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Saturday, August 17, 2019  Spokane, Washington  Est. May 19, 1883
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Keeping people out of crisis: Unit combines law enforcement, mental health worker

Spokane Sheriff’s Deputy Dan Moman and Holly Keller, a clinician with Frontier Behavioral Health, check on a woman with mental health issues. The two work as partners in the Spokane County co-deploy team pairing a mental health worker with a deputy. (Colin Mulvany / The Spokesman-Review)
Spokane Sheriff’s Deputy Dan Moman and Holly Keller, a clinician with Frontier Behavioral Health, check on a woman with mental health issues. The two work as partners in the Spokane County co-deploy team pairing a mental health worker with a deputy. (Colin Mulvany / The Spokesman-Review)

Spokane County Sheriff’s Deputy Dan Moman and Frontier Behavioral Health mental health clinician Holly Keller were riding around on their shift this summer when they got an urgent call.

The family of a man who had run into traffic before had called 911 to report he was running away from home, and deputies who had already responded to the situation said he was not following commands.

Moman and Keller rushed to the scene. When they arrived, the man was standing in the road. But when he saw the two members of the Spokane County Sheriff’s Community Diversion Unit, he recognized them immediately.

“Dan and Holly!” Moman recalled the man calling out to them.

They were familiar to the man because they had been in contact with him at least eight times before.

They approached him and listened.

He was agitated, but eventually they got him out of the road and gave him water, food and a bus pass. The man went from a flight risk to being considered no immediate safety risk at all. He used his bus pass to go stay with a friend.

Without Moman and Keller, however, the outcome could have been very different.

“There was a huge chance they would have used force on him,” Moman said.

What happened that night is exactly what the Spokane County Sheriff’s Office hoped would happen when it founded its Community Diversion Unit program nine months ago. And it’s happened many other times as well.

So far, the sheriff’s mental health diversion team has diverted 89 people from the hospital emergency room, 32 from jail and 30 from using an ambulance to get to the hospital, according to Moman’s count.

The Community Diversion Unit is designed to be a co-deployed team comprised of a Spokane County Sheriff’s deputy and a mental health clinician from Frontier who work together to de-escalate and divert people from going to the hospital or to jail due to mental health crises.

At the heart of their approach, Keller said, is a single question: “Is there an imminent risk of danger?”

Just because a person has a mental illness does not mean they are dangerous or are going to cause harm. And the diversion unit only intervenes when those are the stakes.

But the team’s work goes beyond intervening in crisis situations, and when time allows they do follow-ups and check-ins with people throughout Spokane County.

That’s where Moman and Keller were headed in a sheriff’s department SUV on the bright Friday afternoon of July 5: to a follow-up call in Spokane Valley after deputies asked them to swing by the home of a man they thought might benefit from the diversion unit’s services.

When they arrived, Moman knocked on the door while Keller hung back a bit. After a few minutes – and some dogs barking – a man came out a side door and up to the fence to talk.

The team talked to the man for several minutes, and Keller returned to the still-running SUV to get business cards with phone numbers for services that the man could access in the future.

After about 12 minutes, Moman and Keller left.

“He wanted more support,” Keller said, indicating that the business cards she gave him would probably be used.

That’s a lot of the co-deploy team’s job: providing support to people in the community who are not aware of mental health resources available to them, like counseling or Frontier’s mobile community assertive treatment team, called MCAT.

Calls come in from emails or requests for follow-up from law enforcement, crime watch or dispatch backup.

The work Moman and Keller do typically begins in the late afternoon and carries on through the night, until about 10 or 11 p.m., when they call it quits to finish filling out paperwork and head home by midnight. During their shift, Keller dresses casually, in black pants and a dark blue polo shirt, while Moman wears his full sheriff’s uniform, including his gun and handcuffs. But he rarely uses them.

While Moman can arrest and detain people, it’s not often that he does. Only five people have been arrested and two use-of-force incidents have occurred so far during Moman and Keller’s work.

“We try to be up front about our intentions, and why we’re there,” Moman said.

In a bottom line, financial sense, Keller is there because the Spokane County Sheriff’s Department received a Washington Association of Sheriffs and Police Chiefs grant in 2018 to fund the mental health component of the program. That pays Keller’s salary.

Moman is there because the Spokane County Sheriff’s Office has allocated one of its regular-shift deputies to full-time diversion and mental health work.

The team works to refer people to services, only taking people to the hospital who truly need to go instead of them using it to access other resources. And they work efficiently.

Normally, a deputy could spend hours at the hospital with a person in crisis, but Moman and Keller average less than 12 minutes from an initial encounter to an emergency room bed.

But few of the unit’s encounters are average.

Later on July 5, for example, a follow-up with a woman Moman and Keller know well begins with a knock on her door and continues with an invitation inside her home.

What happens next is unlike any typical law enforcement interaction one might see on the street or on television.

Moman and Keller spend the next hour and 15 minutes with the woman, listening. In fact, the team barely speaks, except to occasionally ask questions like, “What do you need to make you feel more safe?” and “How can we help you feel safer?”

These long calls are normal for the co-deploy team. They see, on average, less than three people per shift and spend about 47 minutes on each call. While this might seem inefficient, it is a time-saver for other deputies.

The woman is in the throes of myriad challenges, but the team patiently listens as they reach the most urgent issue she is facing. She has no way to take her medicine later that night because she does not have food prepared, and her poor physical health prevents her from being able to cook for herself. The team encourages her as she navigates several phone lines to find a caregiver who can come over later to prepare food for her.

In all, the visit takes more than an hour. But besides Moman taking down some notes, the team mainly spent time intently listening to the woman and validating her experiences, which is in line with motivational interviewing, a technique that Moman and Keller learned in training at Frontier.

“We’re not going to solve all of her problems tonight,” Moman said, but he noted that working on small solutions and helping people get to the point where they can make a change is important.

Mariah Rhodes, director of transitional services at Frontier Behavioral Health, said motivational interviewing allows the team to identify areas of change without casting blame.

“The key to motivational interviewing is, it really is about behavior change and it’s about helping a person understand whether or not their behavior is in alignment with what their values are,” Rhodes said. “So if my behavior is out of alignment with my values, then I’m going to have a lot of internal ambivalence about it.”

High empathy is also a key to what Moman and Keller do, as is continuing to follow up with the people they see. Moman and Keller used motivational interviewing in 77% of their calls in June.

“We’ll go back to her tomorrow,” he said, as they pulled away from the house.

But Moman was wrong: The team was backthat night, spending another 40 minutes with the woman and eventually getting her pastor to come cook for her.

And data Moman has collected suggest this kind of on-the-ground intervention is working.

Although the program is still in its infancy, the co-deploy team has reached 363 people so far, with 251 of those people in an active crisis.

Law enforcement agencies in Washington don’t have a choice about implementing diversion- and community-based solutions to keep people from sitting in jail waiting for competency evaluations. They were ordered to do so, after a lawsuit was brought against the state over how people with disabilities and mental illness were treated in jails.

That lawsuit, which is often referred to as Trueblood, found that the state lacked timely competency and evaluation services for this population, often leaving people behind bars for weeks or months at a time.

Spokane-area law enforcement is in the first region to roll out these new programs.

The Spokane Police Department also has four mental health clinicians from Frontier Behavioral Health who rotate on rides with patrol officers. That program has operated for about a year, and an effort is underway to better integrate the city’s and county’s work.

Together, the SPD, the Spokane County Sheriff’s Office and Frontier are applying for another WASPC grant to combine and expand their co-deploy teams.

“The idea is that they are one large team and they are boundary-less, which means that if there’s something happening in the city and the guys in the Valley aren’t on a case, then they are going to come to the city and take care of that,” said Jan Tokumoto, chief operating officer at Frontier Behavioral Health.

Tokumoto said the application asks for four more law enforcement officers, four more clinicians and a sergeant, all in addition to the five teams currently operating.

WASPC expects to select grant recipients this summer, with grantees receiving funds by mid-August.

Already, those involved say the co-responder teams have driven an organizational culture shift, both for law enforcement officers and the clinicians involved in the program. Part of that shift comes from CIT training, which educates law enforcement about how to interact with people who have mental illnesses.

“It really does impact the culture,” Tokumoto said. “It’s a different way of working with individuals who have a behavioral health issue.”

The Trueblood settlement requires the state to seek funding for the Criminal Justice Training Center to provide 40-hour CIT training to 25% of officers on patrol duty.

All Spokane Police Department officers have CIT training within 18 months of being hired. All officers in the Spokane County Sheriff’s Office have received 10 hours of CIT training, but the department is working to get all officers the more comprehensive 40-hour training as well.

Tokumoto said training 100% of a department’s officers in CIT training is not the norm nationally nor is the idea of putting a law enforcement officer and clinician in the same car, practicing motivational interviewing.

“If you think about it, you’re putting two disciplines together (that) could not be more opposite,” she said. “You have law enforcement that is very compliance-based. … And then you have the mental health side of it that wants to know how are you doing? How are you feeling today? … I think motivational interviewing bridges that gap, and that’s a concept easily learned and embraced by both parties. And then we end up speaking this similar language, and we’re all trying to get to the same end-result.”

Not only is CIT training and motivational interviewing changing law enforcement officers’ perspectives, it can change the perceptions mental health clinicians, people who access the mental health care system and law enforcement officers all have of one another.

“It’s a culture change for us, too, to allow our mental health community to feel safer with the law enforcement community,” Rhodes said. “I think that’s the other dynamic we’re seeing, too, is that it’s creating that dynamic shift as well.”

If you or a loved one is experiencing a mental health crisis, Frontier Behavioral Health operates a 24/7 crisis line for people in Spokane, Adams, Ferry, Lincoln, Pend Oreille and Stevens counties and can be reached at (877) 266-1818.

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