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First responders bear the burden of mental health emergencies around Colorado Springs

From the Mental Health Care Crisis: First responders series

Part 4

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This story is part of a yearlong series about Colorado’s broken mental health care system. Read more of the series here. 

Patrol cars sit at a Falcon tire store as a woman sobs in the parking lot, her dog tugging at its leash.

A life is at risk — hers — and the El Paso County Sheriff’s Office wants to hear her terms in their bid to save it.

In this case, a deputy and his partner drop normal protocol and agree to follow her on an errand to the bank, provided their next stop is the AspenPointe Crisis Center to discuss the suicidal threats that led to this weaponless standoff.

“You’re doing great, sweetie,” sheriff’s clinician Robin Schawe tells her by cellphone from an idling SUV, wrapping up negotiations. “I’m proud of you. Thank you for letting us help you.”

In a state notorious for its fractured approach to mental health care, police and first responders are increasingly left to shoulder the load, forced to turn away from traditional tactics and play therapist, nanny and even chaperone as they quell crises that pile up amid systemwide deficits.

The unabated pace of mental health emergencies strains public agencies and fails people in need who are at risk of becoming enmeshed in a well-worn cycle — delivered to frantic emergency rooms, where follow-up care is scant, or locked up in jail, where their problems compound.

When people are a threat to themselves or others, authorities can obtain a judge’s order to hospitalize them for up to 72 hours.

Click here to read previous stories and to view videos in this series

But if no crime has been committed or someone refuses medical treatment, the calls for help are “terminated in place,” letting police and firefighters move on to the next emergency but leaving the vulnerable to fend for themselves, a grim concession in a county pummeled by a decade of rising suicides.

“We’ve become the social workers of society,” said Colorado Springs police Sgt. Eric Frederic, referring to mental health emergencies that cut across jurisdiction lines, affecting every agency in the 911 system. “There’s just not enough true activists and social workers to solve all the problems, so we get relegated that task.”

On the front lines of that battle are a handful of new teams that pair police and therapists to do exactly what Schawe, a licensed counselor, did that day in Falcon — talk someone off the razor’s edge, averting arrests, suicides and shootouts.

How to improve response to mental health crises

But with hundreds of mental health emergencies a year flooding the region, the units are overburdened, underfunded and forced to scramble for temporary grants, with no sign of the windfall required to address unmet needs.

Meanwhile, cries for help keep stacking up.

In 2016, the Sheriff’s Office logged 991 calls to check the welfare of suicidal people, a 24% increase compared with two years earlier. Suicide attempts grew 17% during that period, rising to 125.

More recent figures show little sign of a slowdown, authorities say, marching ever higher in line with El Paso County’s spike in suicides, which have soared over the past decade, nearly doubling. The county has the highest number of suicides each year in the state and has the second highest rate per 100,000 among the state’s major counties.

Each time officers are summoned to a person in need, the key to improving outcomes may be within reach.

“You treat people like people,” said Schawe’s partner, Deputy John Hammond, who watched her calmly take control as a suicidal woman rattled off reasons to give up. “You listen. You let them tell their story. Nine times out of 10, they give you the solution.”

But without enough resources for the job, the goal of “treating people like people,” and arranging for necessary follow-up care meant to keep them out of harm’s way, can fall away amid competing obligations, leaving the cycle to recur.

The grip of psychotic delusions

The problem of how best to handle the pace of mental health-related emergencies in the Pikes Peak region fueled a 2012 community roundtable in Colorado Springs that tried to put a price tag on the swirling dysfunction — measured in the hours wasted, the financial liability incurred and the human toll of bad outcomes that developed incrementally.

Even as a group of mental health providers, public safety experts and local leaders pledged to rally for solutions, a break came, though one born of tragedy, that held out the promise of relief.

Reeling after the 2012 Aurora theater shooting, with its staggering illustration of the stakes involved, state officials set aside $20 million to create programs that would improve emergency mental health care and reduce the burden on Colorado’s emergency rooms and first responders.

AspenPointe, a Colorado Springs nonprofit health care provider, led the effort to secure Southern Colorado’s share, bringing in money to create two walk-in crisis centers that form the backbone of the Pikes Peak region’s strategy — finally giving emergency responders a place to take people who need help but don’t belong in jail or in the ER.

Just as important, they allow the ill to receive immediate care on a 24-hour basis, a critical benefit for those in the grip of psychotic delusions, who account for a common source of emergency calls.

“The longer the delay, the more likely they are to have negative health care outcomes their whole life,” said Shannon Scully, a criminal justice policy analyst with the National Alliance on Mental Illness, which works with police groups to improve their approach to the mentally ill.

The 2012 state funding led to two more important innovations: the creation of a statewide toll-free crisis hotline and a series of specialized public safety units devoted to defusing emergencies involving the mentally ill.

Pairing a therapist and law enforcement officer on a team, the so-called “co-responder units” are equipped to recognize basic mental illnesses and trained in “de-escalation” techniques that seek to restore calm.

The part that comes after — getting people connected to health services — is equally critical, and the special units are adept at navigating the region’s patchwork services, with prior relationships that smooth new arrivals.

“We specialize in resources that a lot of people don’t know exist,” said Kelly Helderman, an AspenPointe therapist who works on one of the Colorado Springs Police Department’s three mental health teams.

Two years after police stood up their program, the El Paso County Sheriff’s Office turned to a separate state grant to create the two-person Behavioral Health Connect Team (BHCON), which negotiated a peaceful resolution at the Falcon tire store. The Sheriff’s Office says it plans to add a second team this year, expanding hours and giving it a wider reach. BHCON began operating in July on a five-year grant.

Yet even amid encouraging progress, the future is uncertain for the collaborative effort.

AspenPointe, whose crisis centers shaved ER visits and cut hospitalizations, is facing a June sunset on the five-year grant that provided the centers with funding. The nonprofit is pursuing continued funding but has no guarantees.

The co-responder units are likewise fueled by temporary grants, requiring ongoing administrative hurdles and upsetting any ability to plan.

“All parts of this are grant funded,” said Julie Keys, a retired Colorado Springs firefighter who helped get the city’s program up and running. “They’re at risk.”

On the streets of El Paso County, evidence is mounting that innovations of the past five years can save lives, avert lawsuits and better manage public resources.

But those gains come at a cost in the form of time and resource-intensive interventions.

Taking a cool-headed approach

By the end of its first six months, BHCON responded to 263 calls and provided services to 222 people, making follow-up checks on roughly half. The Sheriff’s Office says the team freed up other units, improved care for the mentally ill and prevented emergencies by reducing repeat calls.

For all its successes, BHCON’s scope is curtailed by short hours — it operates from Monday to Wednesday — and demands of its caseload, which requires time to follow up on people from past calls, by phone and in person.

Hammond said he and Schawe must refuse calls to allow for necessary interventions, leaving unaddressed demand for their services.

Benefits of their cool-headed approach were evident outside the Falcon Tire King, where Schawe, a civilian therapist from UCHealth Memorial Hospital, determined the woman had good cause to demand the visit to her bank. She had just been informed her account could be closed for insufficient funds, days after her partner of more than 10 years told her he planned to leave. Schawe’s offer to accompany her helped seal the deal, getting the woman in for an assessment.

Technically, the woman was free to go as soon as she calmed to the point she was not a threat to herself or others. She had no weapons and promised she was no longer suicidal.

“We could have said, ‘Go to the bank, good luck,’ but that’s not the point of us,” Schawe said.

The point, she said, is to ensure someone has an established path toward ongoing care.

After delivering the woman to crisis counselors at AspenPointe, Schawe and Hammond said it was doubtful that patrol deputies would be in a position to offer the same service.

Talking down a suicidal person and escorting them to the ER or a crisis center can take hours — time that deputies can’t always spare against the backdrop of other emergencies, leading them to “terminate” calls once a person is deemed safe. On average, the mental health teams say they spend double the time compared to patrol deputies or officers.

The day’s success likewise hinged on the availability of the walk-in center, because the woman was adamant that she not be hospitalized, illustrating how one element of the regional approach can fail without another.

A dread of hospitals is a common obstacle on crisis-related calls, leading AspenPointe to hire peer counselors and focus on making its environment less intimidating and less restrictive — all part of the changes made possible by state grants.

The service is voluntary, and people are free to leave in the absence of threats.

Heroism and compassion

If special mental health units are tied up, or off duty, patrol officers must rely on their best judgment when mental illness or substance abuse might be a factor.

To assist them, police and the Sheriff’s Office jointly hold crisis intervention training — a classroom-based course referred to by some observers as the “gold standard” in training police to seek peaceful resolutions.

The linchpin lies in learning to navigate the teeter-totter that results when someone loses control of their emotions, said Sgt. Frederic, a 15-year police veteran who leads the department’s training.

“As people become emotional, they become less rational,” he said. “We acknowledge the emotions. We use a lot of active-listening skills to build rapport and trust. We’re there to help them solve problems, too.”

He calls it a “major shift in philosophy,” moving away from a doctrine that preaches compliance or consequence toward one that “treats people with respect.”

Sheriff Bill Elder has made the crisis intervention course mandatory for all patrol deputies, but Colorado Springs police keep the courses open only for officers who volunteer.

There’s no telling when a patrol officer might encounter a life-and-death stakes call, and stories of heroism and compassion abound, from officers wrestling weapons from suicidal people to talking them off ledges real and figurative.

In 2018, Colorado Springs police officer Joshua Weise received a Rotary Club award for averting a “suicide-by-cop” attempt on the city’s east side — coaxing a man with a knife out of South Academy Boulevard as traffic stacked up around them.

At one point, the man, ranting and waving the weapon, announced he wanted a drink and started walking toward a 7-Eleven, knife in hand.

Had he taken one more step, Weise would have been legally justified to shoot in protection of customers — and he was ready.

“That was the second time I thought I was going to shoot him,” he said.

But Weise made a final plea for peace, and the man dropped the knife. Once the man was handcuffed in the back of a patrol car, Weise went into the convenience store and bought him the drink he was willing to die for, reflecting on how close it came to happening.

When things go wrong

The calls that go bad can prove disastrous — for the mentally ill, the people around them and the responders charged with restoring order.

In February 2018, former paralegal Don Woodson, 61, choked his then-wife and prevented her from leaving their kitchen table for hours, all while ranting incoherently in their north Colorado Spring home.

When the woman finally managed to call for help, police surrounded the home and spent hours angling for a peaceful resolution before sending in a SWAT unit with a dog.

Woodson, who was in the bath when the raid came, was nude when he was bitten repeatedly while in his upstairs hallway and fell or was dragged down the stairs, he said.

While being held in jail, he developed gangrene that caused his leg to be amputated just below the knee. He also was not treated for a brain bleed that could have killed him, according to a pair of civil claims filed in August.

In the claims, Woodson, who was in the grip of psychosis, blamed his life-altering injury on missteps by Colorado Springs police and El Paso County jail deputies, demanding up to $15 million from each agency. A police report and medical records corroborate his medical condition and injuries.

At the time, Woodson’s wife had already left the house, but police determined he couldn’t be permitted to remain home because he had access to a gun. The decision was made in consultation with the city’s mental health units, a police supervisor previously told the newspaper.

Falling through the cracks

There are also those who fall through the gaps in what police can accomplish under the laws and protocols governing them.

A woman who asked to be identified as Lynn W. recounted the years she spent trying to get help for her husband and herself.

Amid heavy drinking, he began flying into violent rages and inexplicable delusions in their home just outside Colorado Springs, haunted by a persistent fear of being under surveillance. The Gazette agreed to withhold her name because she is fearful of retaliation by her husband, who she said lashes out when confronted.

She described coming home one day to find that her prized, framed photographs had been thrown outside and shattered. Another fight ended with him fashioning his hand into a gun and pulling the trigger.

Time after time, she has called police only to be told there is nothing they can do because he isn’t a danger and won’t accept help.

Meanwhile, her husband’s health is breaking down, including repeated hospitalizations to have his abdomen drained of blood due to complications from drinking, which she believes hides a serious psychiatric illness.

“The first time he was in the hospital, when he thought the spies were after him, the hospital psychiatrist talked to me. ‘Well, when are you going to leave him?’ That’s what I get. ‘You need to take care of yourself.’ ”

She needs someone to help him, she says, regardless of whether he consents.

“What’s going to be better for my mental health — leaving a dying person? Leaving a person in need?”

An arrest record verified at least one prior call to the woman’s home, and her business partner of several years corroborated her daily struggles and repeated pleas for help. Her calls to emergency agencies spanned periods when the couple lived in El Paso County and Colorado Springs, and she said she reached out to mental health units in both jurisdictions, but intervention never came, she said.

“It’s just not right. They make these programs sound all great.”

The mental health units acknowledge that under the law, no one can be forced to accept help, putting the onus on them to rely on persuasion — another of the challenges in navigating a broken system.

When persuasion fails, waiting may be the only option, Keys said.

“Eventually, they decompensate,” she said, meaning that their health unravels to a point where a judge approves an order for an involuntary commitment, or they lose the ability to refuse the medical help they require.

Searching for answers

Amid the prevalence of problems involving emergency response and the mentally ill across the U.S., promising new strategies abound, but much work remains, experts say.

“Even if the way police and mental health professionals are working together is very positive and sophisticated, the follow-up is where everything falls apart,” said Angela Kimball, NAMI’s national director for public policy and advocacy. “I’m not sure that we have seen any single place that has it all together.”

Communities that serve as models have generally achieved gains by expanding capacity through bold political action — and financial sacrifice.

In Tuscon, Ariz., a recent community effort resulted in sweeping changes, including the addition of a crisis center credited with staying on top of ongoing demands.

“(Police) can drive up to the back door and a mental health professional can meet them there. Officers complain if they have to wait 10 minutes,” Scully said.

King County, Wash., which encompasses Seattle, built a system that’s studied nationally by passing a major tax increase — an idea taking root in Colorado, where municipalities across the state have shown an appetite for change. In 2018, at least nine ballot measures passed across the state that sought to address mental health needs through tax increases or budget realignment.

In Denver, a 0.25 percentage point sales tax will raise up to $45 million per year for mental health services and housing, more than double the amount released by Colorado right after the Aurora shooting.

In Larimer County, a similar tax increase will result in a $25 million mental health and drug detoxification facility serving the greater Fort Collins area, dwarfing the budget available in El Paso County, which has a greater population and more need.

A network of volunteers knocked on doors, manned phone banks and staffed public meetings, telling the stories of families and police trapped in an unending pattern. Critically, they persuaded the county to prepare a master plan showing how the money would be monitored and spent, said Gil Barela, who ran the successful campaign.

“It was a firestorm,” he said. “People just wanted us to stop and talk. We had so many places to be it was hard to keep up.”

The measure passed 69% to 31%, a sea change from two years earlier, when a similar measure failed by 4 percentage points.

“It’s going to save lives,” Barela said. “Larimer County is going to be one of the leading counties in Colorado in mental health.”

Whether leaders in conservative El Paso County pursue such action may be out of law enforcement’s hands, even if they absorb the brunt of the dysfunction.

For some, like Woodson, the damage has been done. More than a year after his ordeal, he now has a prosthetic leg, but he says his life won’t be the same. A former high school basketball star, he has been robbed of a sport that fueled a lifelong passion.

His lawsuit, seeking tens of millions of dollars, is imminent, said his attorney, Daniel Soom of New Castle, Pa.

For others, the cycle keeps turning.

In a rage-filled home near Colorado Springs, with a sick husband who smashes her photos and hides from imaginary spies, Lynn W. says she knows when relief will come.

The first time alcoholism landed him in the emergency room, five years ago, the doctors who pumped blood from his abdomen told her he had five years left to live.

With no one able to help, and a husband who refuses to receive it, his prognosis offers the only end in sight, though one robbed of hope.

“I try to tell myself to toughen up,” she said, “and that he’s going to die soon.”

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