This is Indianapolis’ unconventional way to fight the opioid epidemic

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Indy Star on 7/27/2017 by Ryan Martin

Indianapolis wanted a better way to combat drug addiction and mental illness. So the city created its first Mobile Crisis Assistance Teams, consisting of a police officer, paramedic and clinician, to connect offenders to services. Dwight Adams/IndyStar

Dr. Dan O’Donnell speaks to a small group of men and women seated among rows of tables at Indianapolis Metropolitan Police Department’s East District headquarters.

His delivery is matter-of-fact, maybe because the problem he’s talking about — the opioid epidemic — is no surprise to anyone in this room. They’ve seen the “pinpoint pupils,” the bodies that look dead.

Addiction and mental illness are burdening the criminal justice system. The situation is dire, said O’Donnell, medical director for IMPD, Indianapolis EMS and Indianapolis Fire Department. “We cannot use 2010 solutions to this problem.”

The people in the room represent the change.

Starting Monday, four Mobile Crisis Assistance Teams — each with one police officer, one paramedic and one licensed clinician — will begin responding to crisis calls across IMPD’s East District, potentially involving domestic, emotional or substance abuse.

The unit — the first of its kind in Indianapolis — is the result of a partnership between IMPD, IEMS and Eskenazi Health. The concept, considered a pilot project, emerged last December as part of Mayor Joe Hogsett’s calls for criminal justice reform.

The agencies hope to reduce the number of people taken to an emergency room or jail — which are both costly — and to divert people away from the criminal justice system.

“We’re trying to build a new framework,” said Sgt. Catherine Cummings, who supervises the four police officers assigned to the unit. “That’s always the challenge — to trail-blaze.”

The stakes couldn’t be higher. Addiction to heroin and other opioids has swept through the state, showing no signs of slowing down.

And one-third of the inmates in Marion County’s jails have a mental illness, according to a 2016 city report, at a cost of $7.7 million each year for extra security and care.

Members of the new unit interviewed by IndyStar said they recognize the challenges ahead.

They feel a duty to show the community how important this work is; to show Indianapolis leadership that this project will pay off.

More than that, though, they want to provide compassion to those who are vulnerable or misunderstood, and connect them with services they need — whether that’s a medication, a shelter or a conversation.

“We’re not just diverting arrests to divert arrests,” said Melissa Lemrick, an officer assigned to the unit. “We’re trying to get them help.”

In the classroom

 

The team will face a flurry of issues. Addiction. Untreated mental illness. Domestic violence. Patients in distress who attack those who are trying to help.

To prepare, the unit went through hours of classroom training, which started June 5 and ran through July 19.

The sessions touched on suicide, homelessness and prostitution. The unit heard from public defenders, prosecutors, medical professionals and nonprofit workers. They learned firearms safety and how to de-escalate a scene.

In some classroom sessions, the trainees joked with each other. In others, though, including a session about sex trafficking, the room grew quieter, as a counselor tried her hardest to hold back tears while describing what she’s seen in the city she calls home.

As part of the training, the team walked through one of Marion County’s jails, where they witnessed the limited treatment options for people with mental health and addiction issues.

On that day in June, 31 people were being held on the suicide block. They were left in their cells with a gown and a blanket that cannot be tied into nooses. They only leave for showers.

Maj. Tyler Bouma with the sheriff’s office led the tour through the stuffy halls, an environment of concrete, metal and fluorescent lights, with the occasional puddle of urine on the floor.

At the tour’s conclusion, Bouma looked at the group, then looked back toward the cells. “That’s where we take them,” he said, pausing.

“Do they belong in jail? Some do, absolutely, but I hope that’s where you guys come in.”

Jail is no place to treat detox and mental health, Bouma said.

An innovative approach

Indianapolis isn’t the first city to seek new ways to address issues of addiction and mental illness.

Police departments in Memphis and Knoxville, Tenn., and Birmingham, Ala., have introduced different models that blend policing and mental health services, said Risdon Slate, a Florida Southern College criminology professor.

But Indianapolis appears to be one of the first cities to combine an officer, paramedic and clinician, said Slate, who co-authored a book titled “The Criminalization of Mental Illness.”

“The right goal is in place: You’re trying to divert people from the criminal justice system; you’re trying to link people to treatment,”Slate said. “It sounds like an innovative approach to me.”

When asked why officers need nonpolice partners in crisis situations,Slate noted that officers are much like the general public.

“Unless they have a loved one or a friend with mental illness, then they don’t really understand what mental illness is all about,”Slate said. “They get taken in by the stigma surrounding mental illness.”

The interactions can become deadly.

A 2015 IndyStar investigation identified six people in the past decade who were suffering from mental health issues when they were shot and killed by police, because they were holding blades or guns.

In November, a 29-year-old man diagnosed with schizophrenia was shot and killed in nearby Hendricks County, after police said he raised a knife and ran toward a reserve deputy. The deputy was cleared of charges, and the shooting prompted the department to plan a training on mental health.

Art Therapy

Mixing police, medics and mental health professionals on one team holds a great deal of promise, but also some risk. After all, their approaches to crises differ greatly.

As a fresh face right out of the academy, Lemrick, the police officer, remembers heading to a call of a man acting strange. The result: “immediate detention.”

An officer’s response is to take someone with a mental illness, who may be a danger, to a nearby hospital, oftentimes against their will. Seven years later, Lemrick still wonders how the man is doing, and whether he simply needed medicine.

One of her new partners, Brooke Hartwell, interacted with such patients in an entirely different way during her four years as a licensed clinical social worker at Eskenazi Midtown Community Mental Health.

Hartwell used art therapy to treat her patients, who don’t always have the ability or desire to talk about trauma in their lives. But art provides an outlet for them.

The third member of the team, paramedic Bill Eberhardt, said many in EMS are accustomed to rushing from emergency to emergency, finding a thrill while the adrenaline is pumping — not staying at one scene for potentially hours while treating a single patient.

The three approaches are as different as the agencies who employ them, which could create conflict at the scene of a crisis.

“Hopefully there will be times when all three are in agreement on what needs to be done,” Slate said. “But they’re not always going to be in agreement.”

The three don’t yet know how they’ll handle such disagreements.

They don’t know how many calls they’ll see each day, or how long each call will take. They don’t even know what paperwork they’ll need to file with their agencies.

But they’re not overly concerned. They’ve grown close over the past several weeks.

That’s been purposeful, said Cummings. The supervisors allowed the members to pick their own partners, because they’ll need to rely on each other in some potentially turbulent situations.

On the second day of training, Eberhardt, Hartwell and Lemrick knew they would pick each other.

“With us three together, we play off each other,” said Eberhardt.

“A lot of our conversations are free-flowing. No barriers there,” said Hartwell.

“We’ve built that trust. I know they’ve got my back,” said Lemrick.

Ready to go

Lounging beneath a pavilion overlooking Lilly Lake in Eagle Creek Park, for an occasion on July 20 that was part team-building and part celebration, members of the four Mobile Crisis Assistance Teams were asked by their supervisors to reflect on the road ahead.

“I feel a responsibility now that I know everything I know,” Eberhardt said. He admitted to being anxious.

“It’s going to feel uncomfortable in the beginning. It’s supposed to feel that way,” Cummings told the group as part of a last hurrah before they started their final training shifts and deployment.

Then, after a few moments: “I agree with everything Sgt. Cummings said,” said Addison J. Warren, IEMS public safety liaison director, as the group erupted into laughter.

It’s good to have these moments now. Starting Monday, they’ll officially be out of training and in a city with a growing list of problems, in a community looking to them to provide the solutions.

Eberhardt may be anxious about the new assignment, but with 10 years of EMS work under his belt, he’s ready.

He collected every brochure and wrote down every resource introduced during the training. No matter who needs help, he said, he’s ready.

And for those who are afflicted — who are in pain — he wants them to know one thing: he and his partners are now here. Ready to help.