Using a Social Work Approach in Community Policing

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In this second episode, Harold Pollack, the Crown Family School's Helen Ross Professor and Thomas J. Dart, Cook County, (IL) Sheriff discuss what Sheriff Dart has learned about policing and mental and behavioral health, the co-responder model, and how he has enhanced the co-responder model to combine the use of tablets with Crisis Intervention Training. They also talk about how social work and policing can learn from one another to help keep everyone in the community safe. Music by Augusta Read Thomas, UChicago University Professor of Composition in the Department of Music and the College.

We'd like to thank Augusta Read Thomas, University Professor of Composition in the Department of Music and the College, who composed the music.

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Transcript

Harold: Sheriff Dart, thank you so much for joining us here at Crown for our podcast. We've known each other for a while, and it's just a great opportunity to have a conversation about the challenges of mental and behavioral health issues that you and I confront every day in different realms. How much of your day involves people with some kind of mental health issue as Cook County Sheriff and running the jail here?

Tom: I'd say it's easily...it's easily half of my day. The reason I say it's only half is because the office itself, we have about 6,000 employees, and so a lot of what I also have to focus on are personnel issues throughout the course of a day, too. But as far as once you separate out the personnel issues, I'd say well over half of my time deals with mental health related issues, whether dealing with it in the jail, and all the different issues involved with that, or it's on the street in dealing with it through either my police department, my evictions unit, you name it. It's just ever present.

Harold: Yeah, it cert—it's probably the most hot button issue in criminal justice right now, and what is it like to be running a police organization that's trying to help people who might experience a mental health crisis, a behavioral health crisis when you turn on the nightly news and there's a cell phone video of a 911 call that went south or something like that, or just in a very angry and polarized time? It must be just a huge challenge for the morale and wellbeing of the law enforcement officers to be in this environment right now.

Tom: Yeah, it is, Harold, and that's why I honestly feel not just for me, but for everybody involved with it, it's incumbent upon us to be not reactionary, not sitting there saying okay, now that this sad event occurred, you know, let's pick it apart and see, no, but say listen, we've had enough bad events.

And some of the stuff, too, Harold, that's the thing that drives me crazy, is that law enforcement has a wildly difficult job. If you talk to virtually any police officer you've ever met, not one of them would ever say, if you would ask them what was it that got them to law enforcement, not one of them, I think, would ever respond because I wanted to deal with mental health issues, that's my passion. No. Anybody who that's their passion has gone into a social work type of field or something along those lines. And so for law enforcement, they're being asked to work in a field that they specifically don't want to be engaged with.

And so from my standpoint then it's like okay, I understand that. I understand that really well. So what are the things that we can do to either make it so that it's not law enforcement interacting, or if they do it's law enforcement that's trained to deal with the realities of the world as opposed to this sort of idealistic world that does not exist.

Harold: A couple things come to mind with your last comment. One is it is striking to me when I talk to officers who volunteer for CIT training, or various kinds of mental health specific things, it is striking how many of these officer, first of all, how many are women, and second how many have someone in their life who has a mental health challenge that maybe—or maybe they're a veteran and they have friends and colleagues who experienced PTSD related to combat or military experiences, or they have a sibling with a challenge. It is... You're right, people don't go into law enforcement to become mental health workers, but a lot of people in law enforcement, it has touched their lives in an important way. And when we—I don't know if you've observed that as well.

Tom: Oh, absolutely I have. And it's been heartening in the sense that once again, whether dealing with it on the street or dealing with it in the jail, so much of the hurdles are ones that society has put up because of the stigma surrounding mental illness. And so the fact that now there seems to be an openness, not just to talk about the issue as a whole, but to say listen, it's impacting me, my family, it opens up so many different avenues now to approach it.

And so from our officers' standpoint, and to your point, it's easier then when you're talking about crisis intervention training to present it to people who understand what you're talking about, and understand how impactful that can be, not because they have this job that requires them to do it, but because they have a nephew, or they have an uncle who suffers with mental health issues, and they now have been given tools to deal with it.

So it's been very helpful. But once again, it's something that I—I find myself, because you and I have talked about this before—I come at this job from a very different place. I am a history major who became a lawyer, and my tortured path has ended me up here. And I love what I do, but it just has me always sort of looking at things in a historical context, and what are the things that got us to where we're at, and what are things that have been tried, or not tried, or why is it this way.

And by asking those questions, it really is helpful because then you're presented with better ideas of what is practical that can be helpful to people as opposed to something that is more idealistic. And I'm as idealistic as they come, I really am. In spite of my career choices I still have maintained a great deal of idealism.

But inherent in this is that to address this issue you have to have this historical perspective about how we got here and why is it then that in a allegedly thoughtful society we are asking people who don't want to do a job, who aren't trained to do a job, to do that job. We don't do that anywhere else.

We don't literally grab people from a restaurant and throw them in an emergency room and say you're a nurse today. Like, what? Yeah, yeah, you're a nurse. No, no, no, no, I work in a restaurant. I'm very happy in the restaurant. I'm trained to do that. That's where my passion is. No, no, no. You're gonna be a nurse today. It's a heart surgery, you're gonna nail it. It'll be fun. You'll get through it, no problem. Nobody else does this.

So for us, I mean, certain things are obvious, Harold, like give people CIT training so they have crisis intervention training. Give someone a tool box of how you can de-escalate, how you can understand what an issue is. But then we have to go way, way beyond that. And when I say that, though, mind you I'd say in the 90 percentile of law enforcement they don't even have CIT training.

So we've been past CIT training in my office five years ago, six years ago, light years past it. Now you're sitting there saying okay, now we've got that nailed down, how is that we can get the right people out at the door. And that's been my struggle for the last year. And I'm not suggesting I have all the answers. I do not. But I do think we can come up with something wildly innovative to address this issue.

Harold: So I want to get to that. What are some things that you consider to be innovative in these efforts?

Tom: Well, on the street with my police department it started off as more of like a street intervention program, where we were mostly focused on opioid overdoses, but as you and I both know, they co-occur so often with the mental health universe as well that I was really hitting two things at once there. But with the street unit I put out there, it was primarily civilians—mental health professionals, substance abuse professionals—that were out on the street that would respond to overdoses, to work with the family of the person who survived the overdose, to get them into treatment and all these other things, too.

You have this really sort of crystallizing moment. And it's been very, very impactful. We've gotten people into treatment programs, and they've consistently stayed there who historically have not done that because we respond, we're immediate, and we're working with the family on this tragedy. The unit then worked into like all right, let's start intervening on the street. People clearly are having substance abuse issues on the street. Let's see if we can get them in a program. We've had luck with that.

That morphed into what we've been doing now, which is this co-responder plan, I've been doing this now 15 years. I'm not a guy whose press conference is saying we're the greatest, we've solved the world's problems. It's not my shtick.

This is really game-changing what we're doing here. And what this is, is that this very problem you and I talk about, where you're sending the wrong person to the door, and all the things that can go south on you there that we've seen all so often. We've had people that have been vexed by how can we do it.

And in some jurisdictions they've had the luxury of a very small, confined jurisdiction and have resources, so they put together basically triage teams, where they'll have a mental health provider and a EMT specialist in basically an ambulance that will respond to calls where it's a mental health call. They've had the luxury to do that because their areas are so small and they have resources.

Well, areas like Chicago, Cook County, and I'd suggest to you most jurisdictions, it's just not an option because it's not scalable. I mean, just the cost would be astronomical to do that. Because it's not as if you would necessarily trade a police position for this. No, it doesn't work that way.

You would have to hire all these different people, train all these people, buy all the ambulances. And so I looked at those models. I thought they were very noble what they were doing, and it worked in their jurisdictions. It could not work in a place like ours.

So what we did is we took what our street units were doing, which was they were utilizing tablets to work with people on the street, and took this now into the cars. And so what we have been doing for about a year is our police officers are trained in how to use tablets, and that part's not real hard, but with their CIT training, they're trained in knowing when to use it on mental health calls, and the majority of our calls are mental health related. I mean, that's the primary reason we're called there.

And so when we get there, barring it being too volatile or barring the individual's already in the ambulance, our officers know how to dial up a mental health professional on the tablet, and they'll hand it off either to the family member of someone who's in crisis or to the individual in crisis, and then the professional is on the screen talking them through everything.

Harold: There's a couple things that come to mind as you're describing that. One is the necessity—understanding both the necessity and the limitations of improving the first response.

I mean, things like CIT and having the officer with that iPad and, you know, it's time and—the basic principles of CIT, for our listeners, are time and distance are kind of the two basic principles, that someone is behaviorally dysregulated, you keep your physical distance, you don't put your hands on that person and escalate, and also you just, you know, if you can take time, a lot of times people will calm down on their own, or you can get other kinds of help. Maybe it's the person's mom, maybe it's other officers or other kinds of help that you can get.

And there's been a huge amount of attention on managing that call. We don't want anybody to get shot, we don't want anybody to get arrested, we don't want anybody to get hurt, including the officers. We don't want a cell phone video of a tragedy.

And the nice thing about the co-responder model is now you also have a mental health professional who's on it who can say okay, let's get you...let's see how we can get you into treatment. Let's follow up on this. Let's see...let's do the things that the police officer's not trained to do. It's not their job to call the methadone treatment provider and say hey, how can we make sure Harold's connected to the right services?

You mentioned the eviction unit. One of the things that I find so ironic about so many of these crises is if the officer escalates the situation on that eviction call, wow, they're—you can imagine you could end up on the news. There's a cell phone video of something that the officer and everyone else wishes didn't happen.

Tom: Yeah, and see that—

Harold: There's no cell phone video of the housing authority that never answered 15 phone calls from that same person where they're trying to get help, and that was really what precipitated them being evicted.

Tom: Yeah. See, and that's the thing is that this mental health issue is so much more pervasive than people will ever get their arms around. They'll have their preconceived notion based on, you know, a cell phone video or something like that, and I get it, I understand that. But the realities of it are that because as a society, I have yet to stumble across too many countries, okay—there are couple, not many—too many countries where they have really nailed this issue.

But because as a society we have pushed the mentally ill to the fringes, and we have not funded and not given the thought necessary to address issues that are no different than, frankly, if someone has diabetes. You treat them. There's a treatment module. You wouldn't make them wander the street and look for a cop to help them with their diabetes.

But because that has been done this issue pops up everywhere. Not just talking about the more traditional one, when we get the phone call from the mother who said my son, who I adore, who I have taken care of since he's a little child, who has bipolar disorder and doesn't, he hasn't been taking his meds, he threw something at me and I'm done with him, I want him out of the house, and, yeah, those are the traditional ones.

But in the eviction world, without the COVID complication since I first became sheriff, within a year I identified that this was another point where we in a law enforcement capacity were coming across a disproportionate number of people who had mental health issues. And so for me to just sit there and say well, I'm literally just supposed to take their possessions out and put them in the street and I'm off to my next thing, it's like, well, that's wrong on many, many levels.

And so what we did is we put a social work model together so that we go out to the houses long before the eviction is supposed to go on to talk to the people in the house to find out what we have there, and if there are mental health issues, to get the person the help they need.

Some cases, frankly, get them the help combined with a lawyer and they're able to stay in the house because in many of the cases there's like mail laying around with checks that were never cashed. There's all sorts of different issues that if approached and dealt with appropriately at the outset could have obviated this problem completely.

My point being is that in all of these different levels of where society has neglected people, particularly people with mental health issues, we need to get all of our different governmental entities to interact with them because you need training. They shouldn't have to do it, but they need to do it. And the results of it are the non-stories.

You know, that's the thing that always gets me because, listen, I mean, you and I know this. I mean, you can't prove, you know, a negative. But so many of these interactions you'll never, ever hear about, but guess what? Countless, countless, hundreds of times, hundreds and hundreds of times we've gone to like an eviction house, there's a mental health issue.

We've gotten a hold of a social service agency to come there to help us get this person into a program. You've never heard about it. We don't want you to hear about it. This person's getting appropriate treatment. Everyone is in the place they should be in.

But that's not the norm. I sit here now, I think San Francisco is the only other jurisdiction in the entire country out of the tens of thousands of jurisdictions who does this social work model on evictions. And so my point is that anybody in a governmental role, particularly in a law enforcement role, has to have this component rolling into everything you're doing, and otherwise I just don't think you're doing your job if you don't.

Harold: Let me pick up on two other issues. And pardon me for—I appreciate your rolling with me on a sprawling conversation.

Tom: No, Harold, please, I'm happy to do it.

Harold: By the way, when we use the term "mental health crisis," one thing I want to emphasize for our listeners, that's actually a very varied set of issues that...
So you mentioned, for example, the opiate overdose, and substance use is often in the mix. And in fact one of the things that we've found talking to officers and talking to mental health professionals is addiction stigma is a big issue. And a while—you know, if I'm standing out in the middle of the street and I'm a—people can't see me, but I'm a 58-year-old white dude with gray hair—if I start telling Jesus to fuck off and Jesus is responding to me in similar fashion, officers pull up, they're like oh, this guy's got classic, he's having a psychotic episode, poor guy, you know, he's obviously got a serious mental illness.

And particularly if it's Tuesday at 2:00 in the afternoon in Flossmoor and there's not a whole lot else going on I'm going to get a pretty humane response, compared to if there's a lot of alcohol, I'm exuding alcohol, and it looks like a substance use issue, maybe I'm a younger, more muscular guy, whatever.

I'm not hitting the same stereotypical buttons. And my wife and I care for her brother. He has an intellectual disability called Fragile X Syndrome. He's 260 pounds. A lot of people with intellectual disabilities can have a behavioral crisis, too. And so just for our listeners to understand that this notion of a mental health crisis is actually a very heterogeneous set of issues that people have, and—

Tom: You're so right, Harold. I mean, that's the thing, is that my eyes have been so opened.

And as you said, this wide range, this wide range. I mean, I cannot tell you how many times we've seen just situations where dementia issues are actually in play, even at that point if there had been mild intervention that the trajectory would have been completely different here.

But because things have been allowed to deteriorate so bad, we're at a different level now. And so for us it's really...it's something that frustrates me on many levels, Harold. And, particularly talking to yourself and all the different—and I mean this sincerely—all the wonderful things University of Chicago has done, particularly for our office as far as lending assistance and your expertise and stuff, it just pains me that there's not more of that around this country where you even have the people that have the expertise to say listen, these are relatively standard ranges of problems, can you give us the direction, the menus that we need.

You folks have done that. That does not happen very often at all. It just doesn't. And so it pains me that that isn't the norm. It's like come on, why not? I mean, come on, you've got universities sprinkled all over the country here. Why is it not every law enforcement agency has been adopted by a university to sit there and say let's pick this apart?

Harold: I think building a strong partnership between social work and law enforcement and others is really quite important here, and partly so that social work can understand the non-law enforcement things that we need to be working on. So like my brother-in-law's been assaulted four times since he's been...since we've been his guardians in group homes in the southland.

And I know very well, at least in three of the four I know exactly—I know the other man that assaulted him. I feel tremendous sympathy for those. And it was basically procedures, and staff training, and ways that staff were escalating situations.

And we in social work should be learning from law enforcement so that we can say hey, let's go and work with, you know, the CILAs—that's Community Integrated Living Arrangements—around the southland and say let's talk about how the staff are trained. You know, you don't tell people if you don't behave I'm gonna call the cops. Time and distance is pretty good training for staff.

And also ways that the staff themselves need to be supported, in their needs and so on. And that social work partnership is so...is just so essential. Sometimes it's in a co-responder model, but sometimes it's just saying what are the characteristic ways that law enforcement seems to be required, because other systems are failing, and how do we make these other systems work better? How do we make Medicaid a more effective tool so that people with serious mental health challenges can get the supportive housing that they need and so on? And I do think that's just such a promising area—

Tom: Here's [the thing, though]. To your point, though, Harold, I guess the thing that makes me so distressed is the fact most of these things are not novel, they're not revelations. They've been there. And they're just not done.

I mean, think about the insanity of traditional jails. Traditional jails, not because of a person being a good person, bad person, they look at their role and it's just very straightforward. I get an order to hold somebody, I hold them, I get them back and forth to court, I feed them, make sure they don't get hurt, they don't hurt anybody else, I get the order to either put them...transfer them to prison or let them out the front door. And that was considered doing your job. That was considered doing a very good job.
In a thoughtful society, not an extraordinary society, just a thoughtful one, how is that you're not sitting there saying well no, this person's in my custody, clearly there's issues that are present here. Why is it that we're not in charge of it at this juncture here, at this strategic moment, to peel this thing apart and analyze what got this person here, what this person's issues are, what are things that we can do to make this person more likely to succeed in life. Not necessarily set that bar so ridiculously low they're not going to go out and commit any crime. No, to succeed in life, and just pull that apart.

And when you look at it that way, Harold, none of that stuff is that tricky. You sit there and say okay, well, given this person's educational background we need to build that part of it up, okay? You know, given the area this person lives in, and barring something strange is going back in, and it has a deficit in these areas, so we're going to have to connect them with this type of service here. Family issues are there, so we'll work with the family as well. And then upon release we are going to then stay connected to this person either ourselves or through a local provider in the community.

I mean, a child would say well, of course you would do that. That's what thoughtful people do. But that's not done anywhere other than my place that I know of. And so these different areas, Harold, are just more frustrating points to me. And to your point, when you're talking about how it is that we can learn from law enforcement and CILAs and things along those lines.

How much of this, though, then is driven by the fact, though, that we have high turnover rates at locations because they don't pay people very well? And so just once you finally get someone trained well, they got a job making a lot more, because I just know that in a lot of these facilities there's some amazing people, but in a lot of them they aren't paid terribly well, and the benefits aren't really great, either.

And so of course I don't have that problem. You know, we pay people well, they have benefits, so I have the ability to train people, and barring something strange they're going to be with me 20 to 30 years, and so I can build on all that.

Harold: By the way, the direct care workers, they lose, there are very serious competitors are places like McDonald's, which often offer a better job and one that is more supported with a management structure that is attuned to their wellbeing. And one of the ways that we saw that very directly during COVID was a lot of the staff did not want to get vaccinated, and they basically said, you know, if you make me, if you tell me I have to be vaccinated, I'm going to quit, and good luck finding a replacement. And you treat me so poorly, why do I...I don't feel like I've had a voice in this.

And now you're trying to make me get vaccinated. I don't feel great about my situation. I should say I do think people should be required to be vaccinated in those environments because there's medically vulnerable people there. But we haven't supported the direct care workers in a way that makes...that gives us legitimacy to make the ask.

Tom: You talked about it, Harold. You nailed it there. So think about that. We are going through negotiations with our unions right now about mandatory vaccination because much like yourself I believe that's what we should have. And I'm not very open to hearing the latest spin from the internet from somebody with a grade school education and now is a famous epidemiologist, apparently. I'm not.

And so we're going through negotiations. I have a leverage in this scenario that you don't have because we pay well, we have good benefits. And so for most people you either want to get to ten, 20 or 30 years. Thirty is your maximum year on pension, 20 is a very good pension, ten you're eligible for a pension. So if an individual's invested, say, 15 years in our place, they have a vested interest and they're saying you know what, I'm going to make another five years, so if I have to get vaccinated I'll do that.

To your point, because I'm being, you know, well compensated, I'm well taken care of here, they do care about me. But when you treat people as disposable objects, you truly don't care, which is best represented in what you pay people. You're right. It's like why should they buy in, even though logic says for their own health, let alone the people that are [locked in] should be doing it. But you're right. And that's where some of these different models all collapse because yes, you have to have training—training, training, training. I get it. Yes, we do that here.

But if you have a high turnover, good luck. Good luck. I always tell people, because when they come up with models, like some of these models that I'm talking about here for dealing with people on the street with mental health issues, I had to do all of the police work in the town because their police officers are paid 10.50 an hour, and so they walked off the job, and so the town didn't have any policing, and so I had to come in and do that.

And that's not poor Tom, you know, I'm happy to help. It stretched me a little bit, but I'm happy to help. But that department, they're in the midst of negotiations to see if they can come to some resolution, but trust me, if they come to a resolution it's not going to be that they're making $40 an hour, it's going to be maybe $12 an hour. So you're trying to explain to me that now we can train that department in all these different things, on CIT, on how to use co-responder models. They can't even hang onto people. They're lucky if their radios are working.

And so unless we come up with comprehensive plans that take into account the reality of this world, not our ideal, fantasy world, but reality to say listen, there's certain communities that are not very affluent by anyone's analysis, and so for them we're going to do X, and for ones that are affluent we do Y. But we never seem to even want to tackle that. We want to say oh, that's their problem, not ours. And that's just not the way you operate.

Harold: You're actually jumping ahead of one of the things I wanted to ask you about. I live in the south suburbs. I live in one of the Yuppie squares on the checkerboard—

Tom: Yeah, yeah.

Harold: —in the south suburbs, in Flossmoor, but there are all of these communities a bicycle ride from my house that are...that are...that are economically incredibly challenged, that have been victimized by historic redlining and other practices.

Tom: Yeah, absolutely.

Harold: How do you, as—and people have mental health crises there, and every other problem. How do we do things like co-responder models in a community that, you know, that has really high poverty and really low tax base for public services? It seems like that ends up being on your plate.

Tom: Yeah, but see that's so important, because—and Harold, I would love to tell you because of my obvious brilliance I dreamed this thing up years ago and it's all coming to fruition. That's not the case. I somewhat stumbled into getting to here where I'm at now. But the ideal thing about the co-responder model is literally all I really need to do, baseline—I want to add more, don't get me wrong—but all I need to do is get your department to either, you know, understand how to operate tablets, and then understand the scenario to use them and how best to use them.

And those are not as difficult, okay? Now that gets me to first base. But right now we're not even at first base in most of these departments, with no horizon saying we're ever going to get there. So the beauty of this, though, is with just that modicum of effort, just baseline training of saying, okay, officer, even though you don't have like an advanced college degree, you understand that we trained you that this is a mental health crisis, here's your tablet, here's how you dial it up, talk to the family member, give it to them, and then back off. Good things are going to happen.

Now will I want to then build? I mean, of course I will. But this is very unique in the sense that I can still operate in towns and villages that have historic issues, as you said. These go back hundreds of years, a lot of these [things], these [people] towns. And I can work with that here. And what the tablets, you know, I'm not trying to be dismissive here, but they just aren't that expensive now.

So the fact that, you know, this one broke, this one's missing, we'll work our way through that and we'll... But we have the ability to go from the most affluent towns to the least affluent towns with this model and to at least address this, which will frankly, it will get closer to addressing this than frankly rape kits that sit unanalyzed in evidence rooms because they have no detectives.

Harold: That's interesting that there's an economy of scale at play with those tablets, too, that you could have somebody at Stroger who's available or, you know—

Tom: Right.

Harold: —at [Ingalls] Hospital who's available to interact with someone via a tablet, you know, in videoconference or whatever, and you don't need to have somebody in—you don't need to have four people in Crestwood who are going to spend most of their time not interacting with anybody, because it's a pretty small community.
Tom: Harold, you just nailed it. That was the thing I kept telling people. I go listen, you know, they talk about even a broken clock's right twice a day. Well, I'm the broken clock. I got this one right.

You aren't having someone sitting...as I say, these other models, like this one in Oregon, a very nice model, but I'm not having someone sitting in an ambulance with an EMT, a mental health provider, sitting there because there's no calls, there's nowhere to go, and that shift they had no call, so they sat there. And people sit there and say well, it's not...and it's cost effective [is the thing].

This is the most cost effective because literally the way we've been utilizing this, we already have the Village of Oak Lawn's been utilizing it now for about two months with the same results of ours, which is oh my god, where was this tool? This is amazing how this works. We have the ability to scale this immediately.

And frankly, I've told people, I had a meeting just today about it, I said listen, I just need you to give me a new problem, and that new problem is Tom, we are now past our ability to answer the tablet all the time, and then that's my new problem. I want that problem. Because then—I told [you], I go listen, I'll either—maybe I can help go and hire a couple more mental health professionals to be on the other end or maybe I contract it out.

And maybe then I come up with a regional model where I sit there and say, to your point, Harold—I never thought of it, frankly, until you mentioned it, and if it works I'll steal the idea and say it was mine.

Harold: Okay. [unintelligible] that's what you're supposed to do.

Tom: [Laughs.] Exactly. Exactly. You know, go to Ingalls Hospital and say listen, can you and professionals handle the following five towns that immediately surround your hospital, maybe they'd get on board, and say okay, can I contract with you? Can you bring on five people, we believe five's enough. If it turns out it's more we'll contract for more.

But I believe because we're really at the birth of this it's now time for creative people to jump in and say Tom, okay, this model works, clearly. It works clearly for towns that have resources. For these towns that don't have resources, Tom, what do you think about trying A, or B, or C? I'm literally open to any ideas right now because I just know it will be wildly successful.

Harold: By the way, two things that come to mind as you're saying that. One is bringing Medicaid into the mix because when you said, when you were describing—I mean, the cost to you of having, or a local police department of having an ambulance with a team that sits idle, that's actually a lot for that police department. It's actually not a lot in terms of Medicaid.

You know, there's a ton that is sitting idle at Ingalls Hospital all the time that we have a surge capacity, and Medicaid pays for that, and private insurance pays for that, and bringing, you know, there's a lot of debate about defund the police and so on. The Medicaid budget dwarfs any possible dollars that the defund the police is talking about. The—

Tom: And Harold, that's where like someone like yourself can be so helpful because that is so, so far above my pay grade. That's not something, I really don't...I've never interacted with. But yet there might be literally pools of money sitting there that we could access that I wouldn't even know about.

Harold: The...you know, I do, I think every...every government entity probably needs to have a Medicaid office that serves vulnerable people and say what can we do—and you guys in the jail have certainly worked on that. When people are leaving the jail trying to get them, making sure that people are Medicaid enrolled. That's the definition of a sustainable program, is somebody has a Medicaid card, you know, for whatever—and Medicaid pays for whatever it is that we're trying to do for them.

I'll mention one final thing, and then I want to ask you what hasn't come up in our conversation that you want to talk about, which is part of the...one aspect of first response that we haven't talked about, which I'm very sensitive to as a caregiver, is we want people to know that they can actually call.

So, you know, we're, my wife and I are on Facebook groups with other families who have similar challenges that we do. And whenever there's some sort of a tragedy that involves 911, you know, of course people are talking about it. And I remember sitting across the breakfast table from my wife one day, and she just said, by the way, never call 911 if my brother's—he can be beating the crap out of me, whatever, I...there's nothing that a random police officer is going to be able to do that's going to make this better in this moment.
And that was the way she felt after she had just seen one of these incidents that had gone south. And one of the great things about these alternative response models and the improved training is that the family member—you know, imagine you're a 60, or your example that you gave, I'm a 60-year-old mom. I have a son who's bipolar who I love but who sometimes can be dangerous to me, and he gets frustrated, he throws things at me or whatever he does. We cannot leave that mom in a situation where she feels like if she calls 911 it could lead to a tragedy, and therefore he just threw a coffee cup at me and it's better for me to just get through it.

And when I talk to mental...people who run homeless shelters and so on, one of the things that they say is CIT has made a big difference in our willingness to call. Because we just know that somebody gets it because they signed up for the training.

And so I feel more comfortable as a...as a homeless shelter operator calling 911 because that's who's going to respond. And there's all kinds of complicated blocking and tackling about whether that response is going to be great. They certainly have a long list of ways that they would like it to be better.

But I think that the aspect that the public... I think it's a very ideologically polarized debate, and there's one thing that I think on the progressive side that people who need to appreciate is there are people who have a mental illness, there are people who have developmental disabilities or substance use disorders who can at times become behaviorally dysregulated.

And particularly for people close to them there could be a physical safety issue. Those people need to know that they can get a first response that's going to keep them safe, but it's also going to keep their loved one safe.

Tom: Yeah.

Harold: You know, and that is really critical.

Tom: It is, it is. It's such a valuable point because if you think about it, I mean, at the end of the day that should be sort of the baseline, you know, whatever you did you feel comfortable when you pick that phone up and call that the response is not going to make things worse, it's going to make things better. I mean, we would hope that would be the bottom line here.

And, so, like within my world, as I say, I'm always questioning, and we've got to keep doing that. You just have to have this inquisitive mind, I guess. But I'm always talking, like, when we first did CITI, I said it's imperative that we talk to my staff after they get done with it what did they think because there's so many trainings that people are forced to go through that frankly you might as well sit in the corner and say hey, can you count ceiling tiles for the rest of the afternoon.

Harold: I see you went through our CITI training at the University of Chicago.

Tom: [Laughs.] No comment. But when I talk to some of the people, got the feedback, it was phenomenal. I cannot tell you [how many] people said I had no interest in this, did not want to go to it, and I can tell you this was the best training I've ever been to. I mean, [it wasn't] people trying to blow smoke because many of these things were anonymous responses back from people.

They say I finally feel like I have the ability to address the situations that I face more often than not on any given day. And so that was great. But the other part of it was, was this way to touch the families. And so for us, once we're at the house, the one thing that's literally the first thing that comes out is not, you know, a gun or taser, it's our card, our business card that we give to the family members to say listen, if you need us at all, here's how you call us.

Not, you know, you can call 911. Here's how you call us, and that's how you'll access the mental health professional. The one that's on the tablet now, that's how you get a hold of them again. So when we have something that's percolating that it's not bad yet, but we're worried, or it is bad but you're just anxious about who's going to be coming to the door, call us. Please call us. Here's how you do it. You build that rapport with them. And we're not trying to jam things down people's throat. We're saying no-no-no. You saw how this played out, you saw what our tools are, what we have access to.

And to your point, most of these families have been living with this for a lifetime, and so for them there's very little convincing that we have to do. It's more like oh my god, where have you been? Oh my god, this is fantastic.

And the other point that we've been really on, and it was something I was adamant about, is like we've got these body worn cameras that we have on us, you know, I want our policies [in the office] setting aside the mental health issue right now for a second, I just want to be reviewing those all the time. It's the best way for us to say our, not just, did something bad happen, you know, but the other side.

But are we doing things correctly, are we doing things by the book, are we being appropriate, are we talking to people the way we want our staff to be talking and all that. But to this point, though, it's when we have the incidents at the houses where we're using the tablet, we'll review the body camera footage to say okay, is there a better way we could do that.

And when I get reports—I get the police reports every morning, and it's the first thing I read every morning, and I look at certain scenarios where it's like okay, we did not use the tablet, and then I write notes and it goes to the people that operate this and say do you see a window where we could have used the tablet here?

Harold: You're... But one thing is giving the mundane its due, that there's a lot of... It is, you know, when you started saying, a child would understand the importance of this, at the same time there's a granularity and a difficulty in the execution—

Tom: That's why it's incumbent upon people like me and others to get in the weeds all the time. Not just to look in the report and say okay, the tablet was used right. No-no-no. To get in the weeds on ones where the tablet's not used and say okay, I'm not trying to second-guess someone. I was not at that house. I don't know that. No one got arrested, no one got hurt, but yet I still think it would have been nicer if this person had, you know, 15 minutes with a mental health professional. Why was it not done?

And then to get through, as you say, the granular part to say no, at that point in time he was locked in the room and the parents said he's done this in the past and we need to make sure he has his space, and so that's why we thought the last thing we need to do was to slide a tablet to the mom who is going to try to put it under the door or something like that.

But Harold, you nailed it. Our world is complicated. Our world requires us to get granular. These, frankly these idiots who think you can come up with this great, cute little Facebook post that is so neatly encapsulated and all that you just solved all the problems, where have you been all our life, you're so brilliant. No. This is, as you said, the mundane. And that's where you make the difference.

Harold: One final thing, which is the mental health of officers and staff. They bear witness to a lot. They risk a lot. Not only do they risk their own personal safety, but they risk all kinds of ways that things can go wrong that they either will be accountable for or that they will feel a sense of moral injury if it goes badly. And how do you maintain the positive mental health of officers who are dealing with people in behavioral crisis, or maybe having...they're being exposed to everything that they're exposed to?

Tom: That's a really good point because it's been a focus, thankfully, by a lot of the country these days, and I'm ecstatic about that. We have, you know, a peer support group that we've had for years. We have a group called Empower that really just works on the mental health and wellbeing of our staff. We have all those. We have the typical programs that you would hope we'd have.

But I think a lot of it comes down to the fact that when your staff realizes that from the top on down that you just don't care because I gave some, speech or some nonsense like that, but that you're constantly innovating, and you're innovating in your world. You're not doing something by some type of obtuse, you know, idea that really has no practical effect for them.

But when they see that you are literally, from the boss on down, you are impacting the real world because you're dealing with that, I think that reinforces them and says listen, we know your job is tough, we know you've been asked to do things that you never signed up to do that no one else in society is signing up to do, and so here's what we're doing to try to make it easier. And then to do it and get their feedback and say listen, what else can we do here? I mean, what do you need us to do? And I know with me, whenever I'm interacting with my staff, and before COVID I used to do it a lot more, I always ask them. I go, well, what can we do for you?

Because that's where I really get some really cool ideas on something that is really mundane, to your point, and yet was really big into an operational issue on the street that reinforced the people. It's like no, we know it's tough and we want to help you there.

And to the point you brought up earlier, this universe of people historically have always had this notion of being tough and that we can handle stuff. And that is always a little bit of a tough nut to crack. And so a lot of what we've done is peer-to-peer, and we have found that that has been really helpful. But we're always looking for more.

But I do think it's, from the boss's standpoint, you better not be out there just checking off the box and say okay, I have peer support up and running so, you know, on to the next thing. No. I mean, obviously we're saying, okay, how are we getting an update here? What do we need to do that's going to be innovative and do it differently?
And just really quickly, I abolished solitary confinement in our place like going on six years now, and it's something that doesn't sound that dramatic. I'm the only person in the country that's done it. I mean, no one else has done it.

Why is that impactful? Obviously because of the mental health of the detainee, obviously. But the other part of it is for my staff. The big beneficiary of that wasn't just the detainee, but my staff. The assaults on staff dropped off a cliff. So staff that originally was hesitant because they thought I'm taking a tool away from them found that it was the opposite, I was actually making their life and their work better. And so it's really incumbent upon bosses to be in the mundane, in the weeds, and sitting there trying to innovate.

Harold: Well, thank you so much for this conversation. We're going to hire you as an expert consultant for the Dick Wolf Law & Order social worker show...

Tom: Yes.

Harold: It's been wonderful to have this time with you.

End.