“Trump, $1.50, I’m in Fort Collins and it’s the 23rd,” the woman said as Fort Collins Police Services’ mental health co-response team approached her in the Poudre River.
It was at least the fourth time officers had paid her a visit that week. The woman, wise to their routine, was answering their coherency-testing questions before they could even ask them.
She was in the water, fully clothed, practicing her backstroke as she clutched a throwing knife.
After a lengthy conversation with co-responder Stephanie Booco and community paramedic Julie Bower, the team was able to get the woman to the hospital for treatment. She wasn’t arrested or ticketed — although that might’ve been the outcome before the days of Fort Collins’ co-response program, which dispatches UCHealth employees Booco, a licensed therapist, and Bower, a specialized paramedic, to calls where mental health or substance abuse issues are driving volatile behavior.
“A lot of times, people look at police and say, ‘You guys need to do something,’ but they don’t realize that police’s hands are oftentimes tied,” said Booco, who’s been Fort Collins’ police co-responder since July 2018. “Police have three options: A (mental health) hold, walk away, or charge them with a crime. Really none of those are ideal, because a cop shouldn’t be interfacing with that person to begin with. It’s actually a heath care problem, not a police matter.”
Anyone you ask at the department will call the co-responder program an unqualified success at connecting people to resources, preventing unnecessary trips to the jail and emergency room, and quelling repeated 911 calls from a small group of community members known as “high utilizers.” Same goes for similar programs at Larimer County Sheriff’s Office and Loveland Police Department.
The only problem when it comes to law enforcement co-response, officers and deputies say, is that the region needs more of it.
Especially in light of the COVID-19 outbreak, which has driven mental health flare-ups resulting from financial strain, cabin fever, isolation, disconnections between patients and providers, and the ever-looming anxiety of leading one’s life amid a global pandemic, where each new day seems to bring something new to worry about.
For Fort Collins police, the number of mental health-related calls during March and April 2020 was more-than quadruple the volume during that time last year.
The coronavirus fallout has only exacerbated an existing crisis, Fort Collins police psychologist Dan Dworkin said. He described a far-reaching dysfunction that involves many failures, from the defunding of mental health services to the opioid crisis to Colorado’s unusually high suicide rate.
A Mental Health America report using survey data from 2016 and 2017 report found that in Colorado:
- 9% of those surveyed had experienced a substance abuse disorder within the previous year, higher than 42 U.S. states.
- 20% of adults reported experiencing mental illness within the previous year.
- 49% of adults with a mental illness didn’t receive any treatment.
- 5.4% of adults surveyed had serious thoughts about suicide within the previous year, a higher rate than every state except Idaho and Utah.
Colorado has one of the highest suicide rates in the country and only 10 public psychiatric beds per 100,000 people, far below the standard of 50 beds per 100,000 people recommended by the Treatment Advocacy Center. The center calculates a 4-to-1 risk of incarceration versus treatment for a Coloradan dealing with severe mental illness.
The statewide shortcomings inspired the recent voter-approved passage of a mental and behavioral health tax in Larimer County, which will fund the creation of a 64-bed behavioral health facility and increased support for mental and behavioral health services. The facility is expected to open in 2022.
Co-response can’t fully address law enforcement’s mental-health-related challenges, officials said. But they see it as an integral piece of the solution.
“All these systems in people’s lives, they’ve let them down in some way,” Special Operations Lt. Dan Murphy said. “And then they get to a breaking point, and some cop is supposed to show up on the river bank with a woman throwing a knife and figure it out in what, 10 minutes? And do it perfectly, and don’t use too much force, and say all the right things at the right time. It’s not an easy task.”
Co-response, he said, makes it easier.
Larimer agencies buy in to co-response
It took Dworkin some convincing to get Fort Collins police leaders on board with the idea of co-response. Some feared the liability of placing a non-officer in police scenes, or they were wary of the seemingly “unnatural” notion of a social worker tagging along with a cop, Dworkin said.
But the facts were on his side: Mirroring a nationwide trend, Fort Collins police have dealt with a climbing volume of mental health-related calls throughout Dworkin’s 20-year tenure with the department. With time and, crucially, the emergence of SummitStone Health Partners and UCHealth as initial funding and operational partners, the co-response program gained traction and regional interest.
Fort Collins launched its program with therapist Booco as the sole co-responder in summer 2018. The sheriff’s department started its program in early 2019 with one SummitStone therapist paired with Deputy Cheryl Jacobs, and Loveland launched its own co-response program with SummitStone in 2016.
Co-response makes sense because trained therapists have different strengths and skill sets than police officers, Dworkin said.
“We pick up more subtle cues of what’s going on,” Dworkin said, and because mental health professionals are better versed in navigating the regional web of resources, “the range of options for response becomes broader.”
The sheriff’s department and Fort Collins programs have since grown.
Fort Collins added Bower to the program this year as it shifted from being embedded within the police department to operating under UCHealth, which is working to hire a second co-responder and community paramedic. Bower and Booco work Mondays through Thursdays, and a second therapist will allow the department to be outfitted with at least one co-response team seven days a week.
The sheriff’s office worked with SummitStone to hire a second therapist and tasked a second deputy to its co-response program last year, providing 10-hour-a-day, 7-day-a-week coverage for all of the county outside of Fort Collins and Loveland. The department is working to secure grant funding to hire a third co-responder.
The Loveland Police Department’s co-response team is now made up of two SummitStone mental health professionals.
Booco and Bower work as a team, meeting police, fire department and EMS teams on-scene to assist. Some of the most common calls they respond to are suicidal threats, ideation or attempts; welfare checks; and people who are going through a mental health crisis. They also follow up with people they’ve previously contacted and take referrals from first responders and health care providers who come across people who need help connecting to services.
High-utilizers get help
And then there are the high utilizers — people who call 911 four times or more in a 90-day period. Booco estimates that group includes roughly 50 to 80 people in Fort Collins, and she and Bower focus on the top 25 each month to keep their caseload manageable.
The sheriff’s department co-response team estimates that responding to high utilizers accounts for about 20% of their calls.
The typical high utilizer in Fort Collins is 52 years old and calls 911 about 16 times a month. About 72% are men, 60% of the group abuses drugs or alcohol, and about 60% are homeless.
One high utilizer in Fort Collins is an alcoholic who frequently calls 911 saying he has a stomachache. In reality, Bower said, he typically calls because his throat hurts from drinking something like cooking sherry or nail polish remover. If he gets “riled up” during a call, up to a dozen emergency responders could end up lingering on-scene, she added, tying up emergency resources.
“They don’t realize what an emergency is,” Booco said. “For some people who are traumatized, their ability to differentiate emergency from non-emergency just doesn’t work. They just know, ‘I’m either comfortable or uncomfortable.’”
A key part of Booco and Bower’s job is pre-empting calls from people in the high-utilizer group. They spend their mornings driving around areas where the high utilizers tend to hang out and checking in with them, reminding them to drink water, call their case manager, take their medications and not call 911 for nonemergencies.
The high utilizer group shines light on the overlapping challenges that often contribute to a police situation: Some combination of drug and alcohol abuse, homelessness and mental health can create the perfect storm, police said. The result can be a revolving door effect, where the same people are booked in and out of the jail or emergency room without receiving substantive care or intervention. The experience of being in the emergency room or jail can also lead to further trauma and stressful bills, co-responders said.
Murphy recalled officers’ former frustration of being “handcuffed” to a limited array of unproductive options when faced with a person going through a mental health crisis.
“We’d bring someone (to the ER) for a mental health hold, and they’d sit down with a therapist, who’d ask, ‘Are you going to kill yourself?’ They’d say, ‘No,’ and then it’s, ‘OK, here’s your appointment for 2 p.m. next Tuesday.’ And then they’d walk out the door before the cop would get there with the paperwork. And then they’d go back out and cause the next call.”
Co-responders are more likely to work with people to create home safety plans so they don’t need to go to the hospital unless absolutely necessary, Booco said.
It’s equally important for co-response teams to use discretion when dealing with petty crimes, said Sgt. Robert Cooke, who oversees the sheriff’s department co-responder program.
“Maybe a person shoplifted a pound of ground beef from the store, but the real issue is their mental health is suffering,” Cooke said. “What’s the better way to deal with that person and give them the help they need? Taking them to jail and booking them into custody on a theft isn’t really going to help their mental health.”
What therapists, paramedics bring
Co-responders can “be the bridge” between law enforcement and mental and behavioral health resources, said Melissa Bauman, SummitStone’s co-responder program supervisor.
For Bower and Booco, that sometimes means literally acting as the go-between for service providers and people who are struggling with addiction but resistant to getting help. Working with people who struggle with addiction is personal for Bower, whose son is a recovering heroin addict. She put him through rehab three times and helped him through the court system countless times before he recovered.
“I watched him circle the drain,” she said. “His addiction ran my life. But that experience with my child, with his mental health issues and drug use, it really touched me. I understand (addicts). … Sometimes you have to get through the rough edges and the outer shell, but there’s a human in there somewhere, and that’s somebody’s mother, daughter, son. Just like my son.”
Bower’s role as a specialized paramedic is regionally unique — she’s essentially “the doctor’s eyes in the house,” she said. Community paramedics have more training in social work-related skills and focus on chronic conditions and preventive care. Bower medically evaluates people and helps them sort out medications and other health care needs.
Recently, she and Booco helped a man in his 80s from Greeley who was homeless because he’d been charged with domestic violence, which triggers a restraining order. He was turned away from the homeless shelter there because of his charges and dropped off in Fort Collins with no ID, clothes, phone or medicine. Bower was able to connect with his doctor and get orders for his necessary medications, including insulin, at a Fort Collins pharmacy, and secure payment from Homeward Alliance. She checked on him daily until service providers were able to get him a hotel room after the temporary homeless shelter at the Northside Aztlan Community Center closed in June.
Bower’s work is a more personal type of care than traditional paramedicine, which she practiced for over 25 years. Now she knows the family histories, personalities and likes and dislikes of the people she cares for. She knows what they look and act like on a good day versus a bad day.
The deeply personal and distressing nature of the work is part of what makes co-response such a hard job, Booco said.
“When we go to training to be a therapist, or at least when I did, it was like, ‘OK, I’m going to sit and talk with people all day long in a comfy office in my cute clothes, drinking my tea, and it’s going to be totally relaxed and easy,’ ” she said. “This is the antithesis of that.”
She and Bower wear heavy ballistic vests as they head to uncomfortable, ever-changing police scenes. Officers clear the scene and make sure it’s safe before they come in, but “things change on a dime,” Booco said.
She recalled one recent scene that was supposed to be a cold call — until she heard feet stomping up the stairs and a man burst through the door, pulling up his shirt to reveal what first appeared to be a gun but turned out to be a knife. In the moment, Booco feared someone was going to get shot.
She recounted holding an infant in her arms for two hours while waiting for social services to arrive after a woman got wound up and chucked a remote across the room.
She talked to a man whose beloved wife was struggling with dementia and had just dropped a 12-pack of Pepsi on his head because she “couldn’t stand him.”
She walked over broken glass and plastic a week before Christmas after a kid grabbed all the ornaments off a tree and crushed them against the wall before their parent had to tackle them and call the police.
“It takes somebody with thick skin that doesn’t scare very easily, is willing to be uncomfortable and maybe, to some extent, cares more about other people than they do themselves in an effort to get them the care they need,” Booco said. “Because sometimes, people need that.”
The co-responder role is so unique that Jacobs, the sheriff’s deputy, refers to those best-suited for the job as “unicorns.”
Libby Nelson, one of the SummitStone co-responders who works with the sheriff’s office, said the job is a good fit for her because she has a military background and is used to assessing and mitigating risks. Jacobs, who has been a police officer and sheriff’s deputy for over 20 years, said mental and behavioral health has always been a passion of hers and she had encouraged her superiors to bring a co-responder program to the sheriff’s office for years.
“I’ve done my bit of chasing bad guys, and nobody asks to be born with a mental illness,” Jacobs said. “To be able to help somebody through that is definitely a calling.”
Co-response and ‘defund the police’? They are similar with key difference
The demands of the job, paired with the rigorous background check required to work with Fort Collins police, has made for a long and so-far fruitless search for Fort Collins’ second co-responder, Fort Collins Police Chief Jeff Swoboda said.
But he’s confident the department and UCHealth will find the right person, and he wants to secure funding for more co-responders. His vision is 24/7 coverage and, eventually, having several co-responder teams on duty at the same time. He also hopes to have trained mental health professionals staffing the emergency dispatch center and talking on the phone with people in crisis.
The calls that would benefit from co-response far outweigh the program’s resources, Booco said.
“If somebody’s calling 911, in their mind, they have exhausted every other resource and it is beyond their ability to manage it themselves,” she said. “De facto, it’s a crisis. And when somebody’s in crisis, they’re not going to be thinking straight, they don’t have the resources they need, it’s beyond their ability to tolerate that level of distress. Who wouldn’t need support in that moment?”
Swoboda noted that co-response bears similarities to an idea that has gained traction during the “Defund the Police” movement and growing calls for police reform and reconstruction since the death of George Floyd at the hands of Minneapolis police officers: Why not replace some cops with social workers, trained in responding to crisis and geared by nature toward conciliation?
The main difference between the idea and the practice is that co-response isn’t a zero-sum game, Swoboda said. It’s about social workers and officers, not social workers instead of officers.
“If you get a call with a man who has a gun under his chin, a social worker isn’t going to knock on the door and go in and talk with that person alone,” Swoboda said. “People who are contemplating suicide, even if they’re not armed, are in crisis. They’re not thinking clearly, potentially. To just send out a person who doesn’t have the means to protect themselves is not even a viable option. It sounds great to say, ‘Cops don’t need to be there during those calls,’ but cops do need to be there to keep the social workers safe while they’re doing their jobs.”
Mental health and police funding are part of a complex problem that calls for a complex solution, Dworkin said. Put simply: “It’s going to take more money” for not just co-response, but also mental and behavioral health resources like mid- and long-term care, case management, medication, counseling and substance abuse treatment, he said.
“You can’t just rob Peter to pay Paul,” Dworkin said. “It’s a very simplistic mindset, and it lets the community off the hook. You have to fund law enforcement and also mental health.”
Jacy Marmaduke covers government accountability for the Coloradoan. Follow her on Twitter @jacymarmaduke. Support stories like this one by purchasing a digital subscription to the Coloradoan.