How a Colorado town is untangling behavioral health care from the criminal justice system

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FORT COLLINS, COLORADO — When people are in crisis, they call 911, said Stephanie Booco. 

But just because police are called upon, it doesn’t mean they know what to do. 

That’s why Booco, a behavioral health co-responder and licensed therapist, works alongside Fort Collins, Colorado, police officers in responding to calls relating to behavioral health. 

Fort Collins, with a majority white population, sits north of Denver along the front range. Fort Collins and Larimer County residents have recently backed ballot initiatives to fund behavioral health services and make care more accessible in the community. 

Booco helped launch the co-responder program with Fort Collins Police Services and UCHealth about two years ago. The program pairs Booco, a licensed therapist, with patrol officers when they respond to people in a mental health or substance abuse crisis. 

The program has grown to include Julie Bower, a community paramedic, to help with other medical issues that can impact behavior. In the newest iteration of the program, Fort Collins Police Services has created an entire unit dedicated to behavioral health response with two dedicated police officers assigned to the Mental Health Response Team working in collaboration with the co-responders from UCHealth. 

UCHealth community program coordinator and licensed clinician Stephanie Booco, left, and community paramedic Julie Bower take a call from Fort Collins Police Services.

UCHealth community program coordinator and licensed clinician Stephanie Booco, left, and community paramedic Julie Bower take a call from Fort Collins Police Services.
Timothy Hurst, For The Coloradoan

The goal, Booco said, is to provide the appropriate level of care for people who might otherwise end up in the jail or hospital unnecessarily. 

In about 80% of calls they respond to with officers, Booco and Bower treat or provide resources to people in their homes instead of police arresting them or taking them to the hospital. 

Co-responder programs with the Larimer County Sheriff’s Office and Loveland Police Department, established in 2019 and 2016 respectively, have been similarly successful in getting mental health and substance use resources to people in need. 

While overall calls to police decreased in the first part of 2020, behavioral health-related calls went up consistently throughout last year. In Fort Collins, police officers responded to almost 3,000 mental-health related calls in the first eight months of 2020.  

Police officers in Colorado are required to complete a minimum of 556 hours of training before becoming an officer, with four hours focusing on dealing with individuals in a behavioral health crisis. A few other courses also touch on the subject.  

More: Fort Collins Mental Health Response Team ‘bridge the gap’ between policing and mental health

Meet Fort Collins police co-responder Stephanie Booco

Fort Collins police co-responder Stephanie Booco introduces herself in this Fort Collins police video from 2018.

Fort Collins Coloradoan

Fort Collins Police Services requires officers to complete an annual two-hour training course specifically on mental health. Additionally, about a third of Fort Collins police officers are certified in Crisis Team Intervention, which requires a 40-hour course. 

Co-response and police training programs are steps in the right direction for the Larimer County community in providing much needed behavioral health services before they enter the criminal justice system, said Laurie Stolen, Executive Director of Behavioral Health Services in Larimer County. 

Too much of the behavioral health support in the county is intertwined with the criminal justice system, Stolen said. The community lacks proper behavioral health supports and early interventions, leaving too many people to depend on programs through the courts. 

“Until our community has what it needs, I don’t see them being able to be separated,” Stolen said. In the meantime, “we have this entanglement that we need to work ourselves out of.”    

Behavioral health care comes to your door — with cops 

Fort Collins’ co-responder program began with just Booco in 2018 as a part of Fort Collins Police Services.  In 2019, the co-response program moved under UCHealth’s jurisdiction, and Bower was added to Booco’s team to provide more comprehensive health care on scene at 911 calls, Booco said. 

In January, Fort Collins Police Services established an entire behavioral health unit called the Mental Health Response Team specifically for patrol officers and co-responders to respond to calls relating to mental health or substance use. 

Thanks to a $100,000 grant from Larimer County Behavioral Health Services with a matching contribution from UCHealth, the Mental Health Response Team will expand to start covering the city seven days a week. They’ll also hire another community paramedic and mental health professional, and purchase a new software program called Vitals, which gives them access to an individual’s health information. 

Co-responders provide insight into the gray area of behavioral health calls including “welfare checks,” patrol officer Chris Bland said. Their expertise helps treat people in place instead of transporting them unnecessarily. 

“We have a bucket of things we can do,” Bland said. “We try to choose the right solution out of that bucket.” 

Officers responding to a welfare check will talk with the person to establish if they are a risk to themselves or others, Bland said. If there’s enough proof someone needs immediate support, Bland said officers will take them to the hospital for a mental health hold — either voluntarily or by force, depending on the person and the severity of the situation. 

But with a co-responder’s expertise, Bland said, officers and the co-responder can evaluate the situation to determine the best solution together, which often can be on-scene treatment instead of transporting someone to a hospital. 

Community Paramedic Julie Bower, left, Community Programs Coordinator and co-responder Stephanie Booco, center, and Fort Collins police officer Annie Hill stand alongside their vehicles outside Fort Collins Police Services in Fort Collins. The women are among those working in the new Mental Health Response Team unit, the third version of the Fort Collins co-responder program first launched in July 2018.

Community Paramedic Julie Bower, left, Community Programs Coordinator and co-responder Stephanie Booco, center, and Fort Collins police officer Annie Hill stand alongside their vehicles outside…
Community Paramedic Julie Bower, left, Community Programs Coordinator and co-responder Stephanie Booco, center, and Fort Collins police officer Annie Hill stand alongside their vehicles outside Fort Collins Police Services in Fort Collins. The women are among those working in the new Mental Health Response Team unit, the third version of the Fort Collins co-responder program first launched in July 2018.
Bethany Baker, The Coloradoan

People in crisis are often in a stressed or panicked state that can make them act impulsively. Their reaction is often complicated by medical issues, untreated mental illness or substance use, Booco said. 

“The literature shows that these are some of the most dangerous calls anyone can respond to,” she said. 

Unlike EMTs, Booco and Bower wear protective vests under their uniforms. Booco said sometimes she feels comfortable enough to tell the officers she’s responding with to leave while she helps those at the scene, but she wouldn’t feel comfortable responding to a 911 call without an armed officer. 

More: Pairing therapists with cops in the field works, police say. Why don’t we do it more?

Bland said Fort Collins police already try to divert lower-level calls to SummitStone Behavioral Health Services’ mobile crisis response team, like welfare checks involving people who did not make plans or threats to hurt themselves. 

When police respond to those in mental health crises, it can lead to additional criminal charges when it may not be necessary, Stolen said. Police can take someone to the hospital, to jail, or leave them at the scene. Behavior at the hospital, like assaulting staff, can result in harsher felony charges than if a person’s behavioral health crisis was addressed appropriately. 

The voter-approved regional behavioral health facility will provide law enforcement another option when handling individuals in a behavioral health crisis, Stolen said. “They will now get the appropriate level of care the first time.” The facility is set to open in early 2023.

Stolen said they’ve worked with local law enforcement on the design to make sure it meets their needs, to encourage them to use the facility. They’ve added a dedicated law enforcement entrance and an emergency entrance. Officers will also have a secure lobby where they can transfer custody of individuals to the facility, a lounge where they can complete their notes and their own restroom — all behind a secured area away from patients so they can stay armed. 

Diversion programs can actually mean 'heightened involvement’ with the system 

A pilot adult diversion program aimed to get mental health care to people in jail awaiting court proceedings launched last year. Since June 2020, 23 adults have entered the diversion program and 10 have successfully completed it, said Carrie Bielenberg, 8th Judicial District Attorney’s Office diversion coordinator.  

8th Judicial District Diversion Coordinator Carrie Bielenberg says that 10 of the 23 adults who have entered a pilot program for mental health care have completed the program.

8th Judicial District Diversion Coordinator Carrie Bielenberg says that 10 of the 23 adults who have entered a pilot program for mental health care have completed the program.
Courtesy of Drew Bielenberg

Oftentimes, untreated mental health issues result in minor crimes, like small thefts, and with low bonds given in those cases, people who allegedly commit those crimes are usually able to post bond quickly and be out of jail, Diversion Specialist Necole Hampton said. 

Adults are eligible for the diversion program if they are arrested for low-level crimes without victims and if mental health played a role in committing the crime, Hampton said. If they qualify and complete treatment for at least six months, the district attorney’s office can agree to dismiss their case. 

If someone fails to complete the diversion program, their case will return to court and be prosecuted as it would have been before they went through the diversion program, Bielenberg said. 

The way the current adult diversion program works is far too limiting to have a significant impact in the community, Deputy Public Defender Kathryn Hay said. 

Are you OK?: How to do a mental health check

Limiting who can qualify for the diversion program based on the severity of the accusation leaves a lot of people out who could benefit from treatment, Hay said. Felony assault on a peace officer or EMT charges often stem from an incident involving someone in a mental health crisis but is a charge that makes people ineligible for the diversion program. 

Unfortunately, other tools in the system that attempt to decriminalize mental health and substance abuse issues in Larimer County continue to criminalize behavioral health issues, Hay said. 

Kathryn Hay

Kathryn Hay
Courtesy of Kathryn Hay

The 8th Judicial District’s wellness court and drug court both offer paths to treatment for those who have been arrested for crimes and suffer from behavioral health issues, but a person has to take a plea agreement and plead guilty to a crime to get into these programs, Hay said. 

“It actually is the heightened involvement of the criminal justice system.” 

These courts require a lot from individuals to maintain compliance, like weekly court appearances in front of a judge, alcohol and drug screening and other supervision demands. 

The risk for those who don’t — or can’t – comply with these strict requirements is high, Hay said. After spending months in these programs, those who fail to comply with any part of the requirements could face in-program punishments that can include jail time, which can upset the gains a person was making with keeping a steady job and keeping out of trouble. 

Separating the two 

Health care and law enforcement don’t have to be tied together. More early interventions need to be easily accessible so people who need support have places to go before calling police in crisis. 

Stolen sums it up. “We are utilizing the wrong services in the community to treat mental illness.” 

The community has taken the first steps in establishing the appropriate services, Stolen said, with the creation of the co-responder program and the upcoming construction of a behavioral health facility. 

If the community helps address these issues early — with children, teens and young adults — and shows young people how to manage their own mental health, police intervention won’t be necessary, Stolen said. 

The county’s behavioral health services initiative will consult with experts in the community through their advisory groups to help identify the gaps in care and try to identify those who need support as early as possible. 

The goal, Stolen said, is to “really get to the head waters of this river we have to pull people out from.” 

The team behind Justice in My Town – Future of Police 

REPORTING: Cassandra Dickman (Stockton, Calif.), Danielle Ferguson (Sioux Falls, S.D.), Victoria Freile and Will Cleveland (Rochester, N.Y.), Samantha Ickes (Wooster, Ohio), Ahmed Jallow (Burlington, N.C.), Sean Jones (Petersburg, Va.), Nikie Mayo (Greenville, S.C.), Ayano Nagaishi (Staunton, Va.), Jozsef Papp (Augusta, Ga.), Sady Swanson (Fort Collins, Colo.)

PHOTOGRAPHY AND VIDEOGRAPHY: Bethany Baker (Fort Collins, Colo.), Erin Bormett (Sioux Falls, S.D.), Jamie Germano (Rochester, N.Y.), Michael Holahan (Augusta, Ga.), Ayano Nagaishi (Staunton, Va.), Clifford Oto (Stockton, Calif.), Ken Ruinard (Anderson, S.C.), Michael Schenk (Wooster, Ohio), Andrew West (Fort Myers, Fla.)

CONTENT & STORYTELLING COACH: Jeff Schwaner 

EDITORS: William Ramsey, Jeff Schwaner 

DIGITAL PRODUCTION AND DEVELOPMENT: Spencer Holladay, Jeff Morris, Diane Pantaleo 

SOCIAL MEDIA, ENGAGEMENT AND PROMOTION: Mason Callejas, Jessica Davis, Zach Dennis, Sarah Duenas, Kara Edgerson, Ana Hurler, Sarah Robinson