Employing Mental Health Clinicians to Improve Police Outcomes

The following transcript has been edited for clarity and brevity.

Karen Friedman: I'm your host, Karen Friedman. I'm the Director of Criminal Justice Innovation, Development, and Engagement at OJP's Bureau of Justice Assistance. As communities grapple with behavioral health emergencies, the question is whether law enforcement should respond and how to reduce unnecessary law enforcement contact. For years, police officers have been the first—and often only—responders to behavioral health emergencies with emergency departments and jails often serving as the default destination for those officers' encounters. However, we now see a shift as more people recognize that police can't do everything. That's why many communities have hired clinical social workers or are in discussions with their community and city councils to do so, reduce the burden on police and have better outcomes for individuals experiencing behavioral health emergencies.

Today we are speaking with Carleigh Sailon. Carleigh is a licensed clinical social worker and a licensed addiction counselor who has an extensive history working in community behavioral health. She now works for the Council of State Governments, otherwise known as CSG, the Justice Center, where she brings her clinical experience and professional knowledge to provide technical assistance to grantees working to develop alternative responses and law enforcement diversion programs.

This is a topic she knows a lot about. Carleigh was pivotal in developing and implementing Denver's STAR program. The STAR responds to any person in Denver needing urgent help related to mental health distress, poverty, homelessness, substance use resource needs, and more. The team can provide medical assessments, triages, crisis intervention, de-escalation, transportation, and resource connection for needy community members.

Carleigh, I am so happy to have you here today. How are you doing?

Carleigh Sailon: Thank you, Karen Friedman. I'm doing well. I'm glad to be here.

Karen Friedman: Great. So Carleigh, your background we know is in social work. What led you to want to work with law enforcement?

Carleigh Sailon: You know, Karen Friedman, I can't say that when I was in school becoming a social worker, that I ever thought that I would be working with law enforcement or working in a police department but when I was a case manager, I was a case manager for a number of years here in Denver on a high intensity treatment team. And I dealt with, you know, a caseload of acute clients with severe and persistent mental illness and, you know, substance use disorders.

And many of them were justice involved as well. And that's really where my passion for working at the intersection of behavioral health and criminal justice started was through that case management job, working with my caseload of individuals who were on probation, who were frequently arrested, who had a lot of justice involvement.

Karen Friedman: All right. I know you're currently with CSG but tell us about your time in Denver developing Denver's Co-Responder and Star Program.

Carleigh Sailon: Yeah, absolutely. In 2016, the Denver Police Department partnered with a local behavioral health provider, the behavioral health provider where I worked called WellPower, and wanted to start a co-responder program. They wanted to have licensed clinicians working alongside police to be able to take some of those responsibilities of responding to behavioral health calls from police's plate. 

Denver police really recognize that officers are not the best response in these types of situations. And even though the officers in our department are CIT (Crisis Intervention Training) trained, that really didn't hold a candle to the experience that a licensed clinician had. That's really where the conversation started and rolled out that co-responder in 2016, and it's still running today, and it has expanded several times over the years. And while we were working with the co-responder program, we recognized that we were deploying co-responder teams, a clinician and an officer, to a lot of calls where the officer wasn't needed at all. There was no scene safety issue. There were no risk components. That officer was more or less the clinician's Uber ride, and the clinician was really doing case management or brief crisis intervention. And that's really where the idea for STAR was developed, was recognizing that there are so many calls that come into the 911 system that really deal with issues of poverty, issues surrounding lack of access to health care, and issues surrounding low-level behavioral health crisis, that we decided to create the STAR program to be able to divert those calls completely away from police.

Karen Friedman: That makes so much sense. I mean, for many, the idea of clinicians working with law enforcement, it seems like a new trend, but you’ve been working on this in Denver since 2016. As someone who's been involved in the development and growth of this, why do you feel that the result is so essential to improving public safety?

Carleigh Sailon: I think that police have been tasked with too much historically. I mean, they are the ones that show up when someone calls, right? And we want police showing up to violent crimes and, you know, issues where community members are victims or need some sort of law enforcement assistance, but they've really been tasked with responding to behavioral health issues because we didn't have a better option. I think it's really important for communities to create these additional options to really meet the needs of the types of calls that are coming into the 911 system. 

I think that this provides our community members with the more appropriate response. It also allows our officers to focus on, you know, enforcement and investigation and keeping our community safe. I think it's a win for public safety from both law enforcement standpoints and the community standpoint.

Karen Friedman: Yeah, I would agree. It just seems to make so much sense, especially when we're so limited in resources. And like you said, the police are spread so thin. We have so many staffing crisis now with law enforcement and anything that we could take off their plates. And frankly, these clinicians are in a better position to deal with these type of crisis issues than police are. It’s really brilliant. The co-responders program in Denver has grown from four clinicians to 45. Why do you believe that it has been so successful and embraced by residents and police?

Carleigh Sailon: Yeah, we've seen so much success with the co-responder program in Denver. I think it's been successful because our police department really view it as a valuable resource. There were, you know, some officers in the beginning who weren't too sure about having clinicians ride in their car with them, right? We were new. They weren't really sure what we were about. And, you know, overwhelmingly Denver police feel that they wouldn't be able to do their jobs effectively without the clinicians present.

In terms of responding to behavioral health crises, I think that the officers saw it as a win. I think that they saw that these individuals that they were responding to where, you know, they didn't have the right solution for their behavioral health needs, or they weren't aware of all the community resources, saw the clinician’s step in and be able to mitigate these situations and connect people to the appropriate resources easily.

And folks that they were seeing over and over and over again in crisis were now connected to those appropriate resources and were off of their radar. I think that really helped us gain a lot of traction within the police department. And I think the residents were surprised and very glad to see a clinician who was showing up with police, especially family members, who are calling because their loved one is living with mental illness and was in crisis, to be able to see that police were bringing these resources along with them, when these families felt like they really didn't have anyone else to call for help, was just a huge, huge win for us. And we've also seen, Denver has clinicians who ride with patrol. They also have clinicians who work with several different units throughout the police department. Our intelligence unit has clinicians to help them with threat assessments. It became the sort of thing that just spread like wildfire, right? That this skill set, this experience was useful to our officers.

Karen Friedman: And when you're talking about families, these family members don't want to get their loved ones involved in the criminal justice system, but they just felt like they had no alternatives at that point—to have a way to have these issues dealt with that don't directly get them arrested or involved in the criminal justice system in that way is very beneficial.

Carleigh Sailon: Absolutely.

Karen Friedman: We talked a little bit about buy-in, but was that a tough sell to the Denver police. How did they work to bring their officers on board with this idea of working with clinicians? Because I know now they've seen the benefit, but at the beginning, like you said, I'm sure there was apprehension. Was there any specific way they tried to get that buy-in?

Carleigh Sailon: Yeah, definitely. It wasn't too difficult of a sell, but police culture is a hard one to break into, right? And to have a group of clinicians in their cars, who they didn't know, it was awkward for them and it was awkward for us at the beginning. We were still feeling each other out, I think, in a lot of ways. But one decision that was made early on in the program that I think helped tremendously with buy-in, and this decision was made by our chief at the time, Chief Robert White, was that they were not going to select a group of police officers who were going to ride with clinicians. We were not going to have a special co-responder team. They were going to have the clinicians cycle through and ride with all of the officers on the detail. And I think that helped with buy-in because we weren't saying, hey, officers who are really passionate about mental health or who are really interested in this type of program, come work with us. This was really sold as the entire department was going to get on board to providing a better response to behavioral health issues. And, you know, I think won over some officers who maybe never would have signed up to ride with a clinician in the beginning. We got to know them. They got to know us. We found that we had a lot of common ground and worked well together.

Karen Friedman: That's great. That's really great. And speaking of officers, what are the benefits to officer wellness does having clinicians taking part in the daily road call with police and riding along with officers daily have? 

Carleigh Sailon: Yeah, absolutely. I think the roll call piece is very important because it really shows that we're one team, right? The clinicians are in there in the morning or the afternoon in the roll call with officers and are really viewed as part of the team. And I think having so much exposure to the clinicians really destigmatized mental health in a lot of ways to officers. We know officers deal with so much stress, so much trauma from their jobs. They have an extremely difficult job, and they're not always the best about seeking support for themselves when they're struggling or having a difficult time. And I think being able to have such access to the clinicians and to see what behavioral health intervention really looks like, maybe helped them be more accepting of that. And there would be days where one of us would go in and an officer would say, ‘Hey, I'll take the clinician today,’ and you found out that officer volunteered to take you because their child or their family member was struggling with the behavioral health issue and they wanted to sort of get your take on it or see if you had any advice or maybe they were dealing with a difficult time and they wanted to talk to you about it. I think pairing those officers and clinicians together in the car, really having us work as a big team, helped the officers have more direct access to behavioral health clinician that they knew very well and trusted.

Karen Friedman: All right. There are 93 BJA, Bureau of Justice Assistance, grantees that are focused on behavioral health and law enforcement partnerships. Why do you think we're seeing so much attention and interest in this area?

Carleigh Sailon: I think it's a multitude of issues. I think one, we've seen tragedies where police are responding to behavioral health calls and people have died or they have not gone well. Like you mentioned earlier, we're also seeing a significant staffing crisis in law enforcement and a lot of agencies simply don't have the capacity to take on all of these calls. But I think there is a recognition across the country that we need a better response for behavioral health and the way that we've been doing it historically where police respond to everything wasn't necessarily the best fit, we just didn't have another option. I think that we're seeing a big shift in terms of what it means to provide public safety to communities, in terms of response to crimes and response to community members who are in crisis.

Karen Friedman: Yeah, I would really agree with that. And it's exciting to see the field expand. It's exciting to see the new innovations in this area. Different states and different cities are being so creative with it, and we're seeing so many interesting projects and interesting results. It's really exciting. We talk a lot here on Justice Today about community policing. How are programs like this an extension of that idea?

Carleigh Sailon: I think that alternative response programs, whether they be co-responder programs or community responder programs, are the definition of good community policing. Part of good community policing is officers being able to go out and connect with their communities, having the community feel like they can trust their police department and rely on them. But a good part, a big part of community policing is also saying, ‘wait a minute we're not the most appropriate response, and while we might not be the most appropriate response, we're going to do our best to connect you with folks who do have the appropriate expertise and skillset to solve your problem.’ And I think that was one thing that we really saw in Denver was that when a social worker showed up with a Denver police officer or a clinician and a paramedic showed up on STAR, the community really felt like their needs had been met like Denver cared enough about what was going on to ensure that the appropriate responders showed up to that call to not only deal with, you know, with the co-responder program, what legal issues may be going on or low level crimes, but also to provide a clinical perspective and mental health support on those calls.

Karen Friedman: To communities that are still skeptical of the idea, or to people who think that spending money on social workers is not the way to spend public safety budgets, how would you respond to that? What would you say to them?

Carleigh Sailon: I would probably say that in a time where police are being overburdened with calls for service, crime rates in cities, most cities, across the country are going up and we have a shortage of police officers that this is really a good investment in not only your department, but your community. And you know, run a pilot, hire a few social workers. You know, we started with four and grew, but run a pilot program, collect some data, see how it works with your officers and see how it works with your community. And I can almost guarantee that the outcomes of that pilot program would be incredibly positive, and you know that these jurisdictions would want to expand those programs.

Karen Friedman: Well, thank you so much for all your hard work in this area, and we really appreciate your time today, Carleigh. Thanks for being with us.

Carleigh Sailon: Thank you, Karen Friedman. I appreciate it. Great talking with you.