The Rural Co-Responder Model

The co-responder model involves pairing law enforcement officers with mental health clinicians to serve their communities better. There are several different variations of these models used in communities, one being the rural co-responder model.

Programs may consist of mental health professionals and law enforcement teams that ride together to answer all mental health or substance abuse calls. Programs can also operate where officers respond first to all calls and call out mental health workers when it involves a mental health crisis or substance abuse.

Additionally, some programs identify appropriate cases, have mental health experts respond to the crisis independently, and call in support as needed.

Challenges of the Rural Co-Responder Model in Communities

Rural communities experience specific barriers to care coordination that urban communities do not. Fewer providers tend to gravitate to rural areas due to fewer opportunities. Each jurisdiction or service area tends to cover a much larger area making access to care locations harder on the individuals who need help. Moreover, it’s also harder on the care providers. There also tends to be limited access to special services and less financial support available.

Challenge #1 Shortage of Providers

Rural areas often have fewer healthcare providers available; this includes mental health providers. In more urban and suburban areas, the population is denser, allowing providers to have access to a higher number of potential patients. This ‘supply and demand’ access draws providers to these areas, where new providers may have difficulty consistently filling office hours in a more rural area.

Additionally, providers may not be interested in living in a more rural area due to the lack of readily available leisure activities of interest, such as museums, sports facilities, restaurants, etc. Essentially, the same reasons that many other people move to more urban areas attract healthcare providers to those areas.

This leads to a higher-than-average shortage of available providers in rural areas, and many providers in rural areas tend to be older and maybe near retirement. To maintain a co-responder program, the community has to have access to mental health care providers. The more individuals there are to share the responsibility, the stronger the program can be.

This shortage of providers in rural areas significantly impacts specialty providers and programs. There may be very few intensive outpatient programs available within 100 miles. There may not be a psychiatrist to see in person within 150 miles. These things add additional layers of hardship to the community and increase the chances that emergency services will have to take care of psychiatric crises, further expanding the impact that a solid co-responder program can have on the community.

This means that rural Co-responder programs may have to think outside the box when seeking individuals who can help. For example, individuals with a Bachelor’s degree in social work or psychology may be considered as long as they receive additional crisis training and have supervision from a clinician.

Rural communities have overcome this in some areas by providing services remotely, with a clinician supervising and consulting over the phone or via video. While this could be better, it is a way to ensure individuals receive help and can be used to train local individuals and officers in crisis response.

Rural communities may also employ peer providers and individuals who have received mental health or substance abuse treatment and maintained good mental health to expand co-responder teams.  Often these individuals can reach others who may not be open to talking with law enforcement or clinicians.

Other rural areas may provide higher pay or incentives to attract providers to the area. For example, federal programs benefit healthcare providers financially by paying off student loans if they work in rural areas.

Additionally, communities may offer housing assistance and other incentives to make their communities look more attractive to providers and bring in more options. However, these options require community funding, and data will need to be obtained and maintained to justify extra costs to implement a rural co-responder model.

Challenge #2 Larger Co-Responder Coverage Area

Typically, providers and law enforcement have a larger area to cover in rural areas. This creates a challenge for Co-Responders as more travel time is required than may be needed in urban or suburban areas.

Navauda Miller, a licensed personal counselor in Iowa Park, Texas, says, “in my personal experience as a mental health clinician working with law enforcement in a rural area, this often means that one clinician would cover multiple counties of calls at a time. Our team worked with five different counties/sheriff departments, and multiple towns/police department and would frequently need to drive an hour from one call to the next.”

Miller also said this led to a few different problems. “The largest problem encountered was that law enforcement would be left waiting with the individual in crisis for an extended amount of time. The majority of the time, this wasn’t a significant problem, but at times individuals might be markedly paranoid or experiencing hallucinations or delusions and this left the officer attempting to manage the crisis on their own until the clinician could arrive. Officers were often relieved to see the clinician show up.”

Another problem singularly experienced by rural areas is the significant need for more facility resources available in the area. In urban areas, there are typically multiple inpatient or outpatient options; in rural areas, there may be only one or two outpatient options, and individuals may have to drive hours to the nearest inpatient facility. For example, one town served in northwest Texas is a minimum of two hours in any direction to reach an inpatient treatment facility of any type.

Overcoming these obstacles is an essential part of any rural co-responder program. However, rural communities tend to be tight-knit and willing to work together for solutions.

Reaching out to the community and involving all programs is the best way to find solutions. For example, mental health clinicians may donate time to assist with training or work with officers as co-responders on a volunteer basis. In addition, community charities may be willing to donate to help the co-responder program succeed.

Challenge #3 Shortage of Financial Resources

The final major challenge is the need for more financial resources. Again, this is not singularly experienced by rural areas, as many urban areas also need help with the finances available to provide services.

However, because rural areas need more providers and staff, these limited financial resources have a significant impact. As a result, any resources available are typically stretched as far as possible. 

Any mental health response requires funding, and indigent individuals needing inpatient treatment may need help accessing this or any service. In addition, having officers or clinicians tasked with crisis response requires a significant funding allocation.

Rural areas need to seek out federal, state, and local funding. Federal grants are available through the U.S. Department of Justice’s Bureau of Justice Assistance and the Department of Health and Human Services. The American Rescue Plan also funds local governments to expand mental health services, including co-responder programs. State funding may be provided as part of legislation or through the appropriate state agency, local mental health authority, or state substance addiction agency as a pass-through entity for federal block grant funding.

Co-Responder Programs Work in Rural Areas

After reading the challenges, one might be tempted to think that the rural co-responder model cannot work in these particular areas; however, this is not the case. The traditional team/ride-along model can be executed in rural areas with appropriate planning, and less standard models can be implemented that work for each rural community.

New River Valley in rural southwest Virginia implemented the country’s first regional Crisis Intervention Team program. It consists of four counties, one small city, and 14 law enforcement agencies ranging in size from two officers to more than 100. They train law enforcement officers to respond to individuals experiencing mental health crises effectively, and the regional partnership created a therapeutic crisis assessment center. Law enforcement officers can take individuals in crisis to the center and transfer custody to allow immediate evaluation and triage. This kind of out-of-the-box partnership allows for the challenges of the rural co-responder model to be overcome.

Pitkin County, Colorado, also employs a co-responder program called PACT. This program involved mental health workers, law enforcement, community mental health, case manager, and peer support specialist. The program has grown exponentially and is widely appreciated by the community.  PACT uses the cloud-based data platform Julota to coordinate services and maintain measurements of the community’s needs and the program’s efficacy.

Julota is completely HIPAA-/mental health (42 CFR part 2)-/Criminal Justice Information System- compliant. Additionally, Julota can interface with any law enforcement CAD system.  Due to these reasons and others, it is the perfect complement to any community attempting to build a well-connected and successful program. It allows all parties involved in co-responding to a crisis to know pertinent information and improve their response.

Clear and open communication is essential to all co-responder programs regardless of the location and is particularly important in rural areas. Co-responder models can work in any community, large or small. Still, we must remember that maintaining the data on responses and services provided will significantly increase the chances that communities will continue receiving needed funding.