Programs pairing police with mental health professionals to respond to calls involving persons in mental health crises are becoming widespread. Police and clinicians handle some crises better together than either could alone. But what happens next, after the immediate crisis is averted or resolved? Following a crisis, people can fall through the cracks of a disjointed mental health system. People do not always get the help they need, and too often the same individuals require subsequent police responses to mental health crises. In Los Angeles, California, the police and clinicians are doing what they can to fill in those cracks.
The Los Angeles Police Department (LAPD) and the Los Angeles County Department of Mental Health (LACDMH) have recognized that paired teams of police and clinicians can play an important role after a mental health crisis. The LAPD Case Assessment Management Program (CAMP) follows up after a crisis when there is a risk that someone might be slipping through the cracks, especially when such “slipping” could mean death or serious injury. For the police team members, this represents a shift in mission. Rather than engage in traditional strategies of administration of justice, the investigators shift to a model of serving the community through prevention and ongoing management. Building relationships and working collaboratively with individuals and community institutions can improve police responses to crises and help people even after the radio call.
Taking a Second Look
CAMP pairs LAPD investigators with LACDMH clinicians to assess and mitigate risks of violence, suicide, and ongoing emergency service utilization in any case that the responders believe needs a second look. Follow-up looks different in each case, but it always includes the gathering and sharing of information. Further risk mitigation often includes engaging support systems and providers in an individual’s care, attempting to limit access to means of violence or suicide, and efforts to link individuals to appropriate treatment—compulsorily, when necessary.
Information Gathering
Each case begins with the gathering of information. LAPD has developed a system in which police responses to mental health crises are documented to inform and, hopefully, help de-escalate future police responses to the same individual. These records are synthesized with relevant information from the DMH record. This fuller picture of an individual’s history of crises and treatment allows the team to begin to understand what has worked and what has not, as well as recognize any patterns that may emerge.
With recorded historical information in hand, the CAMP teams take the next steps to get a full picture of each case. Team members will speak with the individuals involved in the crisis, their families, their neighbors, their mental and physical health providers, their teachers, their employers, other law enforcement agencies—anyone or any entity that may have relevant information. Police investigators and mental health clinicians are each skilled in gathering information, and each are able to open doors the other cannot. For instance, a clinician is able to get information from a therapist or hospital that would not be shared with police. Likewise, a police investigator is able to obtain information from another law enforcement agency that has had contact with an individual that would be off limits to a mental health clinician. In many situations, the collaborative approach yields far more information than either the investigator or clinician could obtain alone. When principals or therapists get knocks on their doors from partnered police and clinician teams, they seem to understand the import of the situation in a way they might not have otherwise. In interviews, police and clinical approaches are often different but complementary, again yielding more than either professional might be able to learn individually.
All members of the team, police officers and clinicians alike, have learned to approach cases from a nuanced perspective, recognizing risk and protective factors that others may dismiss.
During this process of gathering information, the first step toward mitigating the risk of future crises should be taken—sharing the information. Unfortunately, often people and organizations do not talk to each other in the interests of an individual even when they can and should. Schools do not always tell a student’s mental health providers about significant risk factors exhibited at school. Families do not always tell hospitals the full mental health history of a patient. Hospitals do not tell community clinic providers about the details of inpatient treatment or the crisis that necessitated it. These siloes of information could, if combined, benefit the individual’s treatment and reduce the risk of future mental health crises. Why is this information not shared? Multiple dynamics could be at play. Some individuals, providers, or police officers may be unaware of the value of the information they possess. Members of co-response teams like CAMP, however, have specialized training and experience that allows for accurate assessments of risk. All members of the team, police officers and clinicians alike, have learned to approach cases from a nuanced perspective, recognizing risk and protective factors that others may dismiss. As they work cases, the team assists other professionals in identifying important information and remains available to them for consultation. Unfortunately, many professionals believe they are unable to share information due to privacy laws and practices. Though detailed explanations of these laws and practices are outside the scope of this article, it suffices to say that most information can be shared for purposes of continuity of care and reducing risk of death or injury, which are the reasons CAMP gathers and shares the relevant information a. Ultimately, few entities in the mental health or law enforcement systems have the capacity to do as much investigative work into mental health cases as CAMP does, and CAMP works to ensure that all providers know the details of a crisis and the extent of risk, as having this knowledge improves the treatment an individual receives. The better, more informed the treatment, the lower the risk of future crises.
Risk Mitigation
Informing and engaging families of the individuals CAMP aims to help can have as significant an impact as engaging their providers. While gathering information about an individual from family members, CAMP team members also begin the process of educating and supporting the family. This support includes providing information to families about mental illness, treatment options, and how to recognize risk factors for suicide, violence, and other mental health crises, as well as working with families to develop plans to keep their loved ones safe and supported. CAMP team members facilitate important connections between family members and other entities in an individual’s life including hospitals, treatment providers, and schools. Too often, these entities have not established these connections prior to CAMP’s involvement in a case, limiting both the entities’ knowledge and the family’s ability to advocate for an individual. In addition, CAMP provides families with resources to support them as well, including groups like the National Alliance on Mental Illness (NAMI) and local support options. An informed and engaged family is often capable of intervening in an individual’s life prior to a crisis, reducing the need for police response and limiting traumatic experiences for that individual.
“CAMP team members have seen chronically suicidal individuals, previously requiring multiple police responses a month, engage in treatment and move forward in their lives without further police contact.”
Other than assessing risk and sharing information, securing weapons or other objects that might be used in suicidal or violent acts is one of the most impactful risk mitigation actions CAMP regularly undertakes. CAMP works with individuals and their families to confiscate or otherwise appropriately secure firearms once someone has been hospitalized following a crisis. Multiple laws compel individuals to participate in this planning by prohibiting them from possessing firearms in these situations, but CAMP is often able to gain voluntary compliance even when laws do not compel it. It is rare that a family member refuses to assist CAMP in securing someone’s gun once they learn that person has intended to use it to kill themselves or someone else. In cases where CAMP was initially unsuccessful in securing firearms and no law yet compels an individual to cooperate, the team has worked to obtain and serve Gun Violence Restraining Orders. These orders prohibit an individual from possessing firearms for one year. This tool has been particularly useful in cases where hospitalization may be unnecessary or not possible, but CAMP has identified a need to mitigate the risk of danger to the individual and community.
CAMP extends these efforts to means of self-harm or violence other than firearms, working with individuals and families to secure knives, dangerous medications, and ropes—anything that has been identified as the means an individual may use to harm him- or herself or others. Academic research has shown that reducing access to means substantially reduces suicide deaths. Because of CAMP’s efficacy in this area, local hospitals contact the team to assist in safety planning by securing dangerous items before a person returns home. Securing such items reduces the risk that people will harm themselves or others upon discharge from the hospital. It also reduces the chance that LAPD will need to respond to another crisis call involving the same individual and a dangerous weapon. This is an intervention CAMP is uniquely suited to perform. Few mental health providers have the capacity to visit an individual’s home, search for, and secure a dangerous weapon. Few situations allow mental health providers to ask police for assistance in such a task. The pairing of mental health clinicians with police allows information to be shared and action to be taken in this vital area.
Linking to Treatment
Research has shown that a simple check-in with the individual following hospitalizations increases attendance at follow-up appointments and reduces future hospitalizations.
Ultimately, CAMP attempts to link individuals to appropriate mental health treatment that will reduce the risk and rate of crises. For some individuals, this may be as simple as providing them with the phone number and address to a local clinic. Research has shown that a simple check-in with the individual following hospitalizations increases attendance at follow-up appointments and reduces future hospitalizations. If only every case were so simply resolved. The reality is that many individuals who experience mental health crises requiring police response are reluctant to engage in voluntary treatment. People are compelled into treatment when hospitalized, but the options for compelling treatment following a hospitalization are few and differ by jurisdiction. This is another area where the partnership between police officers and mental health clinicians has proven useful. Many of the individuals engaged in the riskiest and most frequent crises engage in criminal behavior while their mental illness remains untreated. CAMP has sometimes been able to successfully utilize the criminal courts to compel these individuals into mental health treatment in lieu of incarceration. In such cases, the individual may have avoided arrest for low-level crimes or have been incarcerated for brief and ineffective sentences. By working with both prosecution and defense, CAMP has been able to provide the court with a mental health perspective on these cases. In such cases, the court can order conditions designed to compel treatment and reduce risk. CAMP has seen great success in marshalling court-ordered treatment, invested providers, and appropriately concerned family members. When CAMP determines a more serious crime has been committed by an individual the team is hoping to help, they will advocate that appropriate mental health assessment and treatment be integrated into the court case. This may mean as much as advocating that a doubt be declared to an individual’s competency to stand trial or as little as providing jail mental health staff with historical information on the course of an individual’s illness.
Preventing the Next Call
For all of CAMP’s success, they cannot and do not solve every case that comes across their desks. Some people are not ready or willing to accept help and no amount of motivating conversation, sharing of information, or securing of means will make much of a difference. There are other obstacles, as well. Sometimes the people CAMP is trying to aid are experiencing homelessness and cannot be found. Sometimes a hospital or provider cannot be convinced to share information, regardless of how much they are educated on the ways in which laws and policies allow it. But, sometimes, it all works. Sometimes this approach stops what was almost certain to be the next mass shooting. CAMP team members have seen chronically suicidal individuals, previously requiring multiple police responses a month, engage in treatment and move forward in their lives without further police contact. CAMP cannot fill every crack in the system, but they can fill some. CAMP cannot help everyone, but they can help some. Results can be seen in the rate of crisis calls for individuals CAMP has assisted, and the team gets calls and letters of gratitude from family members who say they had never before received help like CAMP was able to provide. This is a different, collaborative approach to handle mental health crises. It’s not just responding to the radio call, but trying to prevent the next one.
Please cite as
Daniel Mansfield and Daniel Jones, “After the Crisis: A Co-Response Model for Follow-Up,” Police Chief Online, April 14, 2021.
