Alabama law enforcement looks for new ways to address mental health crises

Some Alabama law enforcement agencies are trying new approaches when called to a scene with someone who may be experiencing mental illness. (Douglas Sacha/Getty Images)

In the summer of 2022, Chase Higgins, an Opelika police officer, got a call from an officer who had been dispatched for a welfare check to the home of an elderly resident.

The woman had stopped responding to members of her own family and was feared to be engaging in dangerous behavior. She refused to open the door for the officer.

“She was paranoid that people were tracking her and after her,” Higgins said.

The other officer remained at the residence for 10 to 15 minutes but could not get anywhere.

“He called me and said, ‘Here is the situation. What can we do?’” Higgins said.

Higgins and the officer could have left the scene. They could try to hold her on other charges to give her a safe place to spend the night. “I think, traditionally, that second answer has been law enforcement’s default for decades,” Higgins said.

But the Opelika Police Department had recently implemented a program aimed at diverting calls related to mental illness and providing resources instead.

“We were designed and set forth to be a place of detention for individuals who are awaiting trial or were serving time based on misdemeanors and that type thing,” said Jay Jones, sheriff for Lee County, where Opelika is located. “In simpler times, that was the case. But as things become increasingly more technical, increasingly more sophisticated, and a lot more elements involved, we have become, in what some sheriffs describe as a ‘de facto center’ in that we are seeing more and more of a percentage of our jail inmate population that have conditions affecting their mental health.”

John Hollingsworth, director of Alabama Crisis Intervention Training (CIT), an initiative that helps to improve the way law enforcement handles situations involving mental health, estimated that anywhere between 20% to 30% of the calls that law enforcement fields involve people in the midst of a mental health crisis. And that number is increasing.

According to a Prison Policy Initiative analysis, people suffering from mental illness in prison are disproportionately represented compared with the population living in the community.

About 14% of the prison population have an issue related to mental illness while it is 4% for all adults in the U.S. The data did not break down the numbers by state.

That increase is straining resources within the jails and emergency rooms, Hollingsworth said. It has become a “revolving door” as law enforcement continue to get called to the scene to address issues involving people with a mental illness.

It can also be dangerous, unfortunately resulting in “drawn guns and tragic endings,” Hollingsworth said.

No state standard

Advocates and researchers said that Alabama does not have a standard that law enforcement abides by when encountering people with a mental health condition or people suffering from a mental health crisis. That specific service and the manner and method for evaluating a person once they are booked into a local jail is determined on an ad-hoc basis.

“There is no oversight body, in Alabama, for the jails, none whatsoever,” said Charlotte Morrison, senior attorney with the Equal Justice Initiative, a nonprofit that focuses on criminal justice reform. “County sheriffs operate on their own. They decide whether to contract with a public hospital or a private contractor for their health care. They have no one they need to report to about that health care.”

Experts interviewed have said that jails are not ideal places to receive treatment for mental illness, or for those undergoing a mental health crisis.

“The jail is the worst possible setting for somebody in a psychiatric crisis, really for anyone,” said Lisa Dailey, executive director of Treatment Advocacy Center, a national nonprofit that advocates for people affected by mental illness. “It doesn’t really help anyone, for a person in active psychosis, to be in jail.”

Areas throughout the country are exploring alternative options to avoid placing those with mental illnesses in jail or sending them to emergency rooms and straining their capacities.

Hollingsworth has established hubs that provide training to law enforcement, including school resource officers. Officers are taught to evaluate situations to gauge whether the individual is experiencing a mental health crisis.

The training also focuses on empathy, giving officers the ability to understand the situation from the perspective of the person experiencing the crisis.

“It really helps you to have rapport, and you need to have rapport before you ever get behavioral change,” Hollingsworth said. ‘“I get all this happened, I understand why you are looking at doing this, but let’s consider this. What if you did this instead of that? How would that work?’”

‘Heard, and validated’

The training is designed to help people in crisis understand the situation and then work through their thoughts, expand the number of options available, and make better choices.

“A lot of people, especially young people, just want to be seen and heard, and validated,” said Nicholas Holman, a school resource officer with the Jefferson County Sheriff’s Office. “We have, as a society, a really bad habit of invalidating people’s feelings.”

Holman said he used elements of crisis intervention when someone had threatened to jump off a bridge. He eventually talked the individual off the bridge with a bottle of water.

“It all goes back to listening and being compassionate with people,” he said. “You have got to come into the situation with almost a disarming approach.”

But it’s only one component of what those involved say is a still incomplete system. That would first involve dispatchers fielding calls and following steps to determine the type of emergency in real time.

The dispatcher would determine the type of emergency and the severity level of the case. If the case deals with a mental health situation but does not rise to the level of urgency that would require a first responder to go out to the scene, the call can be passed to a specialist that deals with mental health situations.

“Most calls of somebody in crisis that goes to 988 or the old crisis line, 95% of them have been able to be resolved over the phone,” Hollingsworth said. “The reason is because the 988 center in Birmingham with the mental health crisis center there, they have 15 minimum, bachelor level commissioned (personnel) or higher who answer the phone.”

According to Hollingsworth, parts of the country are implementing a model in which a clinician who specializes in mental health, along with a peer specialist, will go out on scene to assist those in mental health crisis if an issue cannot be addressed with a phone conversation.

“Anything that needs police, where there is threatening, crime, elements like that, we need trained police officers, a portion of them, on patrol to be CIT specialists, so now the ones that we do have to go to, we go to,” Hollingsworth said.

That is one model available to municipalities, said Kristin Sauerbier, a senior project associate with Policy Research Associates, an organization based in New York that performs behavioral health advocacy.

“Mobile crisis is the best practice and co-response initiatives is what is considered a promising practice because it has been identified as a program and model that works,” Sauerbier said.

Additional time and data are needed to evaluate the co-response model in part because it is a newer program.

“The model that is adopted in each respective community is dependent upon the community, what they have as far as resources, who is willing to buy into the process, funding and sustainability, and the logistical region, and the opportunity for response services,” Sauerbier said.

In some cases, the behavioral health component is embedded with law enforcement, with clinicians hired by the police department. In other cases, police departments and sheriff’s offices will have a person dedicated to behavioral health duties, assigned to handling cases involving mental health crises or coordinate responses with other elements involved with Crisis Intervention Training.

“They are all based on the same basic principle — that you are trying to diffuse the situation and de-escalate so that it doesn’t require that next step, either incarceration or hospitalization,” Dailey said. “But also, with the caveat that you want to have the option of hospitalization if that is required.”

New Orleans implemented a crisis intervention system around the time of the coronavirus pandemic. When someone calls, the dispatcher determines if the call relates to a mental health emergency, then gauges the situation to determine if there is a public safety risk.

If it is a mental health call, the dispatcher will then have the mobile crisis unit respond to the scene. Travers Kurr, who works with the New Orleans Health Department, estimated that roughly half of the mental health calls dispatch receives did not involve a threat to public safety and therefore did not require law enforcement to respond.

Two people will go out on scene, as well as a supervisor who will oversee the different teams on a particular shift and go from scene to scene in a separate vehicle.

Sometimes, police will dispatch the mobile crisis unit to the scene.

“They are actually able to radio dispatch and ask the mobile crisis unit to come out, and hand over the call,” Kurr said. “For example, if 911 receives a call from an elderly person saying that the home is being burglarized, 911 will dispatch a police officer to that scene. An officer on the scene says, ‘You know what, this isn’t actually a burglary. This seems to be like an elderly person who has dementia and has called a couple of times.’”

Opelika relies more on law enforcement to make the determination, according to Higgins. Dispatch will field a call and begin triaging the situation. If the dispatcher believes the situation has a mental health crisis element, an officer with specialized training, such as Higgins, would be called to the scene.

Higgins and officers with similar training will then be responsible for assessing the situation and calling in appropriate resources.

Those who implemented intervention programs promise it has helped, and they are developing metrics and systems to measure the benefits of diverting away from a law enforcement response.

New Orleans is creating a dashboard to display metrics to measure the impact of the mobile crisis teams. And Opelika is beginning to gather data but is not yet ready to release the findings.

For the woman who wouldn’t come to the door, Higgins and the other officer at the scene teamed up with a member of the mobile crisis team that serves Opelika to develop and coordinate a response plan.

“On a rotation, we were going to go back regularly until we were able to make contact with her,” Higgins said.

Higgins’ colleague managed to convince her to come out on the second visit.

“She is bloodied up, which seems to be coming from a fall,” Higgins said. “She is living in squalor.”

Emergency services were dispatched to the scene, and the mobile crisis unit prepared for her to be involuntarily committed after everyone determined that she could no longer take care of herself.

“She ended up receiving treatment in Birmingham,” Higgins said. “Her son ended up calling us and saying, ‘We made contact with her. She was taking her medication. She is back to baseline. She was back to who she was as a person. There is no doubt in my mind that if you all had not contacted her that day, she would have died, and we would have never heard from her.’”