Lexington shooting revives calls for mental health clinicians on 911 dispatches

Behavioral health experts say the police shooting in Lexington over the weekend reinforces the importance of having mental health professionals respond to some 911 calls.

Almost 20 years ago, the Framingham Police Department adopted one of the state’s first models for dealing with mental health 911 crisis calls by inviting professional behavioral clinicians to join police officers when they respond to the scene. The "co-response" model has gotten support of mental health advocates, police chiefs and clinicians — and it’s gaining traction across Massachusetts. The state has allocated millions in grants for more cities to implement such programs.

The co-response model was again brought to light after a fatal shooting last Saturday. Police shot a 35-year-old Lexington man who they say lunged at an officer with a knife. The Middlesex District Attorney’s office is investigating.

The Massachusetts Association for Mental Health president and CEO Danna Mauch said the incident appears to have been a tragedy for all involved.

“I’m not saying that, you know, a 911 call will never end in this kind of a tragedy, but I think so many of these situations could be avoided if we had earlier access to care for people in distress,” Mauch said.

A 2015 study found that people with behavioral health conditions who are approached by police officers are 16 times more likely than other civilians to be killed by police, pointing to the need for de-escalation in interactions with law enforcement.

Mauch said the co-response model enhances a response and “doesn’t put everything on the police in terms of trying to de-escalate someone.”

Sarah Abbott, an associate professor at William James College in Newton and founder and principal of Abbott Solutions for Justice, said these programs existed long before George Floyd’s death in 2020 ignited calls for police reform. She said the co-response model is well received in areas where people have low incomes, lack access to mental health services, distruct police departments, and where residents are disenfranchised.

“Oftentimes, I don’t think people want to call the police for their mentally ill family member,” Abbott said. “You know, it doesn’t seem like the right call to make, but that’s what happens.”

Kallie Montagano, who works at the Framingham-based community mental health center Advocates, explained that the clinicians respond to every call with officers, and once they’re on the scene officers evaluate if they bring relevant skills to that call.

“We are in the cruisers, in the front seat going to calls — any calls,” said Montagano, who leads a Advocates’ training center on co-response programs. “Ideally mental health calls, obviously substance use calls, but also other calls like a sudden death, or a situation where we have a distraught family member and police are dealing with the scene and we, as clinicians, can step out and kind of assist them.”

That type of program is growing more popular, with the state’s Department of Mental Health tallying 23 communities where co-response programs are now in place. The state started off with $100,000 in grants in 2007, held under the broader umbrella of jail diversion programs, including police trainings and other behavioral health supports. But after years of the project’s growth, inching up its budget each year, the department’s investment has soared since 2017, according to its annual report. The number of grant-funded programs nearly doubled from 32 to 61, and the total investment jumped from just under $1.5 million to more than $5 million in grants disbursed in 2020.

“This is a good trend and it needs to accelerate and continue," said Phillip Kassel, executive director of the Mental Health Legal Advisory Committee, a statewide agency that advocates for people with mental health conditions or people with perceived conditions throughout the Commonwealth.

In 2003, Abbott worked with Framingham’s police chief to form the city’s co-response model. She was the first clinician embedded with law enforcement at the Framingham Police Department, paired with officers to de-escalate situations involving individuals experiencing mental health crises and connect them with supportive resources.

Nearly two decades later, Framingham Chief of Police Lester Baker said the program continues to be a success, and they’re starting to invest more heavily in it.

“It’s great if you have somebody willing to talk to somebody other than a police officer,” Baker said.

His department works with two clinicians to cover day and evening shifts, and they’re in the process of hiring a third so that they can have 24/7 coverage.

Baker said his officers embrace the co-response program and the benefits it brings to his force. The types of calls clinicians respond to could be helping people with hoarding or a compulsive disorder, or someone with “a complete mental health crisis,” he said. Baker sees the clinicians as part of his department.

“They don’t just go to the aftermath, they don’t just hang out in the office, they’re actually in the cruisers,” he said.

Inviting a specialized clinician along with police to respond to crisis calls also means law enforcement, over time, can learn strategies and techniques used by behavioral clinicians with a better and safer outcome.

Before the program was in place, Baker said there were times police would respond to the same person over and over and it could result in an arrest for disorderly conduct. But now, he said, a trained clinician can divert repeat calls by de-escalating a crisis situation and instead bringing the person to a clinic or long-term care facility after establishing a relationship.

Melissa Morabito, an associate professor in the School of Criminology and Justice Studies at UMass Lowell, conducted a 2018 study on the effectiveness of clinicians responding to crisis calls in the Boston Police Department, a program that’s been in place since 2011. Morabito said what they learned, just as Baker said, is the clinicians were able to build a rapport with a person in crisis and follow up later on.

“It was a way to check in on people to see if they were, you know, their health was deteriorating to see if they’d be interested in additional services,” she said.

Cutting down on arrests and hospitalizations saves money for the city, Montagano said, another benefit on top of connecting people with more appropriate services.

Jails and prisons have become the largest mental health facilities in Massachusetts and throughout the country, with up to a third of incarcerated individuals living with a serious mental illness. Kassel argues there are better solutions than locking people up — and it’s a practice that has a disproportionate impact on people of color.

“It tends to be that people of color are most afflicted by that response because of implicit bias in society,” he said.

The co-response programs, Morabito said, expose cracks in the existing behavioral healthcare system.

“The system right now is just overburdened,” Morabito said. “Police don’t always know what kind of situations people are going to be in. ... Prevention is really the answer, and that doesn't involve the police, you know? It doesn’t matter, we could train police officers to be doctors, but if there’s no place to get treatment or healthcare — or housing — it doesn't really matter what the police do at that point.”

Mauch said that the expansion and creation of these programs is an encouraging change.

“It is a very important step in the right direction,” Mauch said. “Everybody believes that, in order to provide those resources to every city and town, there will need to be additional investments.”

Hannah Reale contributed reporting.