Experts Say Adopting a 'Care Response' Model for Non-violent Emergency Calls Would Benefit Cleveland Residents, Police and Bottom Line

The City of Cleveland should immediately begin to scale up a mobile crisis response pilot program that reduces reliance on police for those experiencing mental or behavioral health challenges, according to a new report published by Policy Matters Ohio, the Center for Community Solutions and the Mental Health & Addiction Advocacy Coalition (MHAC) .

Known as "care response," unarmed models for responding to non-violent calls that prioritize the health of the person experiencing a crisis have led to enormous cost savings for the cities that deploy them.  Moreover, they result in fewer deadly interactions with law enforcement. The report notes that police across the United States shot and killed more than 1,000 people in 2021 and are on track to do the same in 2022. At least one in four people killed by police has a severe mental illness. 

In Cleveland, Mayor Justin Bibb enthusiastically supported the idea of a co-responder model on the campaign trail in 2021. That's not quite a "care response" model, because it still pairs a law-enforcement officer with a social worker to respond to emergency calls. But it does acknowledge that armed, uniformed police officers are kind of like hammers, and every emergency call isn't a nail. 

A co-responder pilot program currently exists within the Cleveland Division of Police (CDP) and has shown early signs of success, according to the administration.

Per the CDP's mid-year budget report, the Division has 80 officers who are trained as "Specialized [Crisis Intervention Team] officers" who handle the majority of the calls from those dealing with mental or behavioral health crises.  Of that number, five are paired with social workers — these are the "co-responders" — to handle a variety of calls, including from "high utilizers" (repeat callers) in each of Cleveland's five police districts. 

The overwhelming majority of these responses, (between 97.5% and 99.2% since 2020), has not resulted in police use of force, though force is still used more commonly on CIT calls than on standard police calls, which do not result in use of force 99.9% of the time. 

According to Mayor Bibb's press secretary, Marie Zickefoose, City Council recently approved funding for two additional mental health professionals to expand the CIT Unit, and CDP has partnered with the Alcohol Drug Addiction and Mental Health Services (ADAMHS) Board to have 25%-40% of frontline officers trained as CIT Officers over the next four years, in compliance with the Consent Decree.

"The value of crisis intervention to the Department of Public Safety and the Division of Police cannot be overstated," Zickefoose said in a statement to Scene. "It is a major part of the holistic approach to serving the community. The CDP CIT co-responder program is always being reviewed for opportunities for expansion, which is largely dependent on staffing."

Both Mayor Bibb and Cleveland City Council have recommended devoting ARPA dollars to augment the CIT and co-responder programs. These were discussed at a city council caucus Monday. The administration proposed spending $5.1 million in a plan that would add a mental health dispatcher and hire a "senior-level strategist" to connect mental health and public safety efforts.

The CIT expansion represents the largest chunk from the administration's proposed ARPA spending on public safety. It also proposed spending $2.8 million on the controversial ShotSpotter technology, which  uses microphones and artificial intelligence to locate the sound of gunfire. (The controversy stems from the fact that it has been overwhelmingly deployed in communities of color and has been prone to inaccurate reports.)  Additionally, the administration has proposed spending $2.3 million on dash cameras for police vehicles.

As for the authors of the report, they believe that a care response model integrates well with the Cuyahoga County Diversion Center, an alternative to the county jail for those experiencing mental health or substance abuse crises. They say a care response model is not designed to supplant armed law enforcement, but  to be an additive strategy in Cleveland's portfolio  of emergency responses.

Loren Anthes, a Medicaid policy wonk for the Center for Community Solutions, advised on the report.

"I was basically a bag man trying to describe what the financing options were," he told Scene.

In addition to ARPA funds, the report proposes exploring the use of opioid settlement money to fund a care response model. It also points out the potential for Medicaid reimbursements, especially as it pertains to EMS transport to the county diversion center.

"The report is meant to serve as an overarching policy review," Anthes said. "It provides context for policy makers with what might be available and shows how they can leverage existing resources.  I think the mayor and city council have both expressed interest in improving responses toward individuals experiencing mental and behavioral health crises.  The care response model represents an evidence-based approach that saves government money. It's  also the right thing to do."

Anthes referenced the CAHOOTS program in Eugene, Oregon. The "Crisis Assistance Helping Out On The Streets" teams are made up of a nurse or emergency medical technician and a mental health crisis worker. CAHOOTS teams received more than 16,000 calls in 2021 and required police backup only 301 times. Most of the calls were for things like welfare checks and transportation of individuals who were unhoused or dealing with mental health issues. The program had a budget of about $2 million, Anthes said, and saved the Eugene Police Department roughly $8 million.

Timothy Sommerfelt is the Union Secretary for the Cleveland Association of Rescue Employees (CARE) Local 1975. He was also a member of the public safety subcommittee on  Mayor Bibb's transition team and has been engaged on a number of conversations about reimagining emergency response in Cleveland.  He noted to Scene that appointing a cabinet-level official tasked with building a mental health crisis response team was one of the transition team's key recommendations, and he thinks that's an important next step.


"If there's one thing I've learned in 15 years of EMS," he said. "It's that mobile crisis isn't mobile. The current system pretty much abdicates the responsibility for after-hours mental health care to police and EMS, and our members are pretty receptive to the idea of mental health response looking a little bit different in the future. It doesn't have to be an ambulance or a police car with lights and sirens every single time."

Sommerfelt said that one issue identified by the union's membership was the high-frequency callers for whom repeat trips to the emergency room was clearly not a viable solution. He said models that employ a "community paramedicine" approach, with health workers in vans or SUVs proactively working to solve root problems, might be more effective. And it'd certainly be "less triggering" to some of these callers, many of whom have mental health issues, than an ambulance with strobe lights or police cars with armed officers.

He did say, though, that from CARE's perspective, the ultimate question should be, "How do we best serve the needs of citizens," not "How do we build a non-police response team?" And he worried that by focusing exclusively on non-police responses, the report's authors were neglecting some of the most volatile incidents.

Piet van Lier, the lead author of the report for Policy Matters Ohio, agreed. He said that a care response model was not meant to supplant or even take funding away from existing law enforcement, and in fact was a strategy to maximize resources. 

"This is not anything against the police," he said. "But they're just not trained to do this work, no matter how hard they may try. This is not what police officers are there for. We see this as a way to take away some of the work they're not trained for and give them more time and resources to fight violent crime."

Van Lier said Bibb's co-responder model was a "step in the right direction," but that there are clearly an enormous number of calls for which police are unnecessary and for which their very presence can escalate tension. 

"I think a lot of us want people to have the most compassionate, supportive response available, to make sure they get the help they need," he said, "and that's often not somebody showing up with flashing lights, bulletproof vests and a gun."

***
Sign up for Scene's weekly newsletters to get the latest on Cleveland news, things to do and places to eat delivered right to your inbox.