When activists called for cuts to the police budget after the murder of George Floyd by a Minneapolis police officer, they suggested that it didn’t have to be armed officers answering every call. In response, Cambridge police officials pointed to an existing police department program that employs social workers and a psychologist alongside specially trained officers to try to connect mentally ill individuals accused of criminal behavior to services instead of arresting them. Now the department and Cambridge’s two hospitals will be part of a scientific study evaluating the program for the first time, especially in how well it prevents suicide.
CHA Cambridge Hospital and Mount Auburn Hospital are among 15 institutions that will share a $15 million grant from the National Institute of Health intended to prevent suicide by individuals in the criminal justice system. The hospitals and Cambridge police will conduct their research project over the next three years, the city announced Nov. 29. Besides assessing the police department’s Family and Social Justice unit as it exists, the study will examine whether stationing a “navigator” in the hospitals’ emergency rooms to focus on patients brought by police will improve it.
The navigator will facilitate communication between police and emergency room staff, monitor patients’ psychological condition, coordinate services and help follow up with patients in the study after they’re discharged. If it turns out that having a navigator increases effectiveness, the city will “scale up” the navigator position and conduct another research project on its impact, the study proposal said.
Cambridge police started moving in 2007 toward a goal of preventing arrest by diverting troubled youths, mentally ill people and many in the homeless population toward connection with services. A report in 2019 focusing on mentally ill people who are homeless found that the Family and Social Justice unit has been able to move “justice-involved individuals in a mental health crisis” away from arrest and toward services, but there is tension and lack of communication between officers and service providers such as emergency room staff, and even between the special police unit and ordinary officers.
The 2019 report, based on in-depth interviews of officers and service providers by a research unit in the psychiatry department of Cambridge Health Alliance, reported that officers faced problems getting information about clients from emergency room staff and other agencies because of privacy concerns. The report quoted a police officer, who is lightly edited here: “There’s a lot of apprehension sometimes on their part to give information that they feel like violates someone’s confidentiality. And this point, it’s still unclear what type of information is protected, what information is not. And so, when I’m trying to connect someone to services, it’s difficult to get things done.”
An “adversarial relationship” between police and service providers was another challenge, the report found. Speaking of employees of a homeless shelter, one officer said: “You can imagine if their job is to provide shelter for someone who is a member of a vulnerable population and lots of vulnerable people don’t have a positive view of the police department, right, so when they see the police they think arrest, prosecution. They don’t think here comes the police, they’re going to help me get into drug rehab. Well some folks, there are some shelter operators, some medical providers that will not – they will not talk to us.”
Having a “navigator” in the emergency room might change that narrative, police and hospital staff proposed. The study is designed to find out.
Beginning early 2023
The research project comes as the city is setting up a new agency, the Community Safety Department, to handle emergency calls that could be answered by civilians, many involving a mental health crisis. The department was established in response to the calls for a change in policing after the Floyd murder; the City Council asked for an “alternate response” program using unarmed civilians. Though its mission may be similar to the goal of the police department’s Family and Social Justice unit, the new organization won’t be part of the police department. Still. the city’s emergency dispatch service, aligned with police, will decide when to send an officer and when to send a responder from the Community Safety Department.
Christina Giacobbe, director of emergency communications and 911, told city councillors on their Public Safety Committee on Dec. 14 that the new department would probably be ready to start operating in late February or early March. She said the city has hired a coordinator and is renewing its search for a director after getting no response in the summer. The city also is seeking information from local agencies about what services they could provide when the department responds to a call. And it is trying to develop a contract with Heart, the grassroots alternative response organization that some protestors hoped would take over the response function.
Coordination could be key
The severe shortage of mental health staff and hospital beds could challenge the new department as well as the research study. People in psychiatric crisis who go to a hospital emergency room may wait days or weeks for inpatient treatment. Outpatient therapists accepting new patients are in short supply.
“This is a major issue, as the Cambridge police can only help get someone transported to the ER,” police department spokesperson Jeremy Warnick said.”Emergency departments across the state are dealing with the impacts of the closing of inpatient psychiatric beds and staffing difficulties.” The Cambridge police clinical support unit, part of the Family and Social Justice section, “does assist in securing outpatient appointments, however, that has been and continues to be very difficult, due to lack of availability,” he said.
The research project will help improve “the coordination of outpatient services,” which could “reduce the risk of an individual developing a mental health crisis,” Warnick said.
Mental illness and criminal justice
Mental illness is closely entwined with the criminal justice system. According to the research proposal, about 45 percent of people seeking outpatient mental health treatment have had at least one contact with police. Police action results in as many as 26 percent of referrals to a hospital emergency room.
Locally, more than 2,600 emergency room patients in 2019 treated at Cambridge and Mount Auburn hospitals had police involvement, according to an estimate in the research proposal. More than 90 percent had a psychiatric diagnosis. In Cambridge alone this year, clinicians in the police department’s Family and Social Justice unit had handled 1,100 cases as of November – a record number, Warnick said.
Mentally ill people involved with the criminal justice system face a high risk of suicide, the study proposal said. About 45 percent of males and 12.5 percent of females who kill themselves in the United States have a criminal justice history, it said.
“Even brief incarceration (such as pretrial jail detention) can feed cycles of despair that exacerbate suicide risk. For example, it can lead to loss of employment and future employment opportunities, breaks in health care services and treatment, loss of housing and future housing opportunities, and disruptions in family life and social connections that can increase risk for suicide,” the proposal said.
The next three years
The study will compare three groups: 200 patients in mental health crisis brought to the two hospitals by police over the next three years and served by the Family and Social Justice unit; 40 patients who agree to be contacted by a “navigator” in addition to the special police unit; and 800 patients from Somerville and four other cities neighboring Cambridge who are in crisis but get the usual treatment – with no navigator or Family and Social Justice unit. The patients with no extra services will serve as a “control” arm of the study.
Medically treated suicide, suicide attempts and suicide ideation are the primary outcome that researchers will measure. The study will also monitor participants for emergency room use, return to jail, involuntary commitments and interactions with the criminal justice system, using medical, police and court records. And researchers will examine whether patients’ mental health improves based on testing during a six-month period after they go to the emergency room.
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