As mental health crisis surges, so does a push for co-response

Inside the Edgartown Police Department on a recent June morning, an Edgartown man sat in desperation, facing Police Chief Bruce McNamee. Through occasional tears, he told the chief that for several months, he’s been trying to get help for his wife, who he said suffers from bipolar disorder. 

He explained that his wife had experienced severe episodes of rage, which have at times placed herself and others in danger. 

“At one point she took a golf club and broke all of the mirrors in the house, of which there were quite a few, and half a dozen of the windows,” he explained. Afterward, he said, she began laughing and telling him how much fun she had been having during this process. 

Getting help for his wife on the Island, he said, has been a long and challenging road. 

What is especially frustrating for the Edgartown man is that he’s often encouraged to contact the police department, although they don’t always have the right tools to help, nor the training. 

After a recent therapy appointment with Martha’s Vineyard Community Services, for example, he was told to “go right to the police” when his wife loses control. In one instance, feeling like he was out of options, he described calling the local senior center to see if someone could speak to his wife. Their immediate response again was to call the police.

“I just wanted someone to talk to her,” the Edgartown man said. “It’s beyond frustrating. I miss my wife very much, the woman who loved me.” 

While sharing his story, the man paused several times in efforts to collect himself. A Times reporter was present for the discussion with McNamee, who said the man’s presence at the station wasn’t uncommon. He frequently came in, McNamee said, due to his wife’s outbursts. The Times has agreed to withhold his name to respect his family’s privacy.

The man and his wife’s struggles, Island police say, are not a one-off, or even rare, scenario. Mental health–related calls to Island police are growing. One estimate, from a survey conducted by the Oak Bluffs Police Department, puts the number at 1,500 mental health–related calls made across all six towns on the Island in 2022. Hospital officials are seeing a rise as well.

The numbers aren’t unique to the Island. Twenty percent of total 911 calls in Massachusetts, according to state reports, are mental health–related. And according to the National Library of Medicine, there was a 22 percent increase nationally in mental health–related calls to police during the COVID-19 pandemic.

In an effort to adequately assess the rise in mental health calls, Island police departments are seeking additional help. They see a possible solution in a program that has been replicated across the country. It’s called a co-responder program. 

Under the model, a mental health professional teams up with police on certain calls, in order to de-escalate and assess crises involving an individual who is struggling mentally. The program enables a relationship between law enforcement, mental healthcare clinicians, and the person in trouble. 

It’s a “multipronged approach,” Oak Bluffs Chief Jonathan Searle said, which is important. Searle said having licensed professionals on their side would help give police more clarity on how to assess moments of crisis. Professionals can also pick up on cues that police might not.

The concept of a co-responder model is something that dates back decades, according to a report from the International Association of Chiefs of Police. Its original purpose emphasizes a goal to “engage, assess, and direct” individuals with behavioral issues as safely as possible. 

In 2003, Framingham became the first town in Massachusetts to begin a co-responder program. The department’s leaders believed that officers were arresting too many people with mental health conditions.

Since its inception, licensed social worker and co-founder of Framingham’s program Dr. Sarah Abbott said, the co-response program has been beneficial not only in de-escalating situations of crisis at the scene, but also in providing “support and assistance to the families.” 

She said it’s become “massive” in Massachusetts since its beginning in Framingham. 

In 2020, there was a renewed national push for nonpolice crisis response, as it related to police brutality. According to Massachusetts Department of Mental Health reports, 30 towns statewide have already implemented a co-response program through Massachusetts grant funding, although many more communities use the model without the state funding. 

But despite its support on the Island over the past few years, and its growth in popularity across the state, the program has failed to take hold on the Vineyard. And some are frustrated.

McNamee in Edgartown has hoped for this kind of partnership with Martha’s Vineyard Community Services for the past several years. 

“It’s not a novelty. It’s not a new idea,” said McNamee. “Everyone does it but us. Nantucket even has it.” McNamee is frustrated that a program wasn’t initiated years ago.

While there is movement to bring a program to the Island, there are a number of factors at play in why it hasn’t happened yet. 

As several Island officials have acknowledged, money is a challenge. It costs money to hire a clinician to be on call. And there are also staffing issues; McNamee said there just aren’t enough clinicians at Martha’s Vineyard Community Services — a likely partner in a potential program — to help out. He said this ties into the lack of affordable housing on the Island. 

It’s also not an easy job. Not only would the hours be difficult, clinicians are often faced with certain levels of violence and danger at the scene. 

Searle said currently, clinicians are used to working “banker’s hours,” a traditional schedule, five days a week. In the co-responder program, he said, clinicians would need to be prepared to work a “nontraditional role” in “nontraditional settings,” where they aren’t always seeing someone in their office, but rather getting to an individual’s home at the time of a call. 

“The intent would be to schedule clinicians to be on duty during peak hours, but have a clinician available if a particular call came in that required their services after hours,” said Searle. “I guess you could compare them to a volunteer firefighter.”

While it has taken a few years, there is an initiative on the Island that seems to be gaining steam, and could lead to a pilot program on the Island in a matter of months. Local departments have landed a grant, and are looking for more state funding to pave the way. 

Chief Searle, one of the leaders in this effort, said he knows of one clinician who’s ready for the job, whom he would be eager to work with. 

“The plan, which is in the works, is that in the not-too-distant future, we hope to have a pilot program going, based on some money that was secured by Community Services through Blue Cross Blue Shield,” said Searle. The funding, according to the Massachusetts Blue Cross Foundation, is a one-year, $50,000 grant, which was awarded May 9. 

Searle said he’s also working on applying for a grant from the state’s Department of Mental Health that would secure the permanence of the co-responder program. 

Although some officers and healthcare professionals have received appropriate training, not all have, and the grant would aid in “getting everybody, over time, to a higher level,” Searle said.

Beth Folcarelli, chief executive officer at Martha’s Vineyard Community Services, is also optimistic that the missing pieces could come together soon, even in the next few months. 

The Island has gotten a helping hand so far in its effort to begin this pilot co-response program. Abbott, using her expertise in co-founding Framingham’s co-response program, has teamed up with Jared Andrews, the current senior director of administration at Martha’s Vineyard Community Services, and a former Oak Bluffs Police officer. The two of them led a co-response training on the Island in April.

Abbott described that the training involved teaching clinicians how to assess individuals rapidly, without having any prior information as to whom they’re working with. Part of the session included setting up and completing role plays for practice. 

Brian Morris, currently a mental health specialist and substance use disorder access coordinator at Island Health Care, was part of this training. Morris said the training was “fantastic.”

Back in Edgartown, the man who had stopped into the police department to get help for his wife told The Times he thinks a co-response team would be beneficial for his family and others facing a similar predicament. There is only so much law enforcement alone can do to help. 

In June, the resident was in the process of trying to get his wife into the hospital through what’s called a Section 12 hold, as per the Edgartown Police chief’s advice — although Section 12 can be an extreme measure. 

McNamee explained that due to the Section 12 law in Massachusetts, individuals can be brought to a hospital for evaluation without their consent if they are a danger to themself or others. It’s essentially a hold of that individual against their will. 

But co-responder advocates say that the program could prevent Section 12 holds, in some cases. In Framingham, Abbott said she sees a strong correlation between the implementation of a co-response program, and a reduction in the number of Section 12 holds administered. 

“What we’re noticing is that the biggest shift has been away from Section 12,” said Abbott. “There’s been a decrease in people going to overwhelmed and understaffed emergency departments across the state.”

A co-responder program provides a more thorough assessment at the time of crisis, Abbott said.

Martha’s Vineyard Hospital officials also see a need for a co-responder program. 

“The more resources we can have outside the hospital, out in the community, the better the care of people with mental health disorders is going to be,” said Ryn Gluckman, nursing director in the emergency department of Martha’s Vineyard Hospital.

Section 12 holds, although in some cases necessary, are something Gluckman said she never wants to have to do, if avoidable. “We’re literally taking away their human rights,” she said. 

Gluckman said she’s seen that globally, for the 17 years she’s worked as an emergency department nurse, the number of patients that are being seen for a mental health crisis has “exploded” with time. 

Within the Island community now, as the co-responder program moves slowly forward, there are a couple of mental health–centered initiatives gaining momentum. 

Recovery court, as Morris referred to it, is one example. The program enables people struggling with substance misuse, in certain cases, to rehabilitate in a way that doesn’t remove them from their communities. 

“It’s for nonviolent offenses involving drugs, where people can enter into an 18-month diversion program. So it’s not jail time. It’s time served while in the community. It’s accountability,” said Morris.

Kelly McCarron, a clinician at Martha’s Vineyard Community Services, aided in the founding of the recovery court program, which began about three months ago. 

She explained that in her personal experience struggling with substance misuse, she began to discover what kinds of “flaws exist in our criminal justice system.” 

“I was born and raised here on the Island, and when I was 17, I was in a very bad car accident. I was drunk driving, and my passenger did not survive,” said McCarron. 

After the incident, McCarron said she began to see how people can find themselves “trapped” in the criminal justice system, when it comes to cases related to mental illness. She said she thinks a co-response program could help with this.

Gluckman, too, said she thinks a co-response program could be able to “drive down the criminalization” of people suffering from mental illness. “Nobody does well in jail,” she said.

In the midst of gearing up for an official implementation of a co-response model on the Island, Folcarelli said Community Services is also preparing for a model that could eliminate law enforcement altogether, in some cases. 

The new model would be called Mobile Crisis Intervention, potentially coming into effect in the spring or summer of 2025, according to Folcarelli. This model could enable families to call clinicians directly to come to the scene of a crisis. In these situations, law enforcement would not be involved at all. 

For the time being, Islanders are still anticipating their own co-response model, as it continues to circulate the state with success. According to Searle, towns like Plymouth and Pittsfield have been running co-response programs for several years, with “extreme success.”

“The co-responder program has kind of gotten a couple of false starts,” said McNamee, referring to the slow process so far here on the Island. “But I don’t doubt it’s coming.”