Despite Multnomah County leadership’s efforts to steer away from treating mental health crises as a criminal matter, police remain deeply embedded in a county-funded program that responds exclusively to mental health emergencies.
Project Respond, a program of Cascadia Behavioral Healthcare, sends teams of mental health professionals to respond to mental health emergencies across Multnomah County.
These crisis workers perform onsite mental health assessments, and when an individual presents an imminent danger to themselves or others, they can issue an involuntary hold and have them transported to a hospital for further psychiatric evaluation. Otherwise, they work with the individual on a voluntary basis to come up with a plan that will help them manage their mental illness while remaining in the community.
Project Respond is often touted as an alternative to police response in situations where mental health is the primary factor in a disturbance. More than a quarter of requests for service last year came in from friends or family of the person experiencing the crisis or from the person in crisis themselves.
But 70% of the time during the first three months of the year, Project Respond team members brought police with them on calls that came through the Multnomah County Mental Health Call Center. This is in addition to the 40% of Project Respond dispatches that come directly from police who are already on the scene and want the assistance of a mental health professional.
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In some cases, calls are diverted from 911 to the county’s Mental Health Call Center after the dispatcher determines there is no criminal nexus in a mental health emergency. Other times, people call the center directly seeking assistance. In both instances, it’s up to Project Respond to determine whether police should accompany its clinicians to either secure the scene before they enter, provide back up or assist with an involuntary transport.
When all calls are taken into account, Project Respond assisted with mental health crises without a police presence only 18% of the time.
This heavy reliance on police is a departure from Project Respond’s original intent when it was established in 1993.
Julie Larson founded the program and remained on staff in one capacity or another until 2008. She said the mobile crisis teams would not use police regularly during its earlier days, but would ask for their assistance if the incident involved violence or weapons.
This is similar to the New York City health department’s mobile mental health crisis unit, which responds with police only when the person in crisis is armed.
Jason Renaud, of Mental Health Association of Portland, was a communications manager at Cascadia when it absorbed the Project Respond program about 20 years ago after five mental health service providers merged into one.
“Julie’s idea was substantially different,” Renaud said. The goal was to reduce police use of force against people with mental illness during a time when it was common to see police “whaling on someone on Third and Burnside,” he said.
Larson co-wrote a chapter about Project Respond’s approach at the time for a book published in 1997 called “The Police and the Homeless.”
While some aspects of policing and homelessness may have changed since the ’90s, it was striking how little others have appeared to changed.
Larson and co-author Sue Beattie described a landscape in which the homeless mentally ill wandered the streets, frightening shoppers, affecting businesses, and making residents uncomfortable and concerned. No one knew what to do, so they called the police and complained to city officials.
“Most police officers did not enter the police academy to become social workers, yet these are everyday calls to which they must respond,” they wrote.
Nor did they have training, resources or time to effectively address mental health crises in a meaningful and lasting way, she argued.
Discussion of this problem in Portland gave way to Project Respond’s pilot in the early ’90s.
When the program got its start, it often received requests for services during crisis situations from the police, businesses, family members and other community members, she said. But it was also focused on street outreach in the urban core and building relationships with hard-to-service clients slowly over time, in addition to its mobile crisis response
“We tried to neutralize our work and focus a lot on the engagement,” Larson told Street Roots. “We always had a bag packed, granola bars, dry socks, food. I was one person who carried cigarettes – that became controversial – but you can calm someone down when they’re ready to jump off a bridge with a cigarette.”
Teams wore easily recognizable purple jackets, as one goal was to be a visible presence on the streets for people struggling with mental illness and homelessness.
Her staff also did some training with police in order to learn the signs a person might show if they’re about to become aggressive and how to stay safe.
With more mental health services and housing options available, the program had a track record of transitioning people from the streets.
Before founding Project Respond, Larson visited Eugene’s CAHOOTS (Crisis Assistance Helping Out On The Streets) program and borrowed some things she liked from it. While Project Respond is more clinical, CAHOOTS does serve as the mental health crisis response in Lane County.
While CAHOOTS has several master’s-level clinicians on its team, it doesn’t perform mental health assessments and rarely issues involuntary psychiatric holds – but that doesn’t mean it isn’t intervening in some situations that are similar to those Project Respond faces.
“We absolutely respond to folks who are aggressive and agitated,” CAHOOTS Operations Coordinator Tim Black told Street Roots. “Occasionally patrol will be dispatched to respond with us if there are reports of physical violence, but those are very rare situations and the officer will generally leave once the scene is calmed down.”
Less than 30% of CAHOOTS responses involve law enforcement; although the team is primarily focused on street interventions, and not exclusively on mental health.
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Today, Project Respond’s focus has widened beyond homelessness in the urban core. Last year, its mobile teams intervened in 3,188 mental health crises across the county. The majority of those clients were housed, but at least 27% of people assisted were experiencing homelessness.
In addition to Project Respond’s frequent use of police being a departure from its roots, it also strays from the intentions set in 2012, when public officials decided to begin diverting certain 911 calls to the Mental Health Call Center. The idea back then, as reported by The Oregonian, was that with Project Respond taking non-criminal mental health calls, police would be freed up to focus on “actual crimes.” Plus, the psychological trauma, injury, death or unnecessary incarcerations that can go along with police contact, would be avoided.
A co-response between Project Respond and police was not what Thomas Perez, an attorney with the U.S. Department of Justice, had in mind either in 2010, when he suggested the expansion of Project Respond in a letter he wrote to then-Mayor Sam Adams during the Justice Department’s investigation into Portland Police Bureau’s treatment of people with mental illness.
He indicated that based on feedback his department collected from mental health advocates, “people with mental illness or in a mental health crisis may fear interactions with PPB. Advocates informed us that people with mental illness and their families would often prefer interactions with mental health professionals, rather than law enforcement, for welfare checks. Likewise PPB officers informed us that they spend an inordinate amount of their law enforcement time on calls that are principally related to mental health needs.”
Street Roots sat down with two employees at Cascadia Behavioral Healthcare, which runs Project Respond, in February, Cascadia’s senior director of communications, Jennifer Moffatt, and its clinical director of crisis services, Barbara Snow. At the time, they told Street Roots there was no way to pull data that would show the number of dispatches that involved a co-response from police. They also said they couldn’t make an estimation.
After Street Roots obtained records from the county and asked again about police response rates, Moffatt supplied the percentages for the first three months of 2018, which confirmed what people familiar with the program had been saying anecdotally: Project Respond brings police the majority of the time.
“I have heard this similar concern that Project Respond and the police are intertwined and that for a lot of folks, that’s not the right connection for them. But I didn’t realize that number was so high,” Multnomah County Chair Deborah Kafoury told Street Roots. “I can see how that is not helpful to a lot of people that are experiencing mental health crisis.”
She said with recent changes in leadership, the county’s Mental Health Division is undergoing a transformation that involves an evaluation of all its services, from prevention to crises. The recent purchase of a building in downtown Portland for a peer-led mental health drop-in center and temporary shelter emerged from this process, she said, adding there are additional ways to improve the system.
Snow, who oversees Project Respond, said she would love it if police with enhanced crisis intervention training joined her mobile crisis teams every time police were requested, but it’s typically whatever patrol unit is available and nearby that shows up.
But before police are requested, she said, team members try to gather as much information as they can about a situation and the client so they can make a good decision about whether or not they will need law enforcement for safety reasons.
“We understand that it can be incredibly traumatizing to have Project Respond show up – regardless of whether we have law enforcement with us,” Snow said. “Most calls we get, people aren’t asking for us. We’re showing up because someone else requested us, and we have full understanding that bringing law enforcement along with us, potentially, increases that trauma – so we do want to make that really informed clinical decision as much as possible, based on all the information that we have – it’s about keeping ourselves safe, clients safe, trying to balance the traumatization piece.”
Moffatt said Project Respond was primarily focused on outreach before it started contracting with the county in 2004 and began taking police referrals. Snow, who’s been with the program since that time, said there has not been an increase in the use of police since the contract was first signed.
“We do indicate to police officers that they can leave if we have determined that it is safe and their presence is no longer needed,” Moffatt said.
Last year, Project Respond began using ambulances, rather than police, to transport individuals who had been placed on an involuntary hold to medical facilities, she said, although police still assist in getting the individual into the ambulance.
In February, Street Roots vendor program staff became concerned one afternoon when one of the newspaper vendors remained fixated on a delusion throughout the day, becoming increasingly agitated. Eventually, the decision was made to request a visit from Project Respond.
Over the past few years, Street Roots vendor program staff estimates they’ve called Project Respond about 10 times. All but once, Project Respond arrived with police, even in situations where the person in crisis was behaving in a completely non-threatening and non-violent manner. Several times, the call was made because the person was contemplating suicide.
When Project Respond arrived that day in February, Street Roots staff asked that the police remain outside of the newspaper’s sales office; it was filled with vendors, many of whom have had traumatic experiences with the criminal justice system and could be triggered by a police presence. At the time, staff was safely interacting with the person in question.
But the crisis team refused to enter without police. Ultimately, the person fled the premises, refusing to speak with Project Respond.
Project Respond also denied Street Roots’ request to go on a ride-along with one of its mobile crisis response teams on the grounds that our presence might make their clients feel “intruded upon.”
While police presence may be triggering to some of Project Respond’s clients, it’s not typical for a call to end in an arrest. During the first six months of 2018, just eight calls that were dispatched through the county’s call center ended in arrest and three calls that were referred through police ended in arrest.
But when a crisis is exclusively mental health, said Renaud, a mental health advocate, “the real goal is interactions with police should be reduced to zero.”
While recognizable uniforms are a thing of the past, much of Project Respond’s work outside of its mobile crisis response continues today without a police presence. Teams that include peer support, that work in homeless shelters and at libraries and perform family crisis work, all conduct outreach and follow-up visits.
Multnomah County’s mental health division officials, who oversee Project Respond’s $3.5 million annual contract, say tracking police involvement has never been part of their oversight. Instead, managers view quarterly reports to ensure Project Respond is meeting its contractual obligation to keep average call times under 30 minutes and that it’s meeting minimum response volume and repeated individual contact requirements.
“Technically, we could write a contract that says you will never use police, but I feel like they would want the ability to have it be up to their discretion,” said Neal Rotman, community mental health program manager for Multnomah County.
Rotman said the county monitors the success of Project Respond through feedback it receives among mental health providers, businesses and other people familiar with the program. He said while some people who utilize the program say they like that police show up with crisis responders, others, such as mental health advocates, do not. The county does not keep any official record of this feedback and has only received one complaint related to Project Respond over the past five years.
At Street Roots, outcomes experienced after calling Project Respond have been one of two: The person in crisis didn’t want help and declined services or an involuntary hold for psychiatric evaluation was placed on them.
In Oregon, a person must pose an imminent threat to themselves or others to qualify for a psychiatric hold, and meeting this bar can be difficult, as Street Roots reported in October. In 2018, Project Respond contact led to 418 opened commitment investigations on the same day contact was made, but it’s unknown how many of those investigations resulted in actual commitment.
The county provided Street Roots with a fact sheet measuring engagement with mental health services among people Project Respond served. From December 2017 through November 2018, it showed 1,811 unique individuals received more than 13,000 services within 30 days of their contact with Project Respond team members.
But after receiving clarification on those numbers, the reality was less rosy than portrayed. Less than half the individuals mentioned – just 732 people – sought some sort of mental health service.
And within the 30 days before contact with Project Respond, almost just as many – 510 – had already been seeking mental health services.
But it’s difficult to measure the success of Project Respond’s work, Snow said.
“It depends on who you are and what you consider a success,” she said. “If we’re able to offer any help, any hope, any helpfulness to a family, to an individual that’s experiencing a crisis, I consider that a success.”
“I know that Project Respond is helpful for some people in some situations, because of having clinically trained mental health professionals,” Chair Kafoury said, “but in other situations, having a peer is what is the right answer, or in other situations having a place to go is the answer. I think all of these are still kind of stopgaps to the bigger issue, which is we don’t have a place for people to go. Right now we’re using the most expensive solutions for people who are experiencing homelessness and mental health issues, and that is jail and hospital emergency rooms.”