HTLA: Episode 46 - What's Going On With LA’s Mental Health Crisis Response System?

Brian De Los Santos  00:00

Just a quick note. There are mentions of suicide in this conversation.

Public Official #1  00:03

[music in] [audio clip] Today we take a big step forward to ensure equity and justice and fairness for every Angeleno by creating the Community Safety Partnership Bureau in the Los Angeles Police Department.

Public Official #2  00:17

[audio clip] In the tragic aftermath of George Floyd's death, city leadership were called to action. The effort is to have a clinician on board when they approach the door.

Public Official #3  00:26

[audio clip] We need reforms. We need to hold police accountable. We need for transparency. We need to begin to look at public safety in our communities a little differently.

Brian De Los Santos  00:38

This is How To LA, the show where we help you navigate some of the city's complicated issues. I'm Brian De Los Santos. In those clips you just heard, those were a bunch of public officials here in LA, promising to reimagine the way the city responds to mental health emergency calls, and to take the police out of these situations. This idea sparked after the murder of George Floyd at the hands of police and the protests that followed, demanding change in how cops deal with the public.

Herb Wesson  01:08

[audio clip] Today is an opportunity for us as a city to make a giant first step.

Brian De Los Santos  01:18

That's councilmember Herb Wesson. He's speaking after the LA City Council voted to develop an unarmed model of crisis response that would divert non- violent mental health calls away from police.

Herb Wesson  01:29

[audio clip] ...putting in place professional, unarmed response dealing with individuals that suffer from mental health challenges.

Brian De Los Santos  01:39

[music out] That was back in October 2020. It's about to be 2023. So where are we at now? [music in] According to the Treatment Advocacy Center, people with untreated mental illness are 16 times more likely to be killed during a police encounter than others. Data from the Los Angeles Police Department show that out of 37 officer shootings of civilians in 2021, more than half involve individuals experiencing a mental health crisis. And that unarmed response unit the City Council voted on more than two years ago? It still doesn't exist. So what's the issue here? [music out] To help us understand, we're here with Robert Garrova, our mental health reporter for LAist.

Brian De Los Santos  02:23

Hey, Robert.

Robert Garrova  02:23

Hey, Brian.

Brian De Los Santos  02:24

So get us caught up. We've been hearing stuff about this for about two years now. And it seems like progress has been slow.

Robert Garrova  02:31

It really feels like a patchwork of efforts right now. Um, with no one response fully meeting the needs of people who are going through a crisis. I think families are still confused on the right place to call. There are unarmed mental health crisis response teams run by the County Department of Mental Health. The Department says, you know, according to their data, they're handling an average of 1700 calls a month. Earlier this year, they launched a different unarmed response called the Therapeutic Transport Van Program. They're having trouble staffing up that. And then I think it's interesting- It kind of comes at the same time that the LAPD earlier this year, said that their mental health teams, which are made up of clinicians and armed officers, only responded to about 1/3 of mental health calls they received between January of this year and this summer. So it's requesting to add more of those teams. But I think what I heard from DMH, the Department of Mental Health, was that they're really gonna be focusing on the unarmed civilian teams, because that's what they've heard from people living in LA.

Brian De Los Santos  03:25

Based on your reporting, what's your take on what we need to do to move forward after these interviews that you had?

Robert Garrova  03:31

You know, you talk with families, and I think maybe 'heartbreaking' is one of the words you would describe it as. One thing that stuck out was just the timeline of how long it takes to get someone, you know, out to your house or wherever it is for help. I heard that over and over again. And you know, if it takes an hour, two, three hours a day to get someone out to where you're having an emergency, doesn't really feel like an emergency response.

Unidentified Speaker  03:52

[music in] No matter how much you ask for the help, getting the help is not something that is guaranteed. You're left scared, out of your wits, going what do I do now?

Robert Garrova  04:05

There's groups looking at how to do this right. There's a group called the Vera Institute of Justice that put out a toolkit for what they call equitable alternatives to police response. You know, it recommends, among many things, hiring a crisis response workforce that looks like the community it serves. It's also critical to pay that emergency workforce fairly. And then there are programs out there I came across that could sort of be a model for how to go forward, some that people talk about a lot when they think about crisis response.

Ben Adam Climer  04:31

We have a model for how to do it. It's just an issue of rolling it out effectively.

Brian De Los Santos  04:34

[music out] That's Ben Adam Climer. He spent five years as a first responder for CAHOOTS out of Eugene, Oregon.

Ben Adam Climer  04:40

CAHOOTS stands for Crisis Assistance Helping Out On The Streets.

Brian De Los Santos  04:43

And now he runs his own crisis response consulting firm to help other cities develop programs based on the CAHOOTS model.

Brian De Los Santos  04:50

Hey, so thank you so much for joining us today in the studio to discuss this really important issue. First off, just tell me about your work with CAHOOTS.

Ben Adam Climer  04:57

I worked for CAHOOTS for five years. I started there as a crisis counselor, and then got my EMT license while working there and became uh, an EMT for them as well. And I helped develop their first training committee because we had grown exponentially over the last five years since the time that I joined. I responded to over 10,000 calls for service. At CAHOOTS, we have badge numbers. I actually have it tattooed on my chest. That's how much I love that uh, [t-]. It's uh, my favorite job ever.

Brian De Los Santos  05:25

And can you just give us a little bit of a flavor of how your day-to-day looked like when you're responding to these calls, what you confronted, you know?

Ben Adam Climer  05:32

So our goal is to de-escalate them from where they can't think about how to solve their crisis, to help them calm down emotionally, feel better, and then start to think a little more clearly about how they can sort of deal with what's going on. You put on your gear, you have your radio, you check your med bag and your AED, and you check your vehicle to make sure you have all the supplies you need. And then you put yourself in service over the radio. Right away, you're just taking calls. They prioritize them, so based on on things like suicidality, severe mental health issues, somebody's having psychotic issues, or something like that, all the way down to just checking on somebody who is sleeping in the park to somebody who just needs a ride to a social service.

Brian De Los Santos  06:14

Now I understand that you have your own consulting business here in Los Angeles. What do you do now?

Ben Adam Climer  06:18

I've helped different cities throughout the state of California develop teams based on the CAHOOTS model. So right now, the cities that we've launched in include Huntington Beach, Garden Grove, and Anaheim, and then a couple cities in Sonoma County. Petaluma is kind of my shining beacon. They were the first to launch and they've done an amazing job. Rohnert Park and Cotati as well. We're about to launch in San Rafael and Marin County. We just launched most recently at the UC Santa Cruz, which is exciting because it's the first ever college campus to have a CAHOOTS model team responding to calls for service.

Brian De Los Santos  06:53

And tell me a bit more about the de-escalation process. Can you describe what that means, like in practice in the field?

Ben Adam Climer  06:59

My primary way of doing de-escalation is we start with emotional validation. Hey, it makes sense that you're feeling really overwhelmed. Then we work on building a little bit of a history. Once they're feeling a little more calm, then we start working on Okay, what kinds of things can we do today that would make you feel a little bit better? What kinds of things can we help you with that will help you get access to resources that you need. And if we can't come up with anything like that, then you know, we at least sort of help them feel a little bit better and walk away knowing that they felt a little bit better.

Brian De Los Santos  06:59

It seems like you're launching and helping these efforts across cities in California. What is working and what isn't?

Ben Adam Climer  07:16

The teams that adhere closely to the CAHOOTS model have been showing to be very effective, particularly in Petaluma. In their first year and a half, they've done 4500 calls for service. That's a city of 60,000 people. They're doing the same way that the CAHOOTS team does, where they're getting dispatched by the police dispatchers. All the calls for service come through the non- emergency and 911 system. So they're very much like another first response part of that ecosystem. And then our UC Santa Cruz team, we sort of expected their call volume to be quite a bit lower, because it's obviously much smaller community. You know, we've barely rolled out. They're only operating like four days a week, 10 hours a day right now. And they're already taking two to three calls a day.

Brian De Los Santos  08:27

Can you describe a little bit of how these response teams are working with emergency personnel, whether it's firefighters or police officers?

Ben Adam Climer  08:34

Sometimes calls come in, and based on what's being said over the phone, they think that this is some sort of criminal issue. The police show up and they realize like, Oh, this is just somebody having a bad day. Then they'll call the team out, and the team will come out and talk to that person, help them calm down, and all that kind of stuff. Sometimes with fire departments or emergency medical services, they might show up thinking that it's a medical emergency, and then they realize, Oh no, this is more like anxiety or panic attack or something like that, and then they can hand off to our team. And then when there's like a major issue, right, like a suicidal person with a firearm and there's somebody hurt at the scene or something like that, then you just get all three services. You get EMS, you get our team, and you get police as well.

Brian De Los Santos  09:18

I want to turn over to Robert. As we've discussed, LA has not really yet fully delivered on the promises of a mental health response system. What's been the biggest challenges to this, like staffing, is it finances, budgets?

Robert Garrova  09:32

I think it's a lot of that. A big part of the slowness I feel like it's because of the bureaucratic process. Stuff's just trudging its way through the LA City Council right now for that particular effort. And that's not the only effort. It's a new endeavor for cities too. You're basically building a new workforce in some respects and then I think staffing is still a huge issue. The LA County Department of Mental Health had a report in October that said almost 30% of of the positions department wide were vacant. Part of the issue is that they have a hard time keeping those jobs staffed because people will want to move into telehealth work, something else, and not do this crisis work that not everyone is, you know, maybe cut out for.

Ben Adam Climer  10:08

From my perspective, a licensed clinical social worker or a licensed marriage and family therapist, they've got to do four years of bachelor's degree, two to three years of graduate school, and then another two to three years of internship to get to that point. And so they're looking at anywhere from eight to ten years of of training and study to get to a point where quite frankly, they want to work in an office, and they want to work nine to five, and they want to do that kind of stuff, where they're helping people you know, transform their lives through the process of good quality therapy. And it's very hard to get those folks to want to go out and drive around at 2 AM on a Friday night and wake up homeless people and talk to suicidal teenagers and stuff. I, on the other hand, who didn't do all that training and love driving around at two o'clock at night on Friday, and most people sign up to be EMTs to do just that, because they want to do on the street, you know, maybe a little bit risky kind of business. And so the development of CAHOOTS style teams, it taps into that desire to do that kind of work.

Brian De Los Santos  11:10

Robert, you've been reporting on mental health in our city for a while. You talk to city officials all the time. What's your take? Where do we go from here?

Robert Garrova  11:18

You know, while it's true LA hasn't launched its, you know, promised unarmed effort yet, the city has selected a couple of contractors to work on that moving forward. So a lot of this will keep lumbering along and we're continuing to see a patchwork like I was saying earlier, from from San Gabriel Valley to Huntington Beach, where unarmed responses are either launching or they're talking about pilots. So people thinking about this and working on it. And then I think there's this interesting grassroots effort to teach people about, you know, things like de-escalation and um, other alternatives to calling the police. And it'll be interesting to see, you know, how those [music in] grassroots efforts might evolve into into something larger.

Brian De Los Santos  11:49

And Ben Adam, if you could leave our listeners with one idea, what's needed most now for cities or areas like this to roll out?

Ben Adam Climer  12:03

The most important thing to me about mobile crisis response is the idea that so many people live their lives, where there are days where they feel like there's no one to support them, that there's no one who cares. And right now, as a society, we do not have a system set up where if you're having that kind of a day, where you just don't know where to turn, and you don't know who to go to for support, we don't have a way to give that person what they need. We don't have a system designed to get someone to that person to listen to them, to hear them, to support them and say, Hey, you're important, you matter. Your life is important, and it matters. And it makes sense that you're feeling so overwhelmed. And I think we need that system. I think we need to have a set up system where if you feel overwhelmed, you know that somebody can come and listen to you.

Brian De Los Santos  13:03

All right, y'all. Thank you so much for joining me in the studio today.

Ben Adam Climer  13:06

Yeah. Thank you. Appreciate it.

Robert Garrova  13:07

Thanks, Brian.

Brian De Los Santos  13:10

That was Ben Adam Climer of CRISIS Consulting, and Robert Garrova, our mental health reporter. That's all we have for you today. Adios. Support for this podcast is made possible by Gordon and Dona Crawford, who believe that quality journalism makes Los Angeles a better place to live. [music out]