In 2018, the Lincoln Police Department received more than 3,300 mental health calls for service, or just over 60 calls per week that involved a person in crisis.
Here in Nebraska’s capital city, a small group of mental health consumers generate a disproportionate number of these calls for service. About 5% of the individuals who need our attention during a mental health crisis account for 25% of all of our mental health calls for service.
In 2018, 15 of those calls for service came from “Mr. B.” While Mr. B contacted law enforcement 15 times last year, he had been contacting our department considerably more often in prior years. In fact, between 2015 and 2017, Mr. B called the Lincoln Police Department on average 36 times per year. More recently, though, our officers have been hearing from Mr. B less and less. As of July 2019, Mr. B has not called the police department once this year for a mental health crisis.
Inquiring minds of both police and policymakers want to know: Why? Why has Mr. B not generated a single mental health call for service in 2019 after calling us more than 30 times a year for three straight years?
Mr. B is a participant in the R.E.A.L. Program, a post-crisis assistance program made possible by our partnership with our local chapter of the Mental Health Association of Nebraska.
Through the R.E.A.L. Program, which stands for Respond, Empower, Advocate, and Listen, officers can refer individuals to the Mental Health Association and its team of peer specialists. The peer specialists live with anxiety, depression, PTSD, and other mental health illnesses, which gives them considerable credibility when contacting those individuals who have just interacted with one of our officers during a mental health crisis.
Following a referral to the program, a peer specialist will contact the individual within 24 to 48 hours to try and identify the cause of their mental health crisis and develop long-term solutions — such as connecting them with available resources in the community. This contact from a peer specialist is free and nonclinical, and participation in the program is voluntary.
The first referral to the R.E.A.L. Program came in 2011, but our agency’s dedication to supporting individuals living with a mental illness in our community dates back about 20 to 30 years. Over the years, in working with the Mental Health Association, our officers have been trained in de-escalation tactics, trained to better understand what it’s like to live with a mental illness, and taught that arrest and detention are not always the best option for someone in a mental health crisis.
But we also needed a way to support people after the call for service ended because these individuals are still living with a mental illness and typically not connected to the necessary resources.
That’s where the R.E.A.L. Program comes in, and we’ve found it to be a very impactful solution.
Studying the Data
The Lincoln Police Department serves a community of about 285,000 with 350 law enforcement officers. Like many agencies across the country and the world, we want to know what programs work and why. Every agency’s budget is tight, so we need to make the most of our people and resources.
To better understand the impact of the R.E.A.L. Program, we pulled data from between 2011 and 2013, developed a dataset of 775 people, and followed these individuals for three years. The group we evaluated included more females than males (52%), was mostly white (85%), and had an average age of about 36. The most prevalent mental health conditions were depression (27%) and bipolar disorder (14%).
Specifically, we looked at three outcomes – arrests, mental health calls for service, and being taken into emergency protective custody. We examined these outcomes at one, two, and three years after the person was referred.
After one year, we didn’t find any differences in terms of arrest, mental health calls for service, or even protective custody. But at the 24-month period, we started to notice a change.
Between 24 and 36 months, participants referred to the R.E.A.L. Program generated fewer mental health calls for service and were less likely to be taken into emergency protective custody. We still found no difference in the arrest rates at two or three years after referral.
Our research also showed that the R.E.A.L. Program was particularly beneficial to those with longer histories of generating calls for service.
Developing Long-Term Solutions
These findings tell us that it can take between 18 and 24 months for a mental health referral program to benefit participants. This is consistent with anecdotal data, especially stories we hear from peer specialists in the field—it can take a long time for a person to develop a stable mental health plan.
A stable, well-rounded plan may involve not only multiple visits to a doctor or therapist and new medications (or altering the dosages of existing prescriptions), but also finding a place to live, steady employment, and a social support system. Sometimes, issues involving basic necessities can precipitate a mental health crisis. All of these issues take time to resolve—not just months, but years.
As police officers, our goals are the same as mental health advocates: to help individuals develop long-term solutions to improve their quality of life and reduce future encounters with police. When responding to a mental health call for service, officers can’t simply arrive on the scene, take a report, and leave. Instead, we must attempt to identify the root causes of the crisis and initiate the first step towards a long-term solution. Often, this first step is a referral to the REAL program.
We’ve seen a huge buy-in from our command staff and line level officers here at LPD. They have fully embraced the program and its mission. About 99% of our patrol cops have made a referral at one time over the last several years, so it’s not just a small fraction of the officers using it. We were able to initiate the program with some local grant funding, but it is now partially built into the police department budget. The remaining funds continue to come from a grant through the Lincoln Community Health Endowment, although the program is seeking sustainable funding moving forward.
There’s also tremendous buy-in from the Mental Health Association because our referrals help them identify and connect with people in need of mental health resources. When our officers come across individuals in crisis, that contact is hopefully the doorway to peer support, mental resources, and an improved quality of life.
We believe in each other and we believe in the program, and that’s the root the program’s success.
Lincoln’s population is always growing, so we expect the number of mental health calls for service to grow a little bit each year. Despite the continued increase in mental health calls for service, the rate at which we take people into protective custody has remained steady, which shows we’re connecting community members to appropriate resources before, during, and after police contact.
Pending funding, the R.E.A.L. Program may expand its core of three peer specialists to reach a greater percentage of the population.
In terms of further evaluation, our next goal is to look at emergency room usage by mental health consumers. We’d like to know if participation in the R.E.A.L. Program affects emergency room usage and whether or not participants go to the emergency room less often. Additionally, we may use focus groups to see if the program affects the perceptions of police officers by mental health consumers.
We understand that for a variety of reasons, people call the police when someone is experiencing a mental health crisis. This can be a frightening time, so the police are understandably the default option for the public. Through our partnership with the Mental Health Association, we’re able to better support some of the most vulnerable members of our community.
About Notes From the Field
The National Institute of Justice (NIJ) is the research, development, and evaluation arm of the U.S. Department of Justice. NIJ aims to address the critical questions of the criminal justice field, particularly at the state and local levels.
NIJ Director David Muhlhausen developed the Notes From the Field series to allow leading voices in the field to share their strategies for responding to the most pressing issues on America’s streets today.
Notes From the Field is not a research-based publication. Instead, it presents lessons learned by on-the-ground criminal justice leaders, from years of experience and thinking deeply about criminal justice issues.