for the new script was prompted by the tragic death of Walter Wallace, Jr., who was fatally shot by police while wielding a knife.
Frantic 911 calls had been received from family and neighbours, but Mr. Wallace’s mental health status was never discussed. With the implementation of the new script, dispatchers will be better able to identify critical information and direct calls to the appropriate responders.
While feedback regarding the script is mixed, with some saying it is too long, it is a step in the right direction.
What Should Mental Health Response Protocols be For Co-Responder Programs?
In determining response protocols, additional questions stakeholders might consider:
- What mental health responses are needed?
- Can mental health peer support specialists be included in the response?
- How can related partner agencies support the response?
The sharing and tracking of data are critical components of a successful Co-Responder program. Having access to pertinent and timely behavioural health information is essential to ensuring effective responses among law enforcement, mental health system workers, and other community partners.
The ability to access records on their laptops or other devices independently can help ensure that responders are adequately prepared before responding to a dispatch. Teams can then anticipate potential hazards and identify and reconnect patients with treatment services they may have received in the past.
As one responder stated: “We typically try to do our homework when we go out and see somebody, especially if we have a name ahead of time…The police officer will…look at what their record is. Our clinician can look to see…if they have been there before…we can see how many times they have called in the past few years, and now we are putting together a better picture on things.”
All stakeholders should develop and adopt data sharing and tracking guidelines in a straightforward information-sharing approach that outlines what information can be shared, with whom, and for what purposes. Establishing these guidelines from the outset helps build trust among partners and ensures that everyone involved understands and is committed to appropriately using and sharing information.
Because data systems used in healthcare, EMS, behavioural health, and law enforcement often cannot share information, it is vital that a cohesive “triangulation” of information be available. In addition, the interoperability between these systems is a technical and regulatory challenge: they must be able to talk to each other while protecting and securing private health information.
With the aid of Julota’s flexible, interoperable, and compliant cloud-based platform, collaboration can be successfully automated between emergency responders, clinical practitioners, and other agency partners. In addition, Julota’s powerful system helps connect partner agencies for more coordinated responses to crisis situations.
Once stakeholders have identified what data is to be collected during an intercept, approaches to gathering, analyzing, and using that data should be established. SAMHSA has developed the following recommendations to support the development of services:
- The Capturing of baseline data
- Analyzing data in the aggregate and sharing findings across all agencies
- Aggregate data includes information collected from multiple sources or that which is compiled into data summaries or reports
- Collect data in an ongoing way
- Collect data specific to people with mental illness and people with substance use disorders
Following these recommendations developed by SAMHSA can help communities determine whether changes or improvements are necessary. In addition, it can help to identify gaps in services and measure and improve the quality of interactions between community members and co-responder programs.
The importance of stakeholder meetings for Co-Responder Programs is apparent. Working together on shared goals can facilitate trusting relationships among diverse partners.
Consideration should be given regarding the timing and frequency of meetings. Some entities will be best served by regular working meetings, such as law enforcement and mental health agencies that work together daily.
Others, such as community groups or judiciary agencies, may benefit from regular but less frequent discussions. The functionality of Julota’s software can make the process of partner communication seamless through the automation of complex workflows, data aggregation, and reporting.
It is a powerful tool that can provide effective community collaboration and help those living with mental health or substance use issues. Multi-agency case conferencing and after the incident, reviews can be performed so stakeholders can assess the system on an ongoing basis and identify gaps in service or improvements that may be needed.
The handling of mental health crises is an ongoing issue for most communities today. Co-responder programs have been one of the positive movements to address the problem.
Because many individuals living with mental illness have experienced adverse events during a past crisis, partnerships between law enforcement, mental health professionals, and community agencies can provide much-needed reassurance. In addition, as these stakeholders meet and listen to one another with respect, greater understanding and trust will develop among them and their community.