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As social workers join Northeast Ohio first responders, studies of mental health outcomes are few

Annette Amistadi speaks with a patient while sitting in an ambulance with two medics.
City of Shaker Heights
Annette Amistadi, far left, was hired by Shaker Heights in 2022 to work with first responders on crisis calls within the city. Since then, the program has expanded to four more communities.

Earlier this month, four Cuyahoga County suburbs announced they would employ social workers to work alongside police and firefighters — following the lead of Shaker Heights, which started a pilot program in 2022.

The concept is meant to improve outcomes for people suffering mental health crises. And while it's only now beginning to spread in Northeast Ohio, the idea of having trained mental health professionals work with first responders isn't new nationally.

A few police departments have used social workers for decades, according to the Ohio Attorney General’s Office. And while the current count of police and fire departments with social workers is unknown, it appears that a growing number of cities have hired mental health workers amid recent demands for police reform.

How effective is the practice in averting mental health crises?

That's unclear.

A 2018 systematic review published to BioMed Central Psychiatry determined, “There remains a lack of evidence to evaluate the effectiveness of street triage and the characteristics, experience, and outcomes of service users."

The report found there's a lot of variation between departments in terms of hours worked, staffing practices and incident response methods — making it difficult to study overall impacts.

However, researchers from Western Carolina University did note that establishing definitive roles between police and social workers appears to result in better outcomes.

When officers and mental health professionals respond to calls together and play distinct roles in dealing with the crisis, "officers benefit by gaining a better understanding of mental health issues, and community members report that these interactions are less stressful and less stigmatizing than a traditional police response,” the researchers wrote.

Success in other cities

Eugene, Oregon has paired crisis workers with its police department for the past 30 years. When calls that contain a mental health component come in, a medic and a crisis worker employed by a local clinic respond. Police only respond if the situation seems to require their help, according to NPR.

In Denver, a mental health response team that paired social workers with police answered nearly 750 calls in six months with no arrests, NPR reported in 2021. City officials declared that pilot program a success and have allocated funds to continue it.

Closer to Northeast Ohio, the city of Columbus expanded its Alternative Response Pilot Program in 2021 to reduce police involvement in mental health, drug addiction and other calls concerning social matters. That pilot program showed early promise, The Columbus Dispatch reported. All 56 calls received in the first 18 days were handled without any reported use of force, and nearly half required no police or fire presence.

But that program has yet to move from the pilot stage, according to WCMH. Columbus City Council previously said it would set aside money in the city’s operating budget to fund the program, but has failed to do so as of last fall, WCMH reported.

"By intervening early, these teams promote treatment, recovery, and show the community that mental health is taken seriously with the care of the individual in mind."
Scott Osiecki, ADAMHS Board CEO

In Cleveland, police partnered with the Cuyahoga County Alcohol, Drug Addiction, and Mental Health Services (ADAMHS) Board to develop a Crisis Intervention Training — part of a national program designed to train police officers to handle encounters with individuals living with mental illness.

There were nearly 5,000 Crisis Intervention Team incidents in Cleveland in 2022. Of those, mental health issues were present in 89%. Nearly half of those calls required verbal de-escalation techniques while 16% required additional police presence. Only 18 incidents in 2022 required use of force, according to data from the program.

Cleveland has been exploring the concept of sending trained community workers on crisis calls instead of police officers. The city and ADAMHS Board have collaborated on a pilot program expected to launch this summer in two zip codes.

Results in Shaker Heights

The success of Shaker Heights’ mental health response program has led to its expansion to Cleveland Heights, Richmond Heights, South Euclid and University Heights.

Shaker Heights Mayor David Weiss said the city had noticed an increase in 911 calls rooted in mental health issues in the seven years he’s served as mayor, but first responders weren’t properly trained to handle such calls.

As a result, Weiss said the city categorized three types of people served by the mental health response program: someone with known mental health issues, those who weren’t known to have mental health issues and those who were previously in one of the first two categories who may need follow-up care.

Shaker Heights Mayor David Weiss speaks at a podium at the Shaker Heights Fire Department on Tuesday, May 7, 2024.
Stephanie Metzger-Lawrence
Ideastream Public Media
Shaker Heights Mayor David Weiss said he pushed for the city's pilot mental health response program after hearing community concerns about how first responders are trained to handle crises.

Annette Amistadi, the full-time mental health response program clinician in Shaker Heights, works with the city’s first responders and sometimes responds to calls, or provides resources to prevent future incidents. Overall, the skills required of her job differ from other first responders.

“A lot of times, someone in crisis just needs to be heard, and so our mental health professionals and our peers are trained in that active listening and de-escalation to really get what that person needs,” Amistadi said at a press conference earlier this month. “That way, they can refer them to the right service.”

In 2023, Shaker Heights’ program had 645 referrals and completed 730 follow-ups.

Weiss noted that his police and fire chiefs were supportive of the program, contrary to concerns they would feel it infringes on their scope of services.

“In fact, it's just the opposite. They have been huge supporters from day one, and have been terrific partners,” Weiss said.

Stephanie Metzger-Lawrence is a digital producer for the engaged journalism team at Ideastream Public Media.
Stephen Langel is a health reporter with Ideastream Public Media's engaged journalism team.