Contracting out emergency detention transport

When police arrive at the scene of a disturbance they are supposed to seek a peaceful resolution to the situation. In the case of a mental health crisis, when no crime is committed, often the person at the center of the call cannot be safely left alone. Yet safe options for care — as opposed to a jail — may be halfway across the state. And it takes time, money and removing officers from other duties to provide the transport.

This is a problem that law enforcement and medical groups have been raising for years, and the Legislature is currently debating several bills that offer partial solutions, from creating new beds, finding vacant spaces no longer in use for other health needs and allowing an agency to contract for transport by other law enforcement agencies, ambulance companies or third parties to transport emergency detainees to facilities.

Wisconsin Attorney General Josh Kaul has also taken steps to highlight the problem. His 2019 Annual Summit, held last October, focused on these circumstances, a regular part of the job of law enforcement officers across the state.  In addition to these tasks being expensive and time-intensive, they are often draining, if not traumatic, for those involved.

Derek Veitenheimer, Director of the Bureau of Justice Information and Analysis for the Wisconsin Department of Justice reported results of a state-wide survey of law enforcement, with 154 agency responses, including 35 of 72 county sheriffs.

According to the survey, about 80%of departments do their own transportation of those in mental health crisis for emergency detention. “Capacity is clearly a problem,” he told the group, highlighting a frequent recommendation tool to “expand facilities available,” and a particular need for mental health services in smaller communities.

In an interview Waushara County Sheriff Walter Zuelke estimated that his department responds to calls like this roughly once a week, and sometimes as many as  100 per year. “Medical clearance can take three or four hours and depending on shifts for transport, that process can take up to six or seven hours,” he said, “and that’s if there are no delays.”

If a city or village police department has only one or two officers on patrol at a time, a mental-health transport  may mean either the sheriff’s department is assigning a deputy to take over transportation, or to temporarily take over patrol of that municipality.

A bipartisan bill making its way through the Wisconsin Legislature is aiming to reduce the burden of these demands on local law enforcement by allowing use of third-party contractors to transport people in need of emergency mental health services. AB 633, authored by Rep. Mark Born (R-Beaver Dam) and a group of 10 state senators, the bill passed unanimously in the Assembly on Feb. 18 and is now in the Senate waiting to be considered.

The bill has the support of seven law enforcement and medical groups including the Badger State Sheriffs, the Wisconsin Medical Society and the association of sheriffs and deputies. No groups are registered against the measure. 

“Putting someone in a mental health crisis in the back of a sheriff’s car isn’t the best idea to start,” said Rep. Dave Considine (D-Baraboo) and member of the Committee on Mental Health, explaining that some departments have already begun using these kinds of transport services, although the bill would formally codify the practice.

“This is fairly recent,” said Considine on a broader focus of emergency transportation for mental health patients. “We have talked about how, for lack of a better word, awful, it is that transporting a mental health patient like that can only exacerbate whatever crisis they are in.”

In Bayfield County, as a rural community, they deal with fewer calls than other counties, but according to Sheriff Paul Susienka, it is still a matter of frequent emergency transports.

“It depends on how you define it, but I would say that twice a week we have to transport someone to the southern part of the state of Wisconsin,” said Susienka. His department tries to avoid making trips to Winnebago, almost a four-hour drive one way. Fortunately, they are able to work with Behavioral Health in Ashland, usually between 10 minutes and an hour away, but at times the longer drive to Winnebago is unavoidable.

Paula Verrett, National Alliance on Mental Illness Fox Valley counselor and Director of Iris Place Peer Respite, spoke at the Attorney General’s Summit as a professional in the field and as a person who experienced such treatment in the past.

She explained how these cases typically unfold, in which police commonly respond to a “disturbance,” after which the person in crisis will be brought to a local hospital. If there is no space available or the hospital does not have the appropriate psychiatric treatment services, the person may be brought to another hospital, or a state clinic such as Mendota or Winnebago.

For law enforcement, even those on the other side of the state, Winnebago Mental Health Institute in Oshkosh is often the eventual destination, being the only state hospital that is obligated to receive emergency mental health cases. Mendota Mental Health Institute in Madison largely focuses on analysis and treatment of patients who are incarcerated or have pending criminal cases.

“Going to Winnebago or Mendota is never an optimal experience,” explained Verrett. “Number one is the stigma of those two institutions — they do indeed serve the most severe cases of mental illness and so it’s basically perceived as ‘the nuthouse.’ When someone is told ‘that is where we are taking you,’ that can be traumatizing and creates more problems than it solves.”

Also, given the greater intensity of the average treatment at such facilities designed for higher-level trauma, according to Verrett, treatment that might be two to three days elsewhere, is more likely to extend to a week or more.

“Years ago a lot of counties had mental health hospitals and for whatever reason they did away with them,” said Eau Claire Sheriff Ron Cramer, counting three mental health cases in the Eau Claire County Jail in the prior week. He calls them Chapter 51s, referring to the State Alcohol, Drug Abuse, Developmental Disabilities and Mental Health Act. “Our jail captain is over here saying, ‘We have to find a better way of dealing with that population,’ because, again, paranoia, schizophrenia — it seems like the best place to be isn’t a jail.”

When the Eau Claire County Jail was built between 2010 and 2012, one priority, according to Cramer, was placement of cells near the front booking area, so staff could keep an eye on those having manic episodes or mental health crisis.

As the Assembly’s emergency detention transportation bill enters the phase of negotiation with the Senate, there is one detail of concern that has been aired during hearings and debate.

“We offered an amendment that I think is crucial, to make sure that [transportation staff] have training and can respond appropriately if the person is in crisis,” said Considine. “The training we’re looking at is what disability rights groups want, which is different from what a sheriff’s office can offer.”

Although a person’s mental health crisis can be exacerbated by the additional stress of being taken into custody and transported by a uniformed officer in a squad car, there is the question of whether a person providing transportation in that situation will be prepared for this unique task.

As Verrett describes, the expectation would be of a driver taking someone two hours or more to a center. During the course of the trip that person can be expected to be scared, may not know what is happening, could have an altered state of awareness and may believe someone is trying to hurt them.

One of the few companies providing this service is REDI Transports of Green Bay, formerly Lock and Load Prisoner Transport. Company representatives at the Dec. 10 legislative hearing were informally introduced to give a brief description of their business. The company underwent a re-branding in 2019 to reflect expansion into behavioral health services.

“I have been contacted by them and they have offered to assist,” said Zuelke. “At this point, it wasn’t cost effective for us. If we’re talking about calling people on overtime, yes, that would be attractive, but are they available to meet us at a hospital and what is their training in dealing with a person in crisis?”

“This transportation by a third party without law enforcement is a good thing,” said Cramer, “but we need more mental health beds.”

Again, the emergency transportation bill was supported by Bayfield’s sheriff, but with questions and qualifications.

“As to how many agencies could take advantage of a contractor, it would depend upon where they were and how quickly they were available,” said Susienka. “We support it — having that available is a benefit — but how often is it going to be used? I don’t know. It could relieve stress on some law enforcement  in some circumstances.”

Although third-party services can potentially keep a department from losing a patrol officer for a full shift, and prevent overtime expenses, there would still be cost in paying the firm for transportation services and services would need to be available at the time of the emergency.

Though any emergency response, according to Verrett, arguably represents help arriving too late.

“Expanding hospital beds to more communities would be an ideal situation, but honestly, I don’t think that is ever going to happen,” said Verrett. “There are also other clinical programs like therapy and counseling and things like that.”

Describing someone in a mental health emergency as analogous to a person approaching a cliff, Verrett compares a 9-1-1 call and emergency detention to having an ambulance  waiting at the bottom of the cliff.

“We’re the net to catch people before they go over the ledge,” Verrett said of Iris Place Peer Respite, which recently saw its 500th unique visitor over the past five years.

A schedule for a person hospitalized for a mental health crisis may typically include medication, an hour of daily occupational therapy group, a talk therapy group with maybe five minutes talking to a psychiatrist, but for Verrett, much of that seems like it was wasted energy.

“One of the things I found about my hospitalization,” said Verrett, “is that I found that my interactions in the day room with other patients was far more helpful to me sometimes than the talk therapy groups.”

Recommended by the Assembly Committee on Mental Health by a unanimous vote of 11 to 0, AB 633 may show a point of agreement and consensus in an otherwise divisive political environment.

“There are a number of things that we need to do and this [bill] is a step in the right direction,” said Considine. “The governor wants to propose a package that he thought [Republicans] might approve of, and walk that middle ground, and I think they are trying to write similar stuff, but do it better.”

Like many other supporters of the bill, Considine says he believes development of regional mental health centers would help to eliminate the need for such long trips under such dire circumstances.